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BAYSHORE TRAIL - 14-0028-PRCONTRACT (1) This CONTRACT made and entered into this .21 day of ( (l.fiu c2) , 20 5 by and between the City of Clearwater, Florida, a municipal corporation, hereinafter designated as the "City ", and KEYSTONE EXCAVATORS, INC., of the City of OLDSMAR County of PINELLAS and State of Florida, hereinafter designated as the "Contractor ". WITNESSETH: That the parties to this contract each in consideration of the undertakings, promises and agreements on the part of the other herein contained, do hereby undertake, promise and agree as follows: The Contractor, and his or its successors, assigns, executors or administrators, in consideration of the sums of money as herein after set forth to be paid by the City and to the Contractor, shall and will at their own cost and expense perform all labor, furnish all materials, tools and equipment for the following: PROJECT NAME: Bayshore Trail PROJECT NO.: 14- 0028 -PR in the amount of $ 845,900.00 In accordance with such proposal and technical supplemental specifications and such other special provisions and drawings, if any, which will be submitted by the City, together with any advertisement, instructions to bidders, general conditions, technical specifications, proposal and bond, which may be hereto attached, and any drawings if any, which may be herein referred to, are hereby made a part of this contract, and all of said work to be performed and completed by the contractor and its successors and assigns shall be fully completed in a good and workmanlike manner to the satisfaction of the City. If the Contractor should fail to comply with any of the terms, conditions, provisions or stipulations as contained herein within the time specified for completion of the work to be performed by the Contractor, then the City, may at its option, avail itself of any or all remedies provided on its behalf and shall have the right to proceed to complete such work as Contractor is obligated to perform in accordance with the provisions as contained herein. THE CONTRACTOR AND HIS OR ITS SUCCESSORS AND ASSIGNS DOES HEREBY AGREE TO ASSUME THE DEFENSE OF ANY LEGAL ACTION WHICH MAY BE BROUGHT AGAINST THE CITY AS A RESULT OF THE CONTRACTOR'S ACTIVITIES ARISING OUT OF THIS CONTRACT AND FURTHERMORE, IN CONSIDERATION OF THE TERMS, STIPULATIONS AND CONDITIONS AS CONTAINED HEREIN, AGREES TO HOLD THE CITY FREE AND HARMLESS FROM ANY AND ALL CLAIMS FOR DAMAGES, COSTS OF SUITS, JUDGMENTS OR DECREES RESULTING FROM ANY CLAIMS MADE UNDER THIS CONTRACT AGAINST THE CITY OR THE CONTRACTOR OR THE CONTRACTOR'S SUB CONTRACTORS, AGENTS, SERVANTS OR EMPLOYEES RESULTING FROM ACTIVITIES BY THE AFOREMENTIONED CONTRACTOR, SUB CONTRACTOR, AGENT SERVANTS OR EMPLOYEES, TO THE LIMITS OF § 725.06(2). Section V - Bayshore Trail - 122314 Page 3 of 17 11/25/2014 CONTRACT (2) In addition to the foregoing provisions, the Contractor agrees to conform to the following requirements: In connection with the performance of work under this contract, the Contractor agrees not to discriminate against any employee or applicant for employment because of race, sex, religion, color, or national origin. The aforesaid provision shall include, but not be limited to, the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; lay off or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The Contractor agrees to post hereafter in conspicuous places, available for employees or applicants for employment, notices to be provided by the contracting officer setting forth the provisions of the non discrimination clause. The Contractor further agrees to insert the foregoing provisions