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CONTRACT - EDGEWATER DRIVE PARK IMPROVEMENTS
SECTION V CONTRACT DOCUMENTS Table of Contents PUBLIC CONSTRUCTION BOND 1 CONTRACT 4 CONSENT OF SURETY TO FINAL PAYMENT 8 PROPOSAL/BID BOND 9 AFFIDAVIT 10 NON -COLLUSION AFFIDAVIT 11 PROPOSAL 12 r CITY OF CLEARWATER ADDENDUM SHEET 14 BIDDER'S PROPOSAL 15 SCRUTINIZED COMPANIES AND BUSINESS OPERATIONS WITH CUBA AND SYRIA CERTIFICATION FORM 19 SCRUTINIZED COMPANIES THAT BOYCOTT ISRAEL LIST CERTIFICATION FORM 20 SECTION V Pagel Updated 7/9/2025 SECTION V - Contract Documents Bond No PUBLIC CONSTRUCTION BOND (1) This bond is given to comply with § 255 05, Florida Statutes, and any action instituted by a claimant under this bond for payment must be in accordance with the notice and time limitation provisions in sutsections (2) and (10) Pursuant to § 255 05(1)(b), Florida Statutes, "Before commencing the work or before recommencing the work after a default or abandonment, the contractor shall provide to the public entity a certified copy of the recorded bond Notwithstanding the terms of the contract or any other law governing prompt payment for construction services, the public entity may not make a payment to the contractor until the contractor has complied with this paragraph " CONTRACTOR SURETY MTM Contractors Inc [name] Principal Name 6550 53' ST N Pinellas Park, FL 33781 Principal Business Address 727-528-0178 Principal Phone Number Principal Name [Address Line 11 [Address Line 21 Principal Business Address [phone number] Principal Phone Number OWNER City of Clearwater Public Works PO Box 4748 Clearwater FL 33758-4748 (727) 562-4630 PROJECT NAME Edgewater Drive Park Renovation PROJECT NO 25 -0019 -PR PROJECT DESCRIPTION The Scope of Work for the Edgewater Drive Park Renovations Project includes the demolition and removal of existing asphalt pavement within the current parking area, as well as the removal of the adjacent concrete sidewalk along Edgewater Drive The proposed improvements consist of the construction of an expanded parking facility to accommodate additional vehicular spaces The existing 6 -foot -wide concrete sidewalk will be reconstructed and widened to 10 feet to meet updated accessibility and pedestrian circulation requirements Site improvements also include the installation of a stormwater pond, site furnishings such as benches, waste receptacles, drinking fountain(s), bike repair station, landscaping and regulatory/informational signage as specified in the construction plans Adjustments to existing utility structures shall be performed as necessary to match the proposed finish grades and elevations indicated in the construction documents All adjustments shall comply with applicable standards and be coordinated with the respective utility owners The intent of this bid is to obtain competitive prices to establish a contract for construction services All quantities are estimates only and the city of Clearwater (city) is not obligated to purchase any minimum or maximum amount during the life of the contract All the work is to be administered per Section III, Section 11 3, Unit Price Work, of the Contract Documents The Contractor shall provide one (1) [Fixed/Portable] project sign as described in Section III, Section 23 of the Contract Documents Contract Period 4 5 months or 136 consecutive calendar days from November 15, 2026 - March 31, 2027 with substantial completion of the project by March 31, 2027 SECTION V Page 1 of 20 Updated 7/9/2025 SECTION V — Contract Documents BY THIS BOND, We, , as Contractor, and , a corporation, as Surety, are bound to the City of Clearwater, Florida, herein called Owner, in the sum of $762,910 50, for payment of which we bind ourselves, our heirs, personal representatives, successors, and assigns, jointly and severally THE CONDITION OF THIS BOND is that if Contractor 1 Performs the contract dated , between Contractor and Owner for construction of Edgewater Drive Park Renovation, 25 -0019 -PR, the contract documents being made a part of this bond by reference (which include the Advertisement for Bids, Proposal, Contract, Surety Bond, Instructions to Bidders, General Conditions, Plans, Technical Specifications and Appendix, and such alterations as may be made in said Plans 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(1), Florida Statutes, 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 SECTION V Page 2 of 20 Updated 7/9/2025 SECTION V — Contract Documents Bond No PUBLIC CONSTRUCTION BOND (2) 3 Pays Owner all losses, damages, expenses, costs, and attorney's fees, including appellate proceedings, that Owner sustains because of a default by Contractor under the contract, and 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 construction 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 do 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 day of , 20 (If sole Ownership or Partnership, two (2) Witnesses are required) (If Corporation, Secretary only will attest and affix seal) MTM Contractors, Inc By Title Print Name WITNESS WITNESS Corporate Secretary or Witness Print Name Print Name (affix corporate seal) (Corporate Surety) By ATTORNEY-IN-FACT Print Name (affix corporate seal) (Power of Attorney must be attached) SECTION V Page 3 of 20 Updated 7/9/2025 SECTION V — Contract Documents CONTRACT (I) 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 MTM Contractors, Inc , of the City of Pinellas Park County