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MANGO STREET OUTFALL - 13-0041-EN t c,t C'ERTIF'ICATE OF SUBSTANTIAL COMPLETION Project: plan_o Street Outfall Project Contract Number: 13-004 I-EN Location. North Beach on Mango-St. between Bay Es lanade and Eldorado Contract Date: 9115116 Notice to Proceed Date: 10114116 Substantial Completion Date, 813117 'Warranty Expiration Bate; 813015 Consultant. Interflow Engineering The work performed under this Contract has been inspected by authorized representatives of the O neiJ-, Contractor, and Consultant, and the Traject (or specified part of the Project, as indicated above) is hereby declared to be substantially completed on the above date. DEFINITION OF SUBSTANTIAL COMPLETION Substantial completion is the stage in construction when a project or designated portion thereof'is sufficiently complete in accordance with contract documents so that the Owner can use the work or portion theregf for its intended use. Items that affect operational integrity and fitnetion oj'the work must e capable cif continuous use. The Contractor accepts the above Certificate of Substantial Completion and ail, ees to complete and correct the items on the tentative list within the time indicated. Karnmin 7a & Roodvoets Inc. By: 5-7- 17 Contractor Authri epresentative Date The Owner accepts the specified area of the Project as Substantially Complete and will assume full possession of the specified area of the Project on August 3, 2017. The responsibility for utilities, security, and insurance under the Contract Documents shall be as set forth in the Contract Documents. Roger Johnson By: - City of Clearwater Autho ' ive Date CT Cla-;'a PROJECT PUNCH LIST A punch list of items to be completed or corrected by August 24,2017, is appended hereto. This list may not be exhaustive, and the failure to include an item on it does not alter the responsibility of the Contractors to complete all the work in accordance with the Contract Documents. PROJECT ONE YEAR WARRANTY Contract Section /I/, 13.5 WAR RANTYICORRECTION PERIOD If within one year after the date of Substantial Completion or such longer period of time cis niay be prescribed by La,.vs or Regitlations or b'v the terms of any applicable special guarantee required by the Contract Docuflc tnents or by any provision Qf the Contract Docianents, any lVork- isfolind to be defective, Contractor shall promptly, yvithout cost to the 0vner and in accordance with the Owners written instructions,- (i) correct such defective iVork, or, if it has been rejected by the 0hvner, remove itfi-om the site and replace it ivith Klork-that is not defective and(ii)satisfactorily correct or-remove and replace any damage to other ff,ork or the ivork qfothens resulting therefrom... T,Vhere defective Mork (and damage to other tVork-resulting therefiront) has been corrected, removed or replaced under this paragraph the correction period hereunder with respect to such TVork-�vill be extendedfor an additional period of one Year after such correction or removal and replacement has been satisfactorily completed. Substantial Completion Date: 8/3/17 Warranty Expiration Date: 8/3/18 A copy of this signed and executed document should be provided to the following parties: Project Owner Representative Project Contractor City Engineering Construction Office Specialist Project File ENGINEERING DEPARTMENT CITY OF CLEARWATER POST OFFICE BOX 4748, CLEARWATER, FLORIDA 33758 -4748 MUNICIPAL SERVICES BUILDING, 100 SOUTH MYRTLE AVENUE, SUITE 220, CLEARWATER, FLORIDA 33756 TELEPHONE (727) 562 -4750 FAX (727 )-562 -4755 Kamminga & Roodvoets, Inc. Attention: Mr. Marcus Tidey Jr. 5219 Cone Road Tampa, FL 33610 RE: Signature Needed Mango Street Outfall Project # 13- 0041 -EN Dear Mr. Tidey: Received 12 d 2016 City -2'ttorne August 25, 2016 The competitive bids for the referenced City of Clearwater project have been reviewed and evaluated. Kamminga & Roodvoets, Inc. provided a competitive bid and was the lowest and most responsive bidder in accordance with plans and specifications. Enclosed please fmd the original copy of the contract. Please sign (page 8) and return to: City of Clearwater Engineering Contract Specialist — Attn: Lisa Bayly 100 S. Myrtle Ave. Clearwater, FL 33756 Once we have received your signatures, this contract will be awarded and signed by the next City Council on September 15, 2016. Then, the executed copies will be mailed back to you for a proposal bond and to be recorded. Please do not hesitate to contact me if you have any questions or concerns. Sincerely, Roger Johnson P.E. City of Clearwater /lb Contract Documents t■- "EQUAL EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER" SECTION V CONTRACT DOCUMENTS Table of Contents: PUBLIC CONSTRUCTION BOND 1 CONTRACT 3 CONSENT OF SURETY TO FINAL PAYMENT 9 PROPOSALBID BOND 10 AFFIDAVIT 11 NON COLLUSION AFFIDAVIT 12 PROPOSAL 13 CITY OF CLEARWATER ADDENDUM SHEET 16 BIDDER'S PROPOSAL 17 SCRUTINIZED COMPANIES AND BUSINESS OPERATIONS WITH CUBA AND SYRIA CERTIFICATION FORM 18 SECTION V i Updated 6/3/2016 . KEN ouRms CLERK