in all contracts hereunder, including contracts or agreements with labor unions and/or worker's representatives, except sub contractors for standard commercial supplies or raw materials. It is mutually agreed between the parties hereto that time is of the essence of this contract, and in the event that the work to be performed by the Contractor is not completed within the time stipulated herein, it is then further agreed that the City may deduct from such sums or compensation as may be due to the Contractor the sum of $1,000.00 per day for each day that the work to be performed by the Contractor remains incomplete beyond the time limit specified herein, which sum of $1,000.00 per day shall only and solely represent damages which the City has sustained by reason of the failure of the Contractor to complete the work within the time stipulated, it being further agreed that this sum is not to be construed as a penalty but is only to be construed as liquidated damages for failure of the Contractor to complete and perform all work within the time period as specified in this contract. It is further mutually agreed between the City and the Contractor that if, any time after the execution of this contract and the public construction bond which is attached hereto for the faithful performance of the terms and conditions as contained herein by the Contractor, that the City shall at any time deem the surety or sureties upon such public construction bond to be unsatisfactory or if, for any reason, the said bond ceases to be adequate in amount to cover the performance of the work the Contractor shall, at his or its own expense, within ten (10) days after receipt of written notice from the City to do so, furnish an additional bond or bonds in such term and amounts and with such surety or sureties as shall be satisfactory to the City. If such an event occurs, no further payment shall be made to the Contractor under the terms and provisions of this contract until such new or additional security bond guaranteeing the faithful performance of the work under the terms hereof shall be completed and furnished to the City in a form satisfactory to it. Section V - Bayshore Trail - 122314 Page 4 of 17 11/25/2014 CONTRACT (3) The successful bidder /contractor will be required to comply with Section 119.0701, Florida Statutes (2014), specifically to: (a) Keep and maintain public records that ordinarily and necessarily would be required by the City of Clearwater in order to perform the service; (b) Provide the public with access to public records on the same terms and conditions that the City of Clearwater would provide the records and at a cost that does not exceed the cost provided in Chapter 119 or as otherwise provided by law; (c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law; and (d) Meet all requirements for retaining public records and transfer, at no cost, to the City of Clearwater all public records in possession of the contractor upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the City of Clearwater in a format that is compatible with the information technology systems of the City of Clearwater. Section V - Bayshore Trail - 122314 Page 5 of 17 11/25/2014 CONTRACT (4) IN WITNESS WHEREOF, the parties to the agreement have hereunto set their hands and seals and have executed this Agreement, in duplicate, the day and year first above written. CITY OF CLEARWATER IN PINELLAS COUNTY, FLORIDA By: W ,A4C4* ,.b 7- William B. Horne, II City Manager Countersigned: By: Ct Xel\e \40$ George N. Cretekos, Mayor (Contractor must indicate whethe Partnership, Company or Individual.) (The person signing shall, in his own handwriting, sign