of Pinellas and State of Florida, hereinafter designated as the "Contractor" Or if out of state E This CONTRACT made and entered into of Clearwater, Florida, a municipal business m the State ' of Florida, and State WITNESSETH this — day of , 20_ by and between the City' corporation, hereinafter designated as the "City", and a/an (State) Corporation authorized to do of the City of '; ' p , County of of ' ', hereinafter designatedaas fhe,"Contractor" 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 Edgewater Drive Park Renovation PROJECT NO 25 -0019 -PR in the amount of $762,910 50 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 SECTION V Page 4 of 20 Updated 7/9/2025 SECTION V — Contract Documents CONTRACT (2) 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) 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 20 Updated 7/9/2025 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 CUSTODIAN OF PUBLIC RECORDS, Rosemarie Call, City Clerk, at Rosemarie Call@myclearwater com, 727-562-4092, 600 Cleveland St , 6th Floor, 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 pubhc records that are exempt or confidential and exempt from public records disclosure requirements If the contractor keeps and maintains pubhc 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 g) A contractor who fails to provide the public records to the public agency within a reasonable time may be subiect 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 SECTION V Page 6 of 20 Updated 7/9/2025 SECTION V —Contract Documents CONTRACT (4) 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 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 Je ife oirrier City Manager Countersigned By Bruce Mayor Rosemarie Call City Clerk Approved as to form Contractor must indicate whether x Corporation, Partnership Melissa Isabel Senior Assistant City Attorney (Contractor By Company, or individual (SEAL) Print N. e George Toccalino Title President The person signing shall, in his own handwriting, sign the Principal's name, his own naive, 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 Page 7of20 Updated 7/9/2025 SECTION V —Contract Documents CONSENT OF SURETY TO FINAL PAYMENT TO OWNER: City of Clearwater PROJECT NAME: Edgewater Drive Park Renovation Public Works PROJECT NO.: 25 -0019 -EN 100 S Myrtle Ave CONTRACT DATE: [ ] Clearwater, FL 33756 BOND NO.: [ ], recorded in O.R. Book [ ], Page [ ], of the Public Records of Pinellas County, Florida. CONTRACTOR: [ 1 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], SURETY, on bond of MTM Contractors, Inc 6550 53Rd St. N Pinellas Park, FL 33781, 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 Public Works PO Box 4748 Clearwater, FL 33758-4748, OWNER, 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 (Surety) (Signature of authorized representative) (Printed name and title) Page 8 of 20 Updated: 7/9/2025 SECTION V —Contract Documents PROPOSAL/BID BOND (Not to be filled out if a certified check is submitted) KNOWN ALL MEN BY THESE PRESENTS That we, the undersigned, M T M Co 6550 53rd St N Pinellas Park, FL 33781 as Contractor, and Fid lit Maryland as Surety, whose address is 1299 Zurich Wa Schaumburg, IL 60196-1056 , are held and firmly boun of Clearwater, Florida, in the sum of 10% ofAccom•an in Bid ($ ---10% of Bid-- ) (being a minimum of 10% of Contractor's total bid amount) for the pay well and truly to be made, we hereby jointly and severally bind ourselves, our hei administrators, successors and assigns The condition of the above obligation is such that if the attached Proposal of MTM C as Contractor, and Fidelity and Deposit Company of Maryland work specified as 25 -0019 -PR Edgewater Drive Park Renovation Edgewater Park Clearwater, FL Pinellas County 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 arded 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 tractors, Inc o •an of 5th Floor unto the City Dollars ent of which, s, executors, ntractors, Inc as Surety, for Principal must indicate whether x Corporation, Partnership, Company, or Individual Signed this 29th day of July , 2026 M T M Contractors, Inc Contractor George Toccalino- Principal By President Title r moi, 1,(4/\-.) J Anthony T Papa Jr Attorney In -Fa and Licensed Florida Reeldent AgenUA199806 Fidelity and Deposit Company of Marland Surety The person signing shall, in his own handwriting, sign the Principal's name, his own name, where the person is signing for a Corporation, he must, by Affidavit, show his authority to Corporation — provide Affidavit nd his title, ind the SECTION V Page 8 of 16 Updated 7/9/2025 SECTION V — Contract Documents AFFIDAVIT (To be filled in and executed if the bidder is a corporation) STATE OF FLORIDA ) COUNTY OF Pinellas Anthony Toccalino , being duly sworn, deposes and says Secretary of MTM Contractors Inc a corporation organized and existing under and by virtue of the laws of the State of Flonda, principal office at 6550 53rd St Pinellas Park Pinellas (Street & Number) hat he/she is (City) (County) Affiant further says that he is familiar with the records, minute books and MTM Contractors Inc (Name of Corporation) Affiant further says that George Toccalino ,s President (Officer's Name) (Title) d having its FL (State) by-laws of of the corporation, is duly authorized to sign the Proposal for MTM Contractors inc or said corporation by virtue of Resolution of Board of Directors 02/23/2004 (state whether a provision