oFCOURT ' AND COMPTROLLER nmELLma COUNTY,FL |murx 201630821410n0/2016 a«09:08 Am OFF REC Bm:1oo7o pa: 725-727 nvcTypp:BomoRECoRo|mG: *27.00 SECTION v-Contract Documents Hmnd'No.:_1312827O __ _ This bond is given to comply with § 255.05, Florida S1otutco, and any action instituted by u claimant under this bond for payment must be in accordance with the notice and time |hnko1iun provisions in subsections (2)and (|O). Pursuant to § 255.05(()(h)_ Florida Statutes, "Before commencing the work of- before recommencing the work after udefault or abandonment, the contractor shall provide to the yuNicmmtity m certified copy of the recorded bond. Notwithstanding the hnnx of the contract or any other |un/ governing prompt payment for construction »orvicea` the pu6||o entity may not make u puyrnrn( to the contractor und| the contractor has complied with this paragraph." CONTRACTOR SURETY QWNER Kamminga & Roodvoets, Inc Liberty Mutual Insurance Company City n[Clearwater [/,mxo] [no'x«] [I"Inginxc/ing Dept.] 521Q Cone Road 5OUU New King Street, Suite 380 |O08. Myrtle Avenue Tamea, FL 33610 Troy, MI 48098 C|cun°mer, FL 33756 [principal business address] - [principal business uddress) (727)563-[4747 616-849-0800 248-510-1400 [phone number] [phone nuinbei-] PROJECT NAME: |Niuo8v St.0mfaUl PROJECT yVO.: [ 13-0041-2Nl PROJECT 0]D0C8k%PT%ON: [The work oil rh/x 'ecYmxmbts (?/iog)rovxx,ents /w thc3Yunnnater collection �vonv und u/ilif/ex incidenkl to the mxxxtrxd/oo along Mnnm Street and intersecting xtrevts. ] BY THIS BOND, V «` /Komnmin Qa-&._Roud_vmets, Inc..no as Contractor, and Liberty yN , u corporation, Surety, bound to the City of C|eoowu0nr. Ronda, herein called Owner, in ihexum o[$ for payment u[which we bind ourselves, our heirs, pcsoou| ncprcxcntodvcx, uuoccsnnm' and assigns,jointly and xovcca{|y. THE CONDITION 0F '[H|8 BOND is that i[Cnntractor: |. Performs the omntruu( dated between Contractor and Owner for construction n[Mango Street Omtfa/f , Uhucnn1ruo1documcotxbubng /nnduupu� of this bond by reference (which include the /\dvcrtiucmoo< for Bids. Proposal. Contract, Surety Bond. /no(ruubmno to Bidders, General Conditions, P|wnu. Technical Specifications and Appendix, and such u|\esxbonv as may be made in said Munn and Specifications as therein provided for), at the times and in the manner prescribed in the contract; and 2. Promptly makes payments to all claimants, as defined in Section 255.05(l). Florida 8iu$uieo, supplying Contractor with labor, materials, or supplies, used directly or indirectly by Contractor in the prosecution of the work provided for in the contract: and }. Pays Owner all |Vxmuo, dumo8cu. cxpcoucx. ouo1o, and oi0nrncy^x [eco, including appellate proceedings, that Owner sustains because ol'a default by Contractor under the contract. and SECTION Page 1mo Updated 6/3/2016 SECTION V—Contract Documents Bond No.: 13128278 PUBLIC CONSTRUCTION BONI) (2) 4. To the limits of § 725.06(2), Florida Statutes, shall indemnify and hold harmless Owner, their officers and employees, from liabilities, damages, losses and costs, including, but not limited to, reasonable attorney's fees, to the extent caused by the negligence, recklessness, or intentional wrongful misconduct of Contractor and persons employed or utilized by Contractor in the performance of the constriction contract; and 5. Performs the guarantee of all work and materials furnished under the contract for the time specified in the contract, then this bond is void;otherwise it remains in full force. 6. Any action instituted by a claimant under this bond for payment must be in accordance with the notice and time limitation provisions in Section 255.05(2), Florida Statutes. 7. Any changes in or under the contract documents and compliance or noncompliance with any formalities connected with the contract or the changes does not affect Surety's obligation under this bond,and Surety does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract or to the work or to the specifications. IN TESTIMONY WHEREOF, witness the hands and seals of'the parties hereto this (0 day of Q (1/'sole Otarrership or Partnership, two (2) f 'itnesses required). (If Corporaliou, Secve tar.i,onti)tivill attest and c jfix sea!). Kamminga& Roodvoets, Inc. Hy . .................._ .. Title: Print Name: iG��r_�r. WITNESS: WITNESS: Corporate Secretary or Witness Print N,amc: L—(— frr. lnsc�cr!) Liberty Mutual Insurance Company '� . 