the Principal's name, his own name, and his title; where the person is signing for a Corporation, he must, by Affidavit, show his authority to bind the Corporation). Page 6 of 16 Attest: Rosemarie Call City Clerk (SEAL) Approved as to form: Assistant City Attorney KEYSTONE EXCAVATORS, INC. (Contractor) By. Print Name: ��BEl�TI'r Title: PA.eS /DI,Jr 9/12/2014 CONSENT OF SURETY TO FINAL PAYMENT TO OWNER: City of Clearwater Parks & Recreation Dept. 100 S. Myrtle Ave. Clearwater, FL 33756 PROJECT NAME: Bayshore Trail PROJECT NO.: 14- 0028 -PR CONTRACT DATE: BOND NO. : [ 480373P ]', recorded in O.R. Book [ I. Page [ 1, of the Public Records of Pinellas County, Florida. CONTRACTOR: KEYSTONE EXCAVATORS, INC. Pursuant to § 255.05(11), Florida Statutes, and in accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the: Developers Surety & indemnity Company 17771 Cowan Ave, Suite 100 Irvine, CA 92614 on bond of KEYSTONE EXCAVATORS, INC. 371 SCARLET BLVD. OLDSMAR, FL 34677 ,SURETY, ,CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve Surety of any of its obligations to City of Clearwater Parks & Recreation Dept. 100 S. Myrtle Ave. Clearwater, FL 33756 ,OWNER, as set forth in said Surety's bond. IN WITNESS WHEREOF, the Surety has hereunto set its hand this r day of [month], [year] Attest: (Seal): Section V - Bayshore Trail - 122314 (Surety) (Signature of authorized representative) (Printed name and title) Page 7 of 17 11/25/2014 PROPOSALBID BOND (Not to be filled out if a certified check is submitted) KNOWN ALL MEN BY THESE PRESENTS: That we, the undersigned, KEYSTONE EXCAVATORS, INC. as Contractor, and DEVELOPERS SURETY & INDEMNITY COMPANY as Surety, whose address is 17771 COWAN AVENUE, SUITE 100, IRVINE, CA 92614, are held and firmly bound unto the City of Clearwater, Florida, in the sum of TEN PERCENT Dollars ($ 10% ) (being a minimum of 10% of Contractor's total bid amount) for the payment of which, well and truly to be made, we hereby jointly and severally bind ourselves, our heirs, executors, administrators, successors and assigns. The condition of the above obligation is such that if the attached Proposal of KEYSTONE EXCAVATORS, INC. as Contractor, and DEVELOPERS SURETY & INDEMNITY COMPANY_ as Surety, for work specified as: BAYSHORE TRAIL PROJECT 14- 0028 -PR all as stipulated in said Proposal, by doing all work incidental thereto, in accordance with the plans and specifications provided herefor, all within Pinellas County, is accepted and the contract awarded to the above named bidder, and the said bidder shall within ten days after notice of said award enter into a contract, in writing, and furnish the required Public Construction Bond with surety or sureties to be approved by the City Manager, this obligation shall be void, otherwise the same shall be in full force and virtue by law and the full amount of this Proposal/Bid Bond will be paid to the City as stipulated or liquidated damages. Signed this .'da y of 20/1( (Principal must indicate whether corporation, partnership, company or individual) (The person signing shall, in his own handwriting, sign the Principal's name, his own name, and his title; where the person is signing for a Corporation, he must, by Affidavit, show his authority to bind the Corporation). Section V - Bayshore Trail - 122314 YSTONE EXCAVATORS, INC.