of by laws or a esolution of Board of Directors 1f by E olu on give d e o<fi optidn) Sworn to before me this 29 day of July �1ar a JEFFREY T STEVENSON Notary Public State of Florida k. dT Commission p HH 378237 of rP My Comm Expires Mar 23 2027 amormoBonded through National Notary Assn ony Toccalino-SecretaryNice-President Affiant , 2026 N u ►c Type/print/stamp name of Notary Title or rank, and Serial No , if an SECTION V Page 9 of 16 Updated 7/9/2025 SECTION V — Contract Documents NON -COLLUSION AFFIDAVIT STATE OF FLORIDA ) COUNTY OF Pinellas ) George Toccalino President being, first duly sworn, deposes and says that he is of MTM Contractors Inc 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 contrat,t, that said bidder has not colluded, conspired, connived, or agreed, direct) 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 agai 1st 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 ian Sworn to and subscribed before me this 29 day of July 1 1•o4 JEFFREY T STEVENSON �� Notary Public State of Florida Commission # HH 378237 op My Comm Expires Mar 23 2027 Bonded through National Notary Assn ? tom ,2026 SECTION V Page 10 of 16 Updated 7/9/2025 SECTION V — Contract Documents PROPOSAL (1) TO THE CITY OF CLEARWATER, FLORIDA, for Edgewater Drive Park Renovation (25 -0019 -EN) and doing such other work incidental thereto, all in accordance with the contract documents, marked Edgewater Drive Park Renovation (25 -0019 -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 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 SECTION V Page 12 of 20 Updated 7/9/2025 I SECTION V — Contract Documents PROPOSAL (2) Attached hereto is a bond �/o�r certified check on C ciene c •-‘3 0 4' V171 e� o�s'��e1 4,-,Z'erza ova 5CIotLcs($ "'77 0bO," ) f (b g 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 Sectetaty If firm or partnership, the names and addresses of the members or partners '1 he 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, agen , supplier, or employer is contingent upon the award of the contract to the bidder) NAMES ADDRESSES George Toccalino-President 5652 Bayview Dr Seminole, FL 33772 a f� Bank, for the sum o Anthony Toccalino-Vice-President/Secretary 10153 118th Way Seminole, FL 33772 Y. Signature of Bidder 1,A,„/1,t,) The person signing shall, in his own handwriting, sign the Principal's name, his .wn 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 authonty, to bind the corporation George Toccalino ., - evi C tievi-rt tr-1-1 y r s l I Principal x Title Company Legal Name MTM Contractors Inc President Doing Business As (if different than above) Business Address of Bidder 6550 53rd St City and State Pinellas Park, FLonda Phone 727-528-0178 Email Address Zip Code 337 tony a@mtmcontractors coin Dated at 6550 53rd St Pinellas Park, FL 33781 , this 29th day of July , A D , 2026 SECTION V Page 12 of 16 Updated 7/9/2025 SECTION V — Contract Documents CITY OF CLEARWATER ADDENDUM SHEET PROJECT 25-0019-PR•Edgewater Dnve Park Renovation Acknowledgment is hereby made of the following addenda received Specifications Addendum No 1 Date 07/06/2026 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 since issuance of Plans and MTM Contractors Inc (Name of Bidder — ll Sign/re of O icer President 1 (Title of Officer) 07/29/2026 (Date) SECTION V Page 13 of 16 Updated 7/9/2025 SECTION V — Contract Documents BIDDER'S PROPOSAL PROJECT 25 -0019 -PR Edgewater. Drive Park Renovation CONTRACTOR MTM Contractors Inc BIDDER'S GRAND TOTAL $ -7cQ, V 0.6.0 BIDDER'S GRAND TOTAL ,ce;(/ t Th. In L1 v'l died S 3( ',J -S c 4, /"l I ,ew k cJncir-ed 'A do l /C ,c--1 es (Numbers) fig' D Ctn (Words) Insert Bid Tab Table Dere 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 1 THE CONTRACTOR SHALL PROVIDE COPIES OF A CURRENT CONTRACTOR LICENSE/REGISTRATION WITH THE STATE OF FLORIDA AND PINELLAS COUNTY IN THE BID RESPONSE r SECTION V Page 14 of 16 Updated 7/9/2025 SECTION V —Contract Documents BIDDER'S PROPOSAL PROJECT 25 -0019 -EN Edgewater Drive Park Renovation CONTRACTOR BIDDER'S GRAND TOTAL $ (Numbers) BIDDER'S GRAND TOTAL (Words) Line Item Description Quantity Unit of Measure A General '^ r$I [ .0 'i 4,4' 1 Bond 1 LS 2 Survey, Construction Layout 1 LS 3 Survey, As -Built Requirements 1 LS 4 Mobilizaation 1 LS 5 Maintenance of Traffic 1 LS 6 Sediment Trap at Curb Inlet 1 EA 7 Sediment Barrier 1 EA 8 Staked Filter Fabric Silt Fence 8050 LF 9 Erosion Control Diversion Berm 1 EA 10 Tree Baricade 44 EA P „„ , , , 413 i) f , , N B Demolition r � �a��, 11 Clearing and Grubbing 1 LS 12 Tree, to be removed (13"-24") 2 EA 13 Tree, to be removed (Greater than 36") 2 EA 14 Tree, to be removed (stump, dead, etc) 2 EA 15 Tree, to be removed (Palm) 12 EA SECTION V Page 15 of 20 Updated 7/9/2025 SECTION V — Contract Documents 16 Landscape Material, to be removed 1 LS 17 Concrete to be removed 1900 SY 18 Curb to be removed 150 LF 19 Asphalt, to be removed 445 SY 20 Park Furniture, bence to relocated 11 EA 21 Park Furniture, trash receptacle to be relocated 8 EA 22 Park Furniture, dog waste station to be relocated 2 EA 23 Water Fountain to be removed 1 EA 24 Sign, single post to be relocated 14 EA C. Proposed Construction'' Yf 25 Grading 1 LS 26 Root Prune 430 LF 27 Roadway Base, Crushed Concrete, min LBR 100, 8" compacted min thickness 190 CY 28 Superpave Asphalt Concrete, Type SP 9 5, Fine, Traffic Level C 2" Min Thickness 850 SY 29 Pavement, Cement Concrete for Sidewalk, 6" Min