9�, ,••:�°fie (Co•norate�Suretnl) k V i 44- • lay:( GS -o_ 1 h ATTORNEY-IN-FA Print Name: Paul M Hurley (a//r.t corporate seal) (Power q/:911orne.V must he atlached) SECTION V Page 2 of 17 Updated 6/3/2016 SECTION V — Contract Documents CONTRACT (1) This CONTRACT made and entered into this day of , 20 by and between the City of Clearwater, Florida, a municipal corporation, hereinafter designated as the "City ", and Kamminga & Roodvoets, Inc._, of the City of County of and State of Florida, hereinafter designated as the "Contractor ". [Or, if out of state:]' This CONTRACT made and entered into this day of , 20 by and between the City', of Clearwater, Florida, a municipal corporation, hereinafter designated as the "City ", and , a/an! (State) Corporation authorized to do Florida, of the City' of County of and State of , hereinafter designated as the "Contractor ".' business in the State 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: [ Mango St. Outfall Project PROJECT NO.: [ 13- 0041 -EN in the amount of $_1,630,751.10 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 SECTION V Page 3 of 17 Updated 6/3/2016 SECTION V — Contract Documents 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 Page 4 of 17 Updated 6/3/2016 SECTION V — Contract Documents 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 Page 5 of 17 Updated 6/3/2016 SECTION V — Contract Documents CONTRACT (3) In addition to all other contract requirements as provided by law, the contractor executing this agreement agrees to comply with public records law. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, THE CONTRACTORS DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT. CONTACT THE CUTODIAN OF PUBLIC RECORDS AT 727 -562 -4092, Rosemarie.Call umyclearwater.co , 112 S. Osceola Ave., Clearwater, FL 33756 The contractor's agreement to comply with public records law applies specifically to: a) Keep and maintain public records required by the City of Clearwater (hereinafter "public agency ") to perform the service being provided by the contractor hereunder. b) Upon request from the public agency's custodian of public records, provide the public agency with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided for in Chapter 119, Florida Statutes, as may be amended from time to time, or as otherwise provided by law. c) Ensure that the public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the contractor does not transfer the records to the public agency. d) Upon completion of the contract , transfer, at no cost, to the public agency all public records in possession of the contractor or keep and maintain public records required by the public agency to perform the service. If the contractor transfers all public records to the public agency upon completion of the contract, the contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the contractor keeps and maintains public records upon completion of the contract, the contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request from the public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. e) A request to inspect or copy public records relating to a public agency's contract for services must be made directly to the public agency. If the public agency does not possess the requested records, the public agency shall immediately notify the contractor of the request and the contractor must provide the records to the public agency or allow the records to be inspected or copied within a reasonable time. f) The contractor hereby acknowledges and agrees that if the contractor does not comply with the public agency's request for records, the public agency shall enforce the contract provisions in accordance with the contract. SECTION V Page 6 of 17 Updated 6/3/2016 SECTION V — Contract Documents g) A contractor who fails to provide the public records to the public agency within a reasonable time may be subject to penalties under Section 119.10, Florida Statutes. h) If a civil action is filed against a contractor to compel production of public records relating to a public agency's contract for services, the court shall assess and award against the contractor the reasonable costs of enforcement, including reasonable attorney fees, if: 1. The court determines that the contractor unlawfully refused to comply with the public records request within a reasonable time; and 2. At least 8 business days before filing the action, the plaintiff provided written notice of the public records request, including a statement that the contractor has not complied with the request, to the public agency and to the contractor. i) A notice complies with subparagraph (h)2. if it is sent to the public agency's custodian of public records and to the contractor at the contractor's address listed on its contract with the public agency or to the contractor's registered agent. Such notices must be sent by common carrier delivery service or by registered, Global Express Guaranteed, or certified mail, with postage or shipping paid by the sender and with evidence of delivery, which may be in an electronic format. j) A contractor who complies with a public records request within 8 business days after the notice is sent is not liable for the reasonable costs of enforcement. SECTION V Page 7 of 17 Updated 6/3/2016 SECTION V — Contract Documents CONTRACT (4) IN WITNESS WHEREOF, the parties to the agreement have hereunto set their hands and seals and have executed this Agreement, the day and year first above written. CITY OF CLEARWATER IN PINELLAS COUNTY, FLORIDA By: lattLiA 4,414/4774:1 William B. Horne, II City Manager Countersigned: By: —ct tor \C^C.t ,of George N. Cretekos, Mayor Contractor must indicate whether X 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 — provide Affidavit. SECTION V Attest: La a 4. Rosemarie Call City Clerk Approved as to form: litAlk----- Matthew M. Smit Assistant City Attorney Kg by\ tety.. leocifiy4 1*:tjx?,ic„. (Contractor)',, By: Print Na Title: Page 8 of 17 Updated 6/3/2016 SECTION V — Contract Documents CONSENT OF SURETY TO FINAL PAYMENT TO OWNER: City of Clearwater PROJECT NAME: [Mango St. Outfall ] [Engineering Dept.] PROJECT NO.: [13- 0041 -EN < ] 100 S. Myrtle Ave. CONTRACT DATE: [ 1 Clearwater, FL 33756 BOND NO. : f ], recorded in O.R. Book [ ], Page [ ]„ of the Public Records of Pinellas County, Florida. CONTRACTOR: [ 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: [insert name of Surety] [address] [address] on bond of [insert name of Contractor] [address] [address] ,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 [Engineering Dept. ] 100 S. Myrtle Ave. Clearwater, FL 33756 as set forth in said Surety's bond. IN WITNESS WHEREOF, the Surety has hereunto set its hand this day of Attest: (Seal): SECTION V ,OWNER, (Surety) (Signature of authorized representative) (Printed name and title) Page 9 of 17 Updated 6/3/2016 PR0PO0AUBJ00OND (Not to be liIkd out iCa certificd check is submittcd) KNOWN ALL MEN BY THESE PRESENTS: That we. the undersigned. Kmmminom& Rwmdvoets.|nc` as Contractor, and U.� « M ��.||n�-r,n� �nn",n as Surety, `�*c address is --- ' -- - - 2116 are held and firmly City oy Clearwater, Fo,idu , in the sum o [ 1O% of the amount ofbid (S--1�-- ](hcin&u minimum |O�u[[ \ — — onmcxv�xlom| hid amount) for which, well and truly to bc made. 1S hereby jointly and severally hind oumu|ves, our administrators. successors and assi . hon ��de DoU�s d�^�m���otoy heirs, executors, & Rnod«����c as Surety, Thc condition u/ the above obligation isxuchUhx if the ivached Proposal of Namminpa as Contractor. aJld Liberty Mutual Insurance Company for work specified as: Mango Street Stormwater Improvements (13-0041-EN) all as stipulated in said Proposal, by doing all work i ncidental thereto, in accorda plans and specifications provided hcrofx`uH within Pinellas County, is accepted and the contract aw 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 10 bc approved b> the City Manager, this obligation shall be void, nWhcnwixe 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. Inc. Signed this 15th day of Au9ust , 20 16 Principal must indicate whether: X Corporation ---- ' nrm 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, mho* his authonity 1'.) hind the Corporation — provide Affidavit. Contractor ___ Principal By: Nce psiden! itic Liberty Mutual Insurance Compan Surety Paul M Hurley. ' in Fact = f,' SECTION V Page m"/n upC"te uu /201 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. 5982313 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies "), pursuant to and by authority herein set forth, does hereby name, constitute and appoint Anne Barick; Kristyn M. Langbeen; Linda L. Austin; Margaret M. Kohloff; Michael D. Lechner; Michelle Buechel; Paul M. Hurley; Richard S. McGregor; Robert D. Heuer; T. R. Guy all of the city of Troy state of MI each individually if there be more than one named, its true and lawful attomey -in -fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 7th day of February , 2013 STATE OF WASHINGTON COUNTY OF KING On this 7th day of February 2013 before me personally appeared Gregory W. Davenport, who acknowledged himself to be the Assistant Secretary of American Fire and Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Seattle, Washington, on the day and year first above written. By: Kb KD Riley , Not Public ss American Fire and Casualty Company The Ohio Casualty Insurance Company Liberty Mutual Insurance Company West American Insurance Company By: lLu� ti Gregory . Davenport, Assistant Secretary This Power of Attorney is made and executed pursuant to and by authority of the following By -laws and Authorizations of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV — OFFICERS — Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attomeys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey -in -fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII — Execution of Contracts — SECTION 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes Gregory W. Davenport, Assistant Secretary to appoint such attorneys -in -fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, David M. Carey, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attomey of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. CGiN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this day of ( .L L ,20 1(-0. By: David M. Carey, "Assistant Secretary LMS_12873_092012 216 of 1000 SECTION V — Contract Documents AFFIDAVIT (To be filled in and executed if the bidder is a corporation) STATE OF FLORIDA FL ) COUNTY OF W; llanrtu3k ) being duly sworn, deposes and says that he /she is Azil. Secretary of aM414150 : goo ive4 Xnc. a corporation organized and existing under and by virtue of the laws of the State of Florida, and having its principal office at: ?1/3S— 1roctipicer Ave. Si F 6rencl Rap1'cls