__ Principal By: ROBERT C. FORNWALT PRESIDENT Title Surety Page 8 of 17 11/25/2014 AFFIDAVIT (To be filled in and executed if the bidder is a corporation) STATE OF FLORIDA COUNTY OF ( PINELLAS ) JAMIE KAY FORNWALT being duly sworn, deposes and says that he /she is Secretary of KEYSTONE EXCAVATORS , INC. a corporation organized and existing under and by virtue of the laws of the State of Florida, and having its principal office at: 371 SCARLET BLVD (Street & Number) OLDSMAR PINELLAS FL (City) (County) (State) Affiant further says that he is familiar with the records, minute books and by -laws of: KEYSTONE EXCAVATORS, INC. (Name of Corporation) Affiant further says that ROBERT C. FORNWALT is PRESIDENT (Officer's Name) (Title) of the corporation, is duly authorized to sign the Proposal for BAYSHORE TRAIL PROJECT # 14- 0028 -PR or said corporation by virtue of A PROVISION OF THE BY -LAWS (state whether a provision of by laws or a Resolution of Board of Directors. If by Re lution give date of adoption). RAW/! C. Affiant Sworn to before me this lc> day of dci►o1 , 20 1 L! . Page 9 of 16 Notary Public Type /print/stamp name of Notary Title or rank, and Serial No., if any 9/12/2014 NON COLLUSION AFFIDAVIT STATE OF FLORIDA COUNTY OF ( PINELLAS ) ROBERT C. FORNWALT being, first duly sworn, deposes and says that he is PRESIDENT of KEYSTONE EXCAVATORS, INC. , 371 SCARLET BLVD , OLDSMAR , FL 34677 the party making the foregoing Proposal or Bid; that such Bid is genuine and not collusive or sham: that said bidder is not financially interested in or otherwise affiliated in a business way with any other bidder on the same contract; that said bidder has not colluded, conspired, connived, or agreed, directly or indirectly, with any bidders or person, to put in a sham bid or that such other person shall refrain from bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication or conference, with any person, to fix the bid price or affiant or any other bidder, or to fix any overhead, profit or cost element of said bid price, or that of any other bidder, or to secure any advantage against the City of Clearwater, Florida, or any person or persons interested in, the proposed contract; and that all statements contained in said proposal or bid are true; and further, that such bidder has not directly or indirectly submitted this bid, or the contents thereof, or divulged information or data relative thereto to any association or to any member or agent the; of r7 r Affiant Sworn to and subscribed before me this gyp• day of Oc40bQc' , 201 fir Notary PubliQd "Vb Notary Public State of Florida (. Nancy Herg James My Commission FF 08975e Of w Expires 02/21/2018 Page 10 of 16 9/12/2014 PROPOSAL (1) TO THE CITY OF CLEARWATER, FLORIDA, for BAYSHORE TRAIL PROJECT PROJECT # 14- 0028 -PR and doing such other work incidental thereto, all in accordance with the contract documents, marked BAYSHORE TRAIL PROJECT PROJECT # 14- 0028 -PR Every bidder must take notice of the fact that even though his proposal be accepted and the documents signed by the bidder to whom an award is made and by those officials authorized to do so on behalf of the City of Clearwater, Florida, that no such award or signing shall be considered a binding contract without a certificate from the Finance Director that funds are available to cover the cost of the work to be done, or without the approval of the City Attorney as to the form and legality of the contract and all the pertinent documents relating thereto having been approved by said City Attorney; and such bidder is hereby charged with this notice. The signer of the Proposal, as bidder, also declares that the only person, persons, company or parties interested in this Proposal, are named in this Proposal, that he has carefully examined the Advertisement, Instructions to Bidders, Contract Specifications, Plans, Supplemental Specifications, General Conditions, Special Provisions, and Contract Bond, that he or his representative has made such investigation as is necessary