thickness, 3,300 PSI w/ fiber mesh (sidewalk being placed within 10' of existing tree canopy shall be reinforced appropriately for tree preservation) 26300 SF 30 Pavement, Cement concrete for pads, 6 min thickness, 3,000 PSI w/ fiber mesh 450 SF SECTION V Page 16 of 20 Updated 7/9/2025 SECTION V — Contract Documents 31 Pavement, cement concrete for driveway apron, 6" min thickness, 3,000 PSI w/ fiber mesh and WWF 280 SF 32 Curb, Concrete, Straight per City Index #101 320 LF 33 Curb, Concrete, Drop per FDOT Index #520-001 50 LF 34 Wheel Stop, concrete 6 -ft length 14 EA 35 Wheel Stop, concrete 6 -ft length, blue ADA 2 EA 36 Dectable Warning Surface 1 EA 37 Painted Pavement Marking, STD, white, solid 6" 313 LF 38 Painted Pavement Marking, STD, white, solid 24" 14 LF 39 Painted Pavement Marking, STD, blue, solid, 6" 72 LF 40 Painted Pavement Marking, STD, blue, solid, "Handicap Symbol" (2 7 sf) 2 EA 41 Sign, Single Post 15 EA 42 Sign, Project Identification 1 EA 43 Park Furniture, Bench Install 10 EA 44 Park Furniture, Trash Receptacle Install 5 EA 45 Park Furniture, Dog Waste station install 1 EA 46 Fence, material & height tbd 100 LF 47 Water Fountain with pet station (supplied by city, install by contractor) 1 EA 48 Utility Adjustment 6 EA 49 Landscaping 1 LS SECTION V Page 17 of 20 Updated 7/9/2025 SECTION V—Contract Documents 50 Irrigation 1 LS 12Ttot Contigency Line Item Description Quantity Unit of Measure 1 10% Contingency of above table 1 LS A Grand Total 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 CONTRACTOR SHALL PROVIDE COPIES OF A CURRENT CONTRACTOR LICENSE/REGISTRATION WITH THE STATE OF FLORIDA AND PINELLAS COUNTY IN THE BID RESPONSE SECTION V Page 18 of 20 Updated 7/9/2025 [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT ITB No 25 -0019 -PR Edgewater Drive Park Renovation Line Item Description Quantity Unit of Measure, A General Unit Cost Total 1 Bond 1 LS $9 500 00 $9 500 00 2 Survey Construction Layout 1 LS $19 500 00 $19 500 00 3 Survey As -Built Requirements 1 LS $5 805 00 $5 805 00 4 Mobilizaation 1 LS $52 500 00 $52 500 00 5 Maintenance of Traffic 1 LS $18 995 00 $18 995 00 6 Sediment Trap at Curb Inlet 1 EA $1 125 00 $1 125 00 7 Sediment Barrier 1 EA $450 00 $450 00 8 Staked Filter Fabric Silt Fence 8 050 LF $1 95 $15 697 50 9 Erosion Control Diversion Berm 1 EA $2 850 00 $2 850 00 10 Tree Bancade 44 EA $125 00 $5 500 00 B Demolition 11 Clearing and Grubbing 1 LS $18 975 00 $18 975 00 12 Tree to be removed (13" 24") 2 EA $1 220 00 $2 440 00 13 Tree to be removed (Greater than 36") 2 EA $1 850 00 $3 700 00 14 Tree to be removed (stump dead etc) 2 EA $750 00 $1 500 00 [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT Invitation To Bid - Edgewater Drive Park Renovation Page 6 [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT ITB No 25 -0019 -PR Edgewater Drive Park Renovation Line Item 15 Description Tree to be removed (Palm) Quantity 12 Unit of Measure EA Unit Cost $650 00 Total $7 800 00 16 Landscape Material to be removed 1 LS $6 500 00 $6 500 00 17 Concrete to be removed 1 900 SY $13 50 $25 650 00 18 Curb to be removed 150 LF $15 00 $2,250 00 19 Asphalt to be removed 445 SY $13 50 $6 007 50 20 Park Furniture bence to relocated 11 EA $795 00 $8 745 00 21 Park Furniture trash receptacle to be relocated 8 EA $698 00 $5 584 00 22 Park Furniture dog waste station to be relocated 2 EA $775 00 $1 550 00 23 Water Fountain to be removed 1 EA $500 00 $500 00 24 Sign single post to be relocated 14 EA $375 00 $5 250 00 C Proposed Construction 25 Grading 1 LS $12,500 00 $12 500 00 26 Root Prune 430 LF $45 00 $19 350 00 27 Roadway Base Crushed Concrete min LBR 100 8" compacted min thickness 190 CY $55 00 $10 450 00 28 Superpave Asphalt Concrete Type SP 9 5 Fine Traffic Level C 2" Min Thickness 850 SY $32 75 $27 837 50 [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT Invitation To Bid - Edgewater Drive Park Renovation Page 7 [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT ITB No 25 -0019 -PR Edgewater Drive Park Renovation Line Item 29 Description Pavement Cement Concrete for Sidewalk 6' Min thickness 3 300 PSI w/ fiber mesh (sidewalk being placed within 10 of existing tree canopy shall be reinforced appropriately for tree preservation) Quantity 26 300 Unit of Measure SF Unit Cost $11 25 Total $295 875 00 30 Pavement Cement concrete for pads 6 min thickness 3 000 PSI w/ fiber mesh 450 SF $11 25 $5 062 50 31 Pavement cement concrete for driveway apron 6' min thickness 3 000 PSI w/ fiber mesh and WWF 280 SF $11 95 $3 346 00 32 Curb Concrete Straight per City Index #101 320 LF $52 00 $16 640 00 33 Curb Concrete Drop per FDOT Index #520 001_ 50 LF $52 00 $2 600 00 34 Wheel Stop concrete 6 ft length 14 EA $125 00 $1 750 00 35 Wheel Stop, concrete 6 ft length blue ADA 2 EA $150 00 $300 00 36 Dectable Warning Surface 1 EA $450 00 $450 00 37 Painted Pavement Marking STD white solid 6" 313 LF $3 00 $939 00 38 Painted Pavement Marking STD white solid 24" 14 LF $20 00 $280 00 39 Painted Pavement Marking STD blue solid 6" 72 LF $3 00 $216 00 40 Painted Pavement Marking STD blue solid "Handicap Symbol (2 7 sf) 2 EA $350 00 $700 00 41 Sign, Single Post 15 EA $495 00 $7 425 00 42 Sign Project Identification 1 EA $1 525 00 $1 525 00 43 Park Furniture Bench Install 10 EA $295 00 $2 950 00 [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT Invitation To Bid - Edgewater Drive Park Renovation Page 8 [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT ITB No 25 -0019 -PR Edgewater Drive Park Renovation .Line Item 44 Description Park Furniture Trash Receptacle Install Quantity 5 - Unit of Measure EA Unit Cost.