ken+ Atr (Street & Number) (City) (County) (State) Affiant further says that he is familiar with the records, minute books and by -laws of Kanlrlihia -. j<occt cc is, tic. (Name of Corp ration) Affiant further says that tlr,V.s 13. T; dry Sr (Officer's Name) (Title or said corporation by virtue of IC.So Lila) o 4- accr o jitgcoodvocis Xnc is Uitc Resider!t of the corporation, is duly authorized to 'gn the proposal for or1 12.1- aOIS' (state whether a provision of by laws or a Resolution of Board of Directors. If by Resolution give date of adoption). Affiant S ♦h % AA j- Sworn to before me this day of ,/`�U�iU S T ,20 1(0. SECTION V Public 5QIKeS J ,c (YLes Type /print/stamp name of Notary Titl and 9itig ;Ril{th Commission # FF 47 5 My Commission Expires August 22, 2017 1 Page 11 of 17 Updated 6/3/2016 SECTION V— Contract Documents NON COLLUSION AFFIDAVIT STATE OF FLORIDA FL ) COUNTY OF II; 11SLrou5rl ) /Marcus -17c19 3r•. being, first duly sworn, deposes and says that he is UiCr, Presrlclen+ of 'carsn%,r1r . gcodooct ZiC - 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 thereof. Sworn to and subscribed before me this 1 s day of Affi t ,20 1(0• ublic JAMES BARNES Commission # FF 47665 My Commission Expires August 22, 2017 SECTION V Page 12 of 17 Updated 6/3/2016 SECTION V — Contract Documents PROPOSAL (1) TO THE CITY OF CLEARWATER, FLORIDA, for Mantto Street - t iwater Imnrovenaei$ Proieq ( #13=4O4A -EN) and doing such other work incidental thereto, all in accordance with the contract documents, marked Mapgo Street -tornAwater Imarovemrenn Protect (#13-0041-EN) 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 Public Construction 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: SECTION V Page 13 of 17 Updated 6/3/2016 SECTION V — Contract Documents 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 �-., Ijl t4 SL 4-14-11. ,.r -, Bank, for the of ?er Awwu.Lt ($ -- t° 90 ) (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: ,j, �! ADDRESSES: tres + `'itM` I Pon I ?L 3s- grcc Ip cor Ave. ljr'J IZG?;els AT a% iria -- Sec 4-ery kra,) k iynsi 01 34/1s' 13raxdotvr Ave- Cwt. I?ops'.ls MJ y1S1 SECTION V Signature of Bidder: Page 14 of 17 Updated 6/3/2016 SECTION V — Contract Documents PROPOSAL (3) The person signing shall, in his own handwriting, sign the Principal's name, his own name and his title. Where the person signing for a corporation is other than the President or Vice President, he must, by affidavit, show his authority, to bind the corporation. Principal: l- a,nn r►1 i n A- 17• d lI Vo 3 yyn By: 7\c rr •c s b ( 01,25( J e Title: UI C.e._ P( e- (- CI PMt- Company Legal Name: kaMMiq ? I ZOOcoc TM- Doing Business As (if different than above): Business Address of Bidder: Sa 1 Can c City and State: 77.zinpQ Ft Zip Code 13 (p /O Phone: 213.6,23-303/ Email Address: rn b f do ycDisatarin c /Y.a rn Dated at TaAve_ 49 , this t?' day of Au5uS� , A.D., 20/. SECTION V Page 15 of 17 Updated 6/3/2016 SECTION V— Contract Documents CITY OF CLEARWATER ADDENDUM SHEET PROJECT: Acknowledgment is hereby made of the following addenda received since issuance of Plans and Specifications. Addendum No. 1 Date: 14u) $ 141 9049 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: SECTION V kaniminco' I'ocdtjcc /i Inc - (Name of Bidder) (Signs 4!of Officer) icc PIT'S .1 cIrn f (Title of Officer) (Date) Page 16 of 17 Updated 6/3/2016 SECTION V — Contract Documents BIDDER'S PROPOSAL PROJECT: E f CONTRACTOR: Kamminga & Roodvoets. Inc. BIDDER'S GRAND TOTAL: $ 1.630.751.10 (Numbers) BIDDER'S GRAND TOTAL: One Million Six Hundred Thirty Thousand Seven Hundred Fifty One Dollars and Ten Cents (Words) TFnre 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. SECTION V Page 17 of 17 Updated 6/3/2016 SECTION V — Contract Documents Mango Street Outfall - Bid Schedule (ISSUED FOR BID) Item No Item Description QTY UNIT UNIT PRICE AMOUNT 100 GENERAL 101 MOBILIZATION 102 MAINTENANCE OF TRAFFIC 103 CLEARING & GRUBBING 104 REMOVAL & REPLACEMENT OF UNSUITABLE MATERIAL (ALLOWANCE) 105 DEWATERING (OUTFALL) 106 EROSION & SEDIMENTATION CONTROL INCL. SILT FENCE & INLET PROTECTION 107 FLOATING TURBIDITY BARRIER 108 TREE BARRICADES 109 ROOT PRUNING 110 TREE REMOVAL (ALLOWANCE); 8 "< DIA. < 12" 111 TREE REMOVAL TREE REMOVAL (ALLOWANCE); 12" < DIA. < 24" 112 14" ROADWAY BASE (LBR 100) 113 CONSTRUCT VALLEY CURB (CITY INDEX NO. 107) 114 4" CONCRETE SIDEWALK (INCLUDES CURB RAMPS) 115 PEDESTRIAN RAMP DETECTABLE WARNING SURFACE 116 CONCRETE DRIVEWAY RESTORATION (INCLUDES PALLETIZING BRICK DRIVES) 117 SODDING Subtotal General 118 General Contingency 10% Total General 200 STORMWATER 201 F &I 15" RCP CL3 202 F &I 18" RCP CL3 203 F &I 24" RCP CL3 204 F &I 30" x 19" ERCP CL3 205 F &I 38" x 24" ERCP CL3 206 F &I 45" x 29" ERCP CL3 207 F &I 60" x 24" RCB (FDOT 292) 208 F &I 48" DIA MH 209 F &I 48 "x48" CONFLICT BOX 210 F &I 60" DIA MH 211 F &I 72" x 48" CONFLICT BOX 212 F &I INLET (FDOT 232, TYPE C) 213 F &I INLET (FDOT 232, TYPE C) W/ GISB 214 F &I INLET (FDOT 232, TYPE E) W/ GISB 215 F &I INLET (FDOT 232, TYPE H -3 MOD) W/ GISB 216 F &I MES (FDOT 272) 217 CONSTRUCT HEADWALL (FDOT 291) & SEAWALL 218 CONSTRUCT D.B.I APRON DETAIL 219 DEMO & DISPOSE EXISTING STORM PIPE: DIA <12" 220 DEMO & DISPOSE EXISTING STORM PIPE: 12" <DIA <18" 221 DEMO & DISPOSE EXISTING STORM STRUCTURES 222 DEMO & DISPOSE EXISTING HEADWALL 223 FLOWABLE FILL FOR ABANDONED STORMWATER PIPES 224 MANATEE GRATE AT SEAWALL Subtotal Stormwater 225 Stormwater Contingency 10% Total Stormwater 255 1 1,640 470 9 4 6,590 1,860 4,740 20 480 1 1 LS LS LS CY LS LS LS LF LF EA EA SY LF SF EA SY LS LS 271 LF 119 LF 106 LF 624 LF 556 LF 375 LF 66 LF 2 EA 1 EA 6 EA 1 EA 1 EA 7 EA 10 EA 1 EA 1 EA 1 EA 340 LF 1 LS 1 LS 1 LS 1 LS 24 CY 1 EA 1 LS $123,000.00 $123,000.00 $8,500.00 $8,500.00 $87,000.00 $87,000.00 $30.00 $7,650.00 $7,700.00 $7,700.00 $8,000.00 $8,000.00 $700.00 $3.50 $ 7.00 $ 450.00 $ 500.00 $ 20.00 $21.50 $ 4.50 $200.00 $ 77.00 $700.00 $ 5,740.00 $3,290.00 $4,050.00 $ 2,000.00 $131,800.00 $39,990.00 $21,330.00 $4,000.00 $36,960.00 $26,000.00 $26,000.00 $ 517,710.00 $51,771.00 $ 51,771.00 $ 569,481.00 $ 84.00 $85.00 $105.00 $94.00 $116.00 $150.00 $615.00 $4,000.00 $5,000.00 $ 4,500.00 $5,000.00 $3,000.00 $4,000.00 $5,000.00 $9,000.00 $800.00 $20,000.00 $ 42.00 $3,500.00 $ 6,000.00 $ 3,000.00 $3,000.00 $ 322.00 $ 1,500.00 $45,880.90 $22,764.00 $10,115.00 $11,130.00 $58,656.00 $64,496.00 $56,250.00 $40,590.00 $8,000.00 $5,000.00 $27,000.00 $5,000.00 $3,000.00 $28,000.00 $50,000.00 $9,000.00 $800.00 $20,000.00 $14,280.00 $3,500.00 $6,000.00 $3,000.00 $3,000.00 $7,728.00 $1,500.00 $458,809.00 $45,880.90 $504,689.90 SECTION V Page 19 of 20 Updated 5/6/2016 SECTION V — Contract Documents UTILITIES 300 POTABLE WATER 301 F &I 4" DIP WM, RJ; INCLUDING POLY WRAP, FITTINGS, & BENDS 302 F &I 6" DIP WM, RJ; INCLUDING POLY WRAP, FITTINGS, & BENDS 303 F &I 8" DIP WM, RJ; INCLUDING POLY WRAP, FITTINGS, & BENDS 304 F &I 12" DIP WM, RJ; INCLUDING POLY WRAP, FITTINGS, & BENDS 305 F &I 4" RESTRAINTS; EXITING PIPE ONLY 306 F &I 6" RESTRAINTS; EXITING PIPE ONLY 307 F &I 8" RESTRAINTS; EXITING PIPE ONLY 308 F &I 12" RESTRAINTS; EXITING PIPE ONLY 309 F &I 6" G V w/ BOX 310 F &I 8" G V w/ BOX 311 F&I 12" G V w/ BOX 312 F &I 5 1/4" HYDRANT 313 F &I 4" LINE STOP 314 F &I 6" LINE STOP 315 F &I 8" LINE STOP 316 F &I 12" LINE STOP 317 DEMO & DISPOSE EXISTING WM; DIA. < 8" 318 DEMO & DISPOSE EXISTING WM; 8 "< DIA. < 12" 319 REMOVE & REPLACE POTABLE WATER SERVICE CONNECTION (ALLOWANCE) Subtotal Potable Water 320 Potable Water Contingency 10% Total Potable Water 400 SANITARY SEWER 401 F &I 6" DIP SAN 402 F &I 8" PVC SAN 403 F &I 8" DIP SAN 404 F &I 12" STL CASING 405 F &I 14" STL CASING 406 F &I 4' DIA SAN MH 407 DEMO & DISPOSE EXISTING SANITARY PIPE 408 DEMO & DISPOSE EXISTING SANITARY STRUCTURES 409 FLOWABLE FILL FOR ABANDONED SANITARY SEWER PIPES 410 SANITARY SEWER BYPASS 411 REMOVE &REPLACE SANITARY LATERALS WITH CITY INDEX NO. 305 (ALLOWANCE) Subtotal Sanitary Sewer 412 Sanitary Sewer Contingency 10% Total Sanitary Sewer 500 RECLAIMED WATER 501 F &I 4" DIP RCWM, RJ; INCLUDING POLY WRAP, FITTINGS, & BENDS 502 F &I 6" DIP RCWM, RJ; INCLUDING POLY WRAP, FITTINGS, & BENDS 503 F &I 12" DIP RCWM, RJ; INCLUDING POLY WRAP, FITTINGS, & BENDS 504 F &I 4" RESTRAINTS; EXITING PIPE ONLY 505 F &I 6" RESTRAINTS; EXITING PIPE ONLY 506 F &1 12" RESTRAINTS; EXITING PIPE ONLY 507 F &I 4" LINESTOP 508 F &I 6" LINESTOP 509 F &I 12" LINESTOP 510 DEMO & DISPOSE EXISTING RCWM; DIA. < 8" 511 DEMO & DISPOSE EXISTING RCWM; 8 "< DIA. < 12" 512 REMOVE & REPLACE RECLAIM SERVICE CONNECTION (ALLOWANCE) Subtotal Reclaimed Water " " " "" °" " 513 Reclaimed Water Contingency 10% Total Reclaimed Water 35 LF $ 92.00 $ 3,220.00 307 LF $105.00 $ 32,235.00 153 LF $173.00 $ 26,469.00 93 LF $163.00 $15,159.00 4 EA $300.00 $ 1,200.00 12 EA $315.00 $3,780.00 36 EA $345.00 $12,420.00 7 EA $475.00 $3,325.00 4 EA $1,200.00 $4,800.00 4 EA $1,500.00 $6,000.00 1 EA $ 2,400.00 $2,400.00 1 EA $4,200.00 $ 4,200.00 2 EA $2,250.00 $4,500.00 7 EA $2,650.00 $18,550.00 7 EA $3,050.00 $21,350.00 2 EA $4,250.00 $8,500.00 1 LS $2,000.00 $ 2,000.00 1 LS $2,500.00 $2,500.00 17 EA $500.00 $8,500.00 $181,108.00 1 LS 18,110.80 $18,110.80 $ 199,218.80 36 LF $ 97.00 $ 3,492.00 879 LF $49.00 $ 43,071.00 289 LF $123.00 $35,547.00 18 LF $ 71.00 $1,278.00 18 LF $112.00 $2,016.00 7 EA $4,400.00 $30,800.00 1 LS $6,000.00 $6,000.00 1 LS $2,500.00 $2,500.00 5 CY $400.00 $2,000.00 1 LS $12,500.00$ 12,500.00 14 EA $750.00 $10,500.00 $ 149, 704.00 1 LS $14,970.40$14,970.40 $ 164,674.40 21 LF $120.00 $2,520.00 125 LF $137.00 $17,125.00 132 LF $130.00 $17,160.00 4 EA $300.00 $ 1,200.00 10 EA $320.00 $3,200.00 5 EA $475.00 $ 2,375.00 2 EA $2,250.00 $4,500.00 4 EA $2,650.00 $ 10,600.00 2 EA $4,500.00 $9,000.00 1 LS $1,500.00 $1,500.00 1 LS $1 ,750.00 $1,750.00 4 EA $500.00 $2,000.00 $72,930.00 1 LS $7,293.00 $7,293.00 $ 80,223.00 Subtotal Utilties Total Utilities Contingeny Total Utilities $ 403,742.00 $ 40, 374.20 $ 444,116.20 SECTION V — Contract Documents Mango Street Outfall - Bid Schedule (ISSUED FOR BID) Item UNIT No Item Description QTY UNIT PRICE AMOUNT 600 SURFACE RESTORATION 601 2" ASPHALTIC CONCRETE STRUCTURAL COURSE TYPE SP -9.5 720 TN $142.00 $102,240.00 Subtotal Surface Restoration $102,240.00 602 Surface Restoration Contingency 10% 1 LS $10,224.00 $ 10,224.00 Total Surface Restoration $ 112,464.00 Subtotal $1,482,501.00 Total Contingency $148,250.10 Total Contract $1,630,751.10 Total Contract $ 1,630,751.10 Note: Sections 100 and 600 will be distributed on a prorated basis per Utility and invoiced on cost share basis 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. SECTION V Page 21 of 20 Updated 5/6/2016 SECTION V— Contract Documents 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 the Iran Petroleum Sector List, or engages in business operations in Cuba and Syria. STATE OF COUNTY OF On ci S.