to determine the character and extent of the work and he proposes and agrees that if the Proposal be accepted, he will contract with the City of Clearwater, Florida, in the form of contract; hereto annexed, to provide the necessary labor, materials, machinery, equipment, tools or apparatus, do all the work required to complete the contract within the time mentioned in the General Conditions and according to the requirements of the City of Clearwater, Florida, as herein and hereinafter set forth, and furnish the required surety bonds for the following prices to wit: Page 11 of 16 9/12/2014 PROPOSAL (2) If the foregoing Proposal shall be accepted by the City of Clearwater, Florida, and the undersigned shall fail to execute a satisfactory contract as stated in the Advertisement herein attached, then the City may, at its option determine that the undersigned has abandoned the contract, and thereupon this Proposal shall be null and void, and the certified check or bond accompanying this Proposal, shall be forfeited to become the property of the City of Clearwater, Florida, and the full amount of said check shall be retained by the City, or if the Proposal Bond be given, the full amount of such bond shall be paid to the City as stipulated or liquidated damages; otherwise, the bond or certified check accompanying this Proposal, or the amount of said check, shall be returned to the undersigned as specified herein. Attached hereto is a bond or certified check on Developers Surety and Indemnity Company Bank, for the sum of Ten Percent ($ 10% ) (being a minimum of 10% of Contractor's total bid amount). The full names and residences of all persons and parties interested in the foregoing bid are as follows: (If corporation, give the names and addresses of the President and Secretary. If firm or partnership, the names and addresses of the members or partners. The Bidder shall list not only his name but also the name of any person with whom bidder has any type of agreement whereby such person's improvements, enrichment, employment or possible benefit, whether sub contractor, materialman, agent, supplier, or employer is contingent upon the award of the contract to the bidder). NAMES: ADDRESSES: ROBERT C. FORNWALT - PRESIDENT 371 SCARLET BLVD, OLDSMAR, FL 34677 JAMIE KAY FORNWALT — SECRETARY 371 SCARLET BLVD, OLDSMAR, FL 34677 (The bidder must indicate whether Signature of Bidder: artnership, Company or Individual). Page 12 of 16 9/12/2014 PROPOSAL (3) The person signing shall, in his own handwriting, sign the Principal's name, his own name and his title. Where the;erson signing for a corporation is other than the President or Vice President, he must, by affidavit,' 'ow t is authority, to bind the corporation. Principal: Aku, Pis: $Y: i 8 r C6e.tJL✓�1G�' Title: p,4-6a t -'r Business Address of Bidder: 371 SCARLET BLVD City and State: OLDSMAR , FL Zip Code 34677 Dated at OLDSMAR, FL , this ' '"~ day of ■Th , A.D., 20 14. Page 13 of 16 9/12/2014 CITY OF CLEARWATER ADDENDUM SHEET PROJECT: BAYSHORE TRAIL PROJECT # 14- 0028 -PR Acknowledgment is hereby made of the following addenda received since issuance of Plans and Specifications. Addendum No. Date: Addendum No. Date: Addendum No. Date: Addendum No. Date: Addendum No. Date: Addendum No. Date: Addendum No. Date: Addendum No. Date: Addendum No. Date: Addendum No. Date: Addendum No. Date: (The person signing shall, in his own handwriting, sign the Principal's name, his own name, and his title; where the person is signing for a Corporation, he must, by Affidavit, show his authority to bind the Corporation). KEYSTONE EXCAVATORS, INC. (Contractor) By: _ ete .f9. �. (SEAL) Print Name: RoggiZr. ... J�t�,14ie02'j- Title: P K$ /PEAJT' Page 14 of 16 9/12/2014 BIDDER'S PROPOSAL PROJECT: BAYSHORE TRAIL PROJECT , Project #14- 0028 -PR CONTRACTOR: KEYSTONE EXCAVATORS , Inc. BIDDERS GRAND TOTAL :$ 845,900.00 (Numbers) BIDDERS GRAND TOTAL : 6 7 Hundred FD,L'7 ' f/ UC Thousand, /U /Its Hundred Dollars, and Zi2O Cents ITEM NO. PAY ITEM DESCRIPTION UANTITY (Words) 1 101 -1 MOBILIZATION 1 LS $ 17,148.25 $17,148.25 2 102 -1 MAINTENANCE OF TRAFFIC 1 LS $ 10,680.00 $10,680.00 3 110 -1 -1 CLEARING & GRUBBING 3.71 AC $ 10,075.00 $37,378.25 4 104 -10 -3 SEDIMENT BARRIER 3,579 LF $ 1.00 $3,579.00 5 104 -11 FLOATING TURBIDITY BARRIER 48 LF $ 15.00 $720.00 6 104 -15 SOIL TRACKING PREVENTION DEVICE 2 EA $ 2,200.00 $4,400.00 7 120 -1 REGULAR EXCAVATION 171 CY $ 9.00 $1,539.00 8 120 -6 EMBANKMENT 1,055 CY $ 21.00 $22,155.00 9 210 -1 -1 "REWORK LIMEROCK BASE, 6" [ New 6" CRUSHED CONCRETE BASE 1 35,515 SF $ 2.50 $88,787.50 10 334 -1 -11 SUPERPAVE ASPHALTIC CONC., TRAFFIC A (2 ") 435 TN $ 144.00 $62,640.00 11 339 -1 MISCELLANEOUS ASPHALT PAVEMENT (2 ") 29 TN $ 144.00 $4,176.00 12 400 -0 -11 CONCRETE CLASS NS, GRAVITY WALL 358 CY $ 554.00 $198,332.00 13 400 -1 -2 CONCRETE CLASS I, ENDWALLS 13.4 CY $ 830.00 $11,122.00 14 425 -2 -61 MANHOLES, P -8, <10' 1 EA $ 2,982.00 $2,982.00 15 425 -71 INLET RELOCATING 1 EA $ 1,854.00 $1,854.00 16 430 - 175 -115 PIPE CULVERT, OPTIONAL MATERIAL, ROUND, 15" S /CD 15" RCP 75 LF $ 61.00 $4,575.00 17 430 -175 -118 PIPE CULVERT, OPTIONAL MATERIAL, ROUND, 18" S /CD 18" RCP 0 LF $ 0.00 $0.00 17_a 430 - 175 -124 PIPE CULVERT, OPTIONAL MATERIAL, OTHER SHAPE - ELLIP. 24" S /CD 19" x 30" ERCP 41 LF $ 86.00 $3,526.00 18 430 - 175 -130 PIPE CULVERT, OPTIONAL MATERIAL, ROUND, 30" S /CD 30" RCP 33 LF $ 108.00 $3,564.00 19 430 - 175 -230 PIPE CULVERT, OPTIONAL MATERIAL, OTHER SHAPE - ELIP /ARCH, 30" S /CD 24" x 38" ERCP 42 LF $ 122.00 $5,124.00 20 430 - 982 -133 MITERED END SECTION, OPTIONAL ROUND, 30" CD 30" MES 1 EA $ 3,860.00 $3,860.00 21 430 - 982 -633 MITERED END SECTION, OPTIONAL ELLIPTICAL / ACH, 30" CD 24" x 38" MES 1 EA $ 3,973.00 $3,973.00 22 430 - 984 -125 MITERED END SECTION, OPTIONAL ROUND, 18" SD 0 EA $ 0.00 $0.00 23 515 -1 -2 PIPE HANDRAIL - GUIDERAIL, ALUMINUM 3,128 LF $ 33.00 $103,224.00 24 520 -1 -10 CONCRETE CURB & GUTTER, TYPE F 191 LF $ 17.00 $3,247.00 25 520 -2 -4 CONCRETE CURB TYPE D 4,872 LF $ 10.00 $48,720.00 26 522 -2 CONCRETE SID4Wd0 DRIVEWAY, 6" THICK 50 SY $ 43.00 $2,150.00 Section V Page 15_a 9/12/2014 ITEM NO. PAY ITEM DESCRIPTION 27 " TREE MATT BASE FOR CONCRETE" See Below 147 SY 27_a 6" CONCRETE, with REBAR 2' o.c. Both Ways 147 SY $ 56.00 $8,232.00 27 b STONE BED , under Concrete Trail 180 TONS $ 46.00 $8,280.00 27 c FILTER FABRIC , under Concrete Trail 147 SY $ 6.00 $882.00 27 d 4" PERFORATED PIPE w/ CAPS 300 LF $ 10.00 $3,000.00 27_e AERATION RISERS / BOXES - None Shown 0 EA $ 0.00 $0.00 28 527 -2 DETECTABLE WARNINGS 200 SF $ 24.00 $4,800.00 29 530 -1 RIPRAP, SAND - CEMENT 10 CY $ 966.00 $9,660.00 30 536 -1 -1 GUARDRAIL - ROADWAY 528 LF $ 22.00 511,616.00 31 536 -73 GUARDRAIL REMOVAL 540 LF $ 6.00 $3,240.00 32 536 -85 -24 GUARDRAIL END ANCHORAGE ASSEMBLY - PARALLEL 2 EA $ 2,760.00 $5,520.00 33 570 -1 -2 PERFORMANCE TURF, SOD 2,604 SY $ 3.50 $9,114.00 34 WOOD BRIDGE 1 LS $ 55,200.00 $55,200.00 35 Sub -total of line items 1 -34 $769,000.00 36 10% Contingency of line 35 (Items 1 -34)* $ 769,000.00 $ 0.10 $76,900.00 37 Grand Total Line Items 1 -34 plus 10% Contingency $845,900.00 Total Amount in Numbers : $ 845,900.00 Total Amount in Words : -161 7 Hundred 1r'1 'Y— f/l/r Thousand, N//v l-{zfNaee') Dollars and Zse cents COMPANY'S NAME : KEYSTONE EXCAVATORS, INC. ADDRESS: 371 Scarlet