• • _ $250 00 Total $1 250 00 45 Park Furniture Dog Waste station install 1 EA $445 00 $445 00 46 Fence material & height tbd 100 LF $125 00 $12 500 00 47 Water Fountain with pet station (supplied by city install by contractor) 1 EA $1 295 00 $1 295 00 48 Utility Adjustment 6 EA $1 250 00 $7 500 00 49 Landscaping 1 LS $19 995 00 $19 995 00 50 Irrigation 1 LS $12 000 00 $12 000 00 TOTAL $693,555 00 CONTIGENCY Line Item 1 10% Contingency of above table Description Quantity 1 Unit of Measure LS Unit Cost Total . $69 355 50 TOTAL $69,355 50 $69,355 50 [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT Invitation To Bid - Edgewater Drive Park Renovation Page 9 SECTION V—Contract Documents SCRUTINIZED COMPANIES AND BUSINESS OPERATIONS WITH CUBA AND SYRIA CERTIFICATION FORM I 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 FORMAS REQUIRED, MAY DEEM YOUR SUBMITTAL NONRESPONSIVE 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 m Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum ctor List,' or engages m business operations in Cuba and Syria i The affiant, by virtue of the signature below, certifies that Autl{orized Signature George Toccalino Printed Name President Title MTM Contractors Inc Name of Entity/Corporation STATE OF FLORIDA COUNTY OF Pinellas The foregoing instrument was acknowledged before me on this 29th day of July , 20 26 , by George Toccalino (name of person whose signature is being notarized) as the President (title) of MTM Contractors Inc 1 (name of corporation/entity), aersonallyknown to me as described herein George Toccalino , or produced a (type of identification) as ide . a • n, an-rrot take an oath •QICIJEFFREY T STEVENSON r+° Irl Notary Public State of Florida ; Commission K 1111 378237 of n My Comm Expires Mar 23, 2027 Bonded through National Notary Assn My Commission Expires NOTARY SEAL ABOVE SECTION V Not ry Jeffrey T Stevenson Printed Name Page 15 of 16 Updated 7/9/2025 +---,,,,-,40. ,mss ,i,pY Pt% JEFFREY T STEVENSON 1 i �� 'i Notary Public State of Florida P ��� 4 Commission # HH 371237 or no`. My Comm Expires Mar 23 2027 F Bonded through National Notary Assn I SECTION V — Contract Documents SCRUTINIZED COMPANIES THAT BOYCOTT ISRAEL LIST CERTIFICATION FORM PER SECTION HI, ITEM 25, THIS FORM MUST BE COMPLETED AND SUBMITTED WITH THE BID PROPOSAL FAILURE TO SUBMIT THIS FORMAS 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 that Boycott Israel List, or engaged in a boycott of Israel, and 2 The vendor, company, individual, principal, subsidiary, affiliate, or owner is eligible to participate in this solicitation and is not listed on the Scrutinized Companies that Boycott Israel List, or engaged in a boycott of Israel, and 3 "Boycott Israel" or "boycott of Israel" means refusing to deal, terminating business activ ties, or taking other actions to limit commercial relations with Israel, or persons or entities doing business in Israel or in Israeli -controlled territories, in a discriminatory manner A statement by a company that it is participating in a boycott of Israel, or that it has initiated a boycott in response to a request for a boycott of Israel or in compliance with, or in furtherance of, calls for a boycott of Israel, may b6, considered as evidence that a company is participating in a boycott of Israel, 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 that Boycott Israel List, or engaged in a boycott of Israel STATE OF Florida COUNTY OF Pinellas Authorized Signature Goerge Toccalino Printed Name President Title MTM Contractors Inc Name of Entity/Corporation The foregoing instrument was acknowledged before me on this 29thday of July 20 26 , by George Toccalino (name of person whose signature is as the President (title) of MTM Contractors Inc corporation/entity), p saually_kuoaa.ta.tur;as.Jclescnbr ibgrs~in George Toccalino (type of identification) as ide tion, and being notarized) (name of , or produced a tiake an oath My Commission Expires NOTARY SEAL ABOVE SECTION V 11C Jeffrey T Stevenson Printed Name Page 16 of 16 Updated 7/9/2025 i Compliance with Anti -Human Trafficking Laws Pursuant to Section 787 06 (13), Flonda Statutes, this form must be completed by an officer or representative of a non-governmental entity when a contract is executed, renewed, or extended between the non-govemmental entity and the City of Clearwater The undersigned, on behalf of the entity listed below ("Entity"), hereby attests and perjury that r penalty of Entity does not use coercion for labor or services as defined in Section 787 06, Florida Statutes The undersigned is authonzed to execute this form on behal Date July 29 , 202L Signed Entity MTM Contractors Inc Name Anthon Title Vice -President 1 i { 1 City of Clearwater Public Works Marcus Williamson, Department Director 100 South Myrtle Avenue Clearwater FL 33756 [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT ITB No 25 -0019 -PR Edgewater Drive Park Renovation RESPONSE DEADLINE July 29, 2026 at 2 00 pm Report Generated Thursday, July 30, 2026 Company MTM CONTRACTORS INC Email tony@mtmcontractors com Contact Anthony Toccalino Address 6550 53RD STREET NORTH PINELLAS PARK, FL 33781 Phone (727) 528-0178 Website N/A Submission Date Jul 29, 2026 1 34 PM (Eastern Time) MTM CONTRACTORS INC Response