• , '4 A The foregoing instrument was acknowledged before me on this I day of Aust4A 1 , 20 /4 , by 1L, s cl r. (name of perso p w ose signature is being notarized) as the t. ' .. (tit e) of • /, s XI , (name of corporation/entity), er nally know} to me as described herein or produced a (type of identification) as identification, and who did/did not take an oath �'8lic 400 Printed Name Vi cc Prcsicicnf Title kammifl a , IZaoa�cI., Snc. Name of Entit /Corporation JAMES BARNES Commission 4 FF 47665 My Commission Expires August 22, 2017 My Commission Expires: NOTARY SEAL ABOVE CS•2..2.90/7 SECTION V Page 18 of 17 Printed Name Updated 6/3/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ DTCAREFULLY. CONTRACTOR'S BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Policy Number Agency Number PolicyEffective Date CPP20918-" 60201 0165282 04/01/2016 Pol I cyExp1 ration Date Date Account Number 04/01/2017 04/30/2016 10030806 Named Insured Agency Issuing Company COMPANY 1. o. SECTION n-WHO |SAN INSURED is amended to add aaan insured any person mrorganization: (1) Whom you are required to add as an additional insured on this policy under a written contractor written agreement relating hz your business;or (2) Who is named as an additional insured underthis policy on a certificate of insurance, b. The written contract,written ognaemenK. oruartiOoahecfinaurancemust: (1) Require additional insured status for a time period during the term of this policy;and /21 Beexemdedprinr/o(he"bodi|yinjuq/'."propedydomagm''. or"personm|andadvertie|nginjury'|aeding ivaclaim under1hiepo|iuy. c. If,however: (1) "Your work" began undero|etterof intent or work order; and (2) The letter of intent or work order led to a written contractor written agreement within 30 days of beginning such work;and (3) Your customers customary contracts require persons or organizations to be named as additional insureds; vve will provide additional insured status ao specified in this endorsement. 2. SECTION N-WHO |SAN INSURED io amended 0o add the following: |f the additional insured is: a. An individual,their spouse io also an additional insured, b. A partnership orjoint venture, members, partners, and their spouses are a�so additional insureds, o. A limited liability company, members and managers are also additional insureds, d. An organization other than e: (1) Partnership; (2).oin1wanture| or po Limited UabU Illy company; executive officers and directors of the organization are also additional insureds. Stockholders are also additional insureds, but only with respect tn their|iabi|ityasstockholders. e. A trust,trustees are also insureds,but only with respect to their duties as trustees. Includes copyrighted material cf Insurance Services Office, Inc. CG 70 48 09 13 Pagesl of3 I The insurance provided under this endorsement ko limited asfollows: a. That person or organ izat!on is an add itiona I ins u red only with respect to liabi I ity arising out ot (1) Premises you: (a)Own; (b)Rent; hdLaame or (d)Occupy;m (2) Ongoing operations performed by you ormn your behalf, If, however,the written contract,written agreement, or certificate of insurance also requires completed operations coverage,we will also provide comp|eted operations coverage for that additional insured. b. Premises, as respects paragraph 3.a.(I)above, include common or public areas about such premises if so required|n the written contract or written agreement. o. Additional insured status provided under paragraphs 3'm.UVb>mr3.a.(1)(c)above does not extend beyond the end ufa premises lease ur rental agreement. d. Ongoing operations, as respects paragraph 3.a.(2)above,does not apply to"bodily injury"or"property damage"occurring after: (1) All work to be performed by you or on your behalf for the additional insured(s)at the site of the covered operations is complete,including related materials, parts or equipment(otherthan service, maintenance orrepains);or (2) That portion of"yourwork"out of which the injury or damage arises is put to its intended use by any person or organization otherthan another contractor working for a principal as a part of the same project, e. The limits of insurance that apply to the additional Insured are the least of those specified in the: (1) Written contract (2) Written agreement; (3) Certificate of insurance;or pg Deu|erationsuf this policy. The limits of insurance are inclusive of and not in addition to the limits of insurance shown in the Declarations. t Theinsuranoepmvidedbotheodditiona|inaureddoemnotapp|y1n"bodi|yinjury'."propedydannage". or "personal and advertising injury"arising out of an architect's, engineer's,or surveyor's rendering of,or failure Uu render, any professional services, including but not limited to: (1) The preparing,approving, or failing\n prepare orapprove: (a)Maps; (b)Drawings; (c)Opinions; (d) Reports; (e)Surveys; (f) Change orders; (Q)Design specifications;and (2) Supervisory,inspection,or engineering services. Includes copyrighted material of Insurance Services Office, |no. Page 3mf3 CG70480913 �. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4.Other Insurance is deleted and replaced with the following: 4` Other Insurance. Coverage provided by this endorsement is excess over any other valid and collectible insurance available to the additional insured whether a. Primary; b.Excess; c.Contingent;or d.On any other basis; unless the written contract,written agreement, or certificate of insurance requires this insurance be primary. In that case,this insurance will be primary without contribution from such other insurance available to the additional insured. h. If the written contract,written agreement,or certificate of Insurance as outlined above requires additional insured status by use of CG 20 10 1185,then the terms of that endorsement,shown below,are incorporated into this endorsement to the extent such terms do not restrict coverage otherwise provided Uy this endorsement: ADDITIONAL INSURED-OWNERS,LESSEES OR CONTRACTORS(FORM B) This endorsement modifies insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: Blanket Where Required byWritten Contract, Agreement,or Certificate of Insurance that the terms of CG 20 10 1185 apply (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED(Section 11)is amended to include as an insured the person or organization shown in the Schedule,but only with respect to liability arising out of "yourwork"forthat insured by or for you. Copyright,Insurance Services Office, Inc,, 1984 CG 20 10 1185 i If the written contract,written agreement,or certificate of insurance as outlined above requires additional insured status by use of an Insurance Services Office(ISO)endorsement,then the coverage provided under this C8 7O4M endorsement does not apply. Additional insured status iolimited tu that provided by the ISO endorsement. Includes copyrighted material wf Insurance Services Off ice, Inc. CG70480913 Pages 3mf3 AC�® P10/5/2016 ATE(MM/DD/YYYY) CC CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Donna Griffiths NAME: Guy Hurley, LLC PHONE (248)519-1439 1 FAAIC No:(248)519-1401 1080 Kirts Blvd. , Suite 500 E-MAIL d riffiths@ g hbh.com ADDRESS: g INSURERS AFFORDING COVERAGE NAIC# Troy MI 48084 INSURER AAmerisure Insurance Co. 19488 INSURED INSURER B:Travelers 25674 Kamminga & Roodvoets, Inc. INSURER C Amerisure Mutual Ins. Co. 23396 3435 Broadmoor S.E. INSURER D: INSURER E: Grand Rapids MI 49512 1 INSURER F: COVERAGES CERTIFICATE NUMBER:16-17 All Lines UMB Al 2M REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM DDIYYYY MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X i OCCUR DAMAGE TO RENTED 300,000 PREMISES Ea occurrence $ X Y CPP 2091818 4/1/2016 4/1/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ]JERT D LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident) A X ANY AUTO BODILY INJURY(Per person) &$ _- X AU OS LX SCHEDULED CA 2091812 4/1/2016 4/1/2017 BODILYINJURY(Peraccident) $ AUTOS AUTOS Y X NON-OWNED 4 RO RTY DAMAGE $IPer HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR G EACH OCCURRENCE $ 2,000,000 B EXCESS LIAB CLAIMS-MADE II AGGREGATE $ 2,000,000 DED RETENTION ZUP-15530627 4/1/2016 4/1/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN X STATUTE _,,.._. ER ANY PROPRIETOR/PARTNER/EXECUTIVE - NIA E.L.EACH ACCIDENT $ 500,000 C (Mandatory in NH) D y WC 2091813 4/1/2016 4/1/2017 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below QI E.L.DISEASE-POLICY LIMIT $ 500,000. li it DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: K&R #51607. Mango Street Stormwater Improvement Project (13-0041-EN) . The City of Clearwater is an Additional Insured for General Liability (CG7048 09/13 - attached) on a primary and non-contributory basis when required by written contract. Waiver of Subrogation applies in favor of the City of Clearwater for General Liability, Automobile Liability and Workers Compensation when required by written contract. 30 Day Notice of Cancellation (Except Non-Payment of Premium) applies in favor of City of Clearwater for General Liability, Automobile Liability and Workers Compensation when required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Engineering Department ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Construction Office Specialist P.O. Box 4748 AUTHORIZED REPRESENTATIVE Clearwater, FL 33758-4748 Mark Madden/WEAL a - °� "- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 Onl401t