Blvd CITY: Oldsmar ZIP CODE : 34677 TELEPHONE: 813 -854 -2342 FAx : 813- 854 -2993 E MAIL: Dave @KeystoneExcavators.com PRINTED NAME: David Atkins SIGNED: TITLE: Estimator DATE: to /- y THE BIDDER'S GRAND TOTAL ABOVE IS HIS TOTAL BID BASED ON HIS UNIT PRICES AND LUMP SUM PRICES AND THE ESTIMATED QUANTITIES REQUIRED FOR EACH SECTION. THIS FIGURE IS FOR INFORMATION ONLY AT THE TIME OF OPENING BIDS. THE CITY WILL MAKE THE TABULATION FROM THE UNIT PRICES AND LUMP SUM PRICE BID. IF THERE IS AN ERROR IN THE TOTAL BY THE BIDDER, IT SHALL BE CHANGED AS ONLY THE UNIT PRICES AND LUMP SUM PRICE SHALL GOVERN. THE OWNER RESERVES THE RIGHT TO SELECT ANY LINE ITEMS AND /OR REJECT ALL BIDS. THE TOTAL PRICE SHALL BE BASED ON LINE ITEMS SELECTED BY THE OWNER OF THIS PROJECT. CONTINGENCY LINE ITEM SHALL ONLY BE UTILIZED FOR ITEMS NOT IN THE SCOPE OF WORK AS OUTLINED IN THE BID PACKAGE, UTILIZATION OF CONTINGENCY FUND MUST BE IN WRITING BY THE CONTRACTOR OF ITEMS NOT INCLUDED IN THE BIDDING PACKAGE TO THE OWNER FOR ADDITIONAL SCOPE OF WORK AND APPROVED IN WRITING BY THE OWNER IN THE UTILIZATION OF THE CONTINGENCY FUNDS. CONTINGENCY FUNDS NOT UTILIZED IN THE PROJECT SHALL BE RETURNED TO THE OWNER UPON CLOSING OUT PURCHASE ORDER SHORT. Section V Page 15_b 9/12/2014 SCRUTINIZED COMPANIES AND BUSINESS OPERATIONS WITH CUBA AND SYRIA CERTIFICATION FORM PER SECTION III, ITEM 25, IF YOUR BID IS $1,000,000 OR MORE, THIS FORM MUST BE COMPLETED AND SUBMITTED WITH THE BID PROPOSAL. FAILURE TO SUBMIT THIS FORM AS REQUIRED, MAY DEEM YOUR SUBMITTAL NONRESPONSIVE. The affiant, by virtue of the signature below, certifies that: 1. The vendor, company, individual, principal, subsidiary, affiliate, or owner is aware of the requirements of section 287.135, Florida Statutes, regarding companies on the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or engaging in business operations in Cuba and Syria; and 2. The vendor, company, individual, principal, subsidiary, affiliate, or owner is eligible to participate in this solicitation and is not listed on either the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Sector List, or engaged in business operations in Cuba and Syria; and 3. Business Operations means, for purposes specifically related to Cuba or Syria, engaging in commerce in any form in Cuba or Syria, including, but not limited to, acquiring, developing, maintaining, owning, selling, possessing, leasing or operating equipment, facilities, personnel, products, services, personal property, real property, military equipment, or any other apparatus of business or commerce; and 4. If awarded the Contract (or Agreement), the vendor, company, individual, principal, subsidiary, affiliate, or owner will immediately notify the City of Clearwater in writing, no later than five (5) calendar days after any of its principals are placed on the Scrutinized Companies with :Activities in, Sudan List, the Scrutinized Companies with Activities in e Iran Petroleum Sector List, or engages in business operations in Cuba and Syria. STATE OF FLORIDA COUNTY OF PINELLAS Authorized Signature ROBERT C. FORNWALT Printed Name PRESIDENT Title KEYSTONE EXCAVATORS, INC. Name of Entity/Corporation The foregoing instrument was acknowledged before me on this 3Q day of C e \0Qr- , 20 I 4 , by �42.10e4A, C. Coc,r■wo.V% (name of person whose signature is being notarized) as the �,re.l,iee„16 (title) of V,e,sl ,e :,«q,,, g, c, (name of corporation/entity), personally known, to me as described herein , or produced a (type of identification) as identification, and who did/did not take an oath. My Commission Expires: NOTARY SEAL ABOVE Page 16 of 16 Nota P ublic \: ry Printed Name 9/12/2014