CONTACT INFORMATION [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT ITB No 25 -0019 -PR Edgewater Drive Park Renovation ADDENDA CONFIRMATION Addendum #1 Confirmed Jul 29, 2026 10 13 AM by Anthony Toccalino r QUESTIONNAIRE 1 Certified Business* Are you a Certified Small Business or a Certified Minority, Woman or Disadvantaged Business Enterprise? Yes CERTIFIED BUSINESS TYPE* Pick one of the following Certified Small Business CERTIFYING AGENCY* List the Agency that provided your certification Pinellas County, FDOT, City of St Petersburg, Hillsborough County CERTIFICATION DOCUMENTATION* Provide a copy of your certification Smali_Business_Certificates pdf [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT Invitation To Bid - Edgewater Drive Park Renovation Page 2 [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT ITB No 25 -0019 -PR Edgewater Drive Park Renovation 2 Vendor Certification* By submitting this response, the Vendor hereby certifies that A It is under no legal prohibition on contracting with the City of Clearwater B It has read, understands, and is in compliance with the specifications, terms and conditions stated herein, as well as its attachments, and any referenced documents C It has no known, undisclosed conflicts of interest D The prices offered were independently developed without consultation or collusion with any of the other vendors or potential vendors or any other anti-competitive practices E No offer of gifts, payments or other consideration were made to any City employee, officer, elected official, or consultant who has or may have had a role in the procurement process for the commodities or services covered by this contract The Vendor has not influenced or attempted to influence any City employee, officer, elected official, or consultant in connection with the award of this contract F It understands the City may copy all parts of this response, including without limitation any documents or materials copyrighted by the Vendor, for internal use in evaluating respondent's offer, or in response to a public records request under Florida's public records law (F S Chapter 119) or other applicable law, subpoena, or other judicial process, provided that the City agrees not to change or delete any copyright or proprietary notices G It hereby warrants to the City that the Vendor and its subcontractors will comply with, and are contractually obligated to comply with, all federal, state, and local laws, rules, regulations, and executive orders H It certifies that Vendor is not presently debarred, suspended, proposed for debarment, declared ineligible, voluntarily excluded, or disqualified from participation in this matter from any federal, state, or local agency I It will provide the commodities or services specified in compliance with all federal, state, and local laws, rules, regulations, and executive orders if awarded by the City J It is current in all obligations due to the City K It will accept all terms and conditions as set forth in this solicitation if awarded by the City [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT Invitation To Bid - Edgewater Drive Park Renovation Page 3 [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT ITB No 25 -0019 -PR Edgewater Drive Park Renovation L The signatory is an officer or duly authorized representative of the Vendor with full power and authority to submit binding offers and enter into contracts for the commodities or services as specified herein Confirmed 3 E -Verify System Certificattion* PER FLORIDA STATUTE 448 095, CONTRACTORS AND SUBCONTRACTORS MUST REGISTER WITH AND USE THE E -VERIFY SYSTEM TO VERIFY THE WORK AUTHORIZATION STATUS OF ALL NEWLY HIRED EMPLOYEES The affiant, by virtue of confirming below, certifies that A The Contractor and its Subcontractors are aware of the requirements of Florida Statute 448 095 B The Contractor and its Subcontractors are registered with and using the E -Verify system to verify the work authorization status of newly hired employees C The Contractor will not enter into a contract with any Subcontractor unless each party to the contract registers with and uses the E -Verify system D The Subcontractor will provide the Contractor with an affidavit stating that the Subcontractor does not employ, contract with, or subcontract with unauthorized alien E The Contractor must maintain a copy of such affidavit F The City may terminate this Contract on the good faith belief that the Contractor or its Subcontractors knowingly violated Florida Statutes 448 09(1) or 448 095(2)(c) G If this Contract is terminated pursuant to Florida Statute 448 095(2)(c), the Contractor may not be awarded a public contract for at least 1 year after the date on which this Contract was terminated H The Contractor is liable for any additional cost incurred by the City as a result of the termination of this Contract Confirmed [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT Invitation To Bid Edgewater Drive Park Renovation Page 4 [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT ITB No 25 -0019 -PR Edgewater Drive Park Renovation 4 Scrutinized Company Certification* Please download the below documents, complete, notarize, and upload • SCRUTINIZED COMPANIES AND B Scrutinized_Company_Certs pdf 5 Compliance with Anti -Human Trafficking Laws* Please download the below documents, complete, and upload • Compliance with 787 06 form Com pliance_with Anti -Human Trafficking_Laws pdf 6 Section V - Contract Documents* Please download the below documents, complete, and upload • Section V - Contract Docume Section V Contract_Documents pdf 7 W-9* Upload your current W-9 form (available at https //www irs gov/pub/irs-pdf/fw9 pdf) MTM W9_7-22-26 pdf PRICE TABLES EDGEWATER DRIVE PARK RENOVATIONS [MTM CONTRACTORS INC] RESPONSE DOCUMENT REPORT Invitation To Bid - Edgewater Drive Park Renovation Page 5 PINELLAS COUNTY SMALL BUSINESS ENTERPRISE PROGRAM THIS CERTIFICATE IS AWARDED TO MTM Contractors Inc HAS SUCCESSFULLY COMPLETED THE SBE Certification Requirements for Construction Excavation, Sidewalk, Highway and Roadside services Certification Expires 6/29/2028 Apptoved. 6/30/20 MO f,,,J lb< (<, STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION SMALL BUSINESS AFFIDAVIT 1 George Toccalino of MTM Contractors Inc declare 275-000-01 EQUAL OPPORTUNITY OGC — 07/25 Page 2 of 2 am an mei or duly authorized representative (Proposer/name of business) and I do hereby This business pij Meets the definition for a small business pursuant to Section 337 027, F S • Gross revenues, three year average (include affiliate businesses) $ 5,750,550 00 Pursuant to Section 337 027 F S , a small business means a business with yearly average gross receipts of less than $25 million for mad and bridge contracts and less than $10 million for professional and nonpmfessional services contracts A business' average gross receipts Is determined by averaging its annual gross receipts over the last three years including the receipts of any affiliates as defined in Section 337165 F S The undersigned hereby authorize(s) and request(s) any person, firm or corporation to furnish any pertinent information requested by the State of Flonda Department of Transportation deemed necessary to venfy the statements made in this affidavit or regarding the ability standing and general reputation of the Proposer I declare under penalty of perjury that the information provided above and any supporting documents are true and accurate to the best of my knowledge By submittal of the Affidavit certification you are affirming that your firm meets the definition for a small business pursuant to s 337 027, F S It is the responsibility of the owner/authorized representative to inform the Department within 30 days of any change that would affect your small business eligiblity including average gross revenues over the pnor three years exceeding the small business size threshold Changes that would affect eligibility should be communicated to snialibJsinesa(udot state ft us This certification is good for one year or until your firm exceeds the small business threshold whichever is earlier To ensure regulatory compliance and accountability for the Business Development Initiative program firms agree to furnish any pertinent information to verify the statements in this Small Business Affidavit Certification, upon request by the Department If financial documents are not timely provided within 10 business days or financial documents do not confirm small business eligibility the Department reserves the right to revoke this small business certification 03/13/2026 Owne Authonzed Representative Signature Date George Toccalrno/President of MTM Contactors Inc Owner/Authonzed Representative Pnnted Name & Title Notary STATE OF Florida COUNTY OF Pinellas National Notary Assn a - Comm My Comm Bondedthroug ' Nei, JEFFREY T STEWN50N Notary Public State of Florid Commission # HH 378237 a Expires Mar 23 2027 h Before me the above signed authority, personally appeared George Toccalino who is personally known to me or has produced (type of identification) identification and is duly sworn, deposes and says that he/slie•is authorized to represent MTM Contractors Inc (business) Sworn and subscribed to before me this 13th day of March 2026 My Commission/Expires Hillsborough County r -id,: Board of County Commissioners Economic Development Department Small Business Enterprises Division Small Business Enter rises Registration MTM Contractors Inc HC -1946/26 Valid from May 19, 2026 - May 19, 2029 Approved Lines of Business: Contractor - General & Undergiound Utility Excavation Contractor, Site Construction, Concrete Flatwoik, Sidewalks Theresa Kempa, Manager, MCA Small Business Enterpnse Division r s .pelersburg The City of St. Petersburg Small Business Enterprise Certification This certificate is awarded to MTM Contractors Inc SBE Certification Number 217 This certificate is applicable in NIGP 91200 CONSTRUCTION SERVICES, GENERAL, INCLUDING MAINTENANCE AND REPAIR SERVICES) NIGP 91327 Construction, Highway and Road NIGP 91339 Construction, Pipe Culvert NIGP 91345. Construction, Sewer and Storm Drain NIGP 91347- Construction, Sidewalk and Driveway, Including Pedestrian and Handicap Ramps NIGP 91350 Construction, Streets, Major and Residential, Including Reconstruction NIGP 91356' Construction, Utility and Underground Projects NIGP 91362 Construction, Concrete, Pour -In -Place, Form, Place, Finish NIGP 92544 General Construction Management, Scheduling, Cost Estimation Engineenng NIGP 96842 General Construction, The City of St Petersburg Certified February 12, 2024 Expires February 12, 2027 Kourey Hendryx-Bell, J D Manager, Office of Supplier Diversity (727) 893-7226 Kourey Hendryx-Bell@stpete org In aCcord..nce utth the City of St Petersbu-g s S3naII 11115inesS I:nterprts� Ordrnance #789 G youf httSihLss is cat] lied as n Small Business Enterprise h% the City of St pets htirg 'You a ill need to Show proof of %our nett/ Occupational each year as well is renev, your t.cr;tl c:tlton with thrs agcn' evens three)ears [fat anytime the cmmnuSt wn of the S flC staves 01.5. Out firm changes, you naekl c rnp[ete another SBE affidal.it The C ,tt cif St Petersbure()ko nj at mervre the rtt:Iit to terrnro.ue or 42ncei th,a ern:I i anon it anytime cereal 11 >: fau,td That the cumr. ttrvn of the Organtzattuit has changed and rn IunUrr meets the defirttlton establKhed farS13C certification I stir r JEFFREY T STEVENSON (4. • Notary Public State of Florida I Commission N HH 378237 or A. My Comm Expires Mar 23 2027 M Bonded through National Notary Assn I 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 FORMAS REQUIRED, MAY DEEM YOUR SUBMITTAL NONRESPONSIVE The affiant, by virtue of the signature below, certifies that l The vendor, company, individual, principal, subsidiary, affiliate, or owner is aware of the requirements of section 287 135, Flonda Statutes, regarding companies on the Scrutirnzed Companies with Activities in Sudan List, the Scrutinized Companies with Activities m 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, acquinng, 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 ctor List, or engages in business operations in Cuba and Syria Autt%nzed Signature George Toccalino Printed Name President Title MTM Contractors Inc Name of Entity/Corporation STATE OF FLORIDA COUNTY OF Pinellas The foregoing instrument was acknowledged before me on this 29th day of July 20 26 , by George Toccalino (name of person whose signature is being notarized) as the President (title) of MTM Contractors Inc (name of corporation/entity), personally known to me as described herein George Toccalino , or produced a (type of identification) as ide.' .n, and th&T it take an oath My Commission Expires NOTARY SEAL ABOVE SECTION V N9t:ry�i Jeffrey T Stevenson Printed Name Page 15 of 16 Updated 7/9/2025 JEFFREY T STEVENSON Notary Public State of Florida o` Commission # HH 378237 oeNr My Comm Expires Mar 23 2027 Bonded through National Notary Assn SECTION V - Contract Documents SCRUTINIZED COMPANIES THAT BOYCOTT ISRAEL LIST CERTIFICATION FORM PER SECTION IH, ITEM25, 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 that Boycott Israel List, or engaged in a boycott of Israel, and 2 The vendor, company, individual, principal, subsidiary, affiliate, or owner is eligible to participate in this solicitation and is not listed on the Scrutinized Companies that Boycott Israel List, or engaged in a boycott of Israel, and 3 "Boycott Israel" or "boycott of Israel" means refusing to deal, terminating business activities, or taking other actions to limit commercial relations with Israel, or persons or entities doing business in Israel or in Israeli -controlled territories, in a discriminatory manner A statement by a company that it is participating in a boycott of Israel, or that it has initiated a boycott in response to a request for a boycott of Israel or in compliance with, or in furtherance of, calls for a boycott of Israel, may be considered as evidence that a company is participating in a boycott of Israel, 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 wilting, no later than five (5) calendar days after any of its principals are placed on the Scrutinized Companies that Boycott Israel List, or engaged in a boycott of Israel STATE OF Florida COUNTY OF Pinellas Authorized Signature Goerge Toccalino Printed Name President Title MTM Contractors Inc Name of Entity/Corporation The foregoing instrument was acknowledged before me on this 29thday of July 20 26 , by George Toccalino (name of person whose signature is as the President (title) of MTM Contractors Inc corporation/entity), p ,a1y_kao rnIa.m sicsi„nt i rran George Toccalino (type of identification) as ide tion, and 6116 Jeffrey T Stevenson being notanzed) (name of , or produced a ake an oath My Commission Expires NOTARY SEAL ABOVE SECTION V Printed Name Page 16 of 16 Updated 7/9/2025 Compliance with Anti -Human Trafficking Laws Pursuant to Section 787 06 (13), Honda Statutes, this form must be completed by an officer or representative of a non-governmental entity when a contract is executed, renewed, or extended between the non-govemmental entity and the City of Clearwater The undersigned, on behalf of the entity listed below ("Entity"), hereby attests under penalty of perjury that Entity does not use coercion for labor or services as defined in Section 787 06, Florida Statutes The undersigned is authorized to execute this form on behal Date July 29 , 2026 Signed Entity MTM Contractors Inc Name Anthony Toccalino Title Vice -President ZURICH A'v1FRi( AN iNSIiRAN(F (O\11'ANY ( 01 ONiAI V* RI( A\ C AS11Ai 1Y AND SHIM ( 0MPAN1 III)Ff [11 AND DFPOSiI COMPANY 01 i1I1R11AND PON\FR01 11IORN11 kNO\V Al I MI N Hl 1 111 Si PRI SI N1S that the /URIC!! AMI RICAN iNSURANCL COMPANY, a Nov York the C01 ONiA[ AMI RICAN GASUAi I Y AND SURU 1 Y COMPANY t (orpoi niton of the State. of l AND 1)1 POSI1 COMPANY 01 MA RVI ANi) a crnporatton of the Statt. of Illinois (helm eolle_tttel) called the 'C Murray Vice Piesid&nt in pursu1nce of authotuv granted by Altaic V S*chon ft of the liy-1 iv s of said Cnntpan the re.serse aide la -lint Ind are beach% eutilied to be in lull toric mil elicit on the d lie hcrwl du hueb) nominate appoint lnthuny 1 P 1P 1, IR , ( hristinc 1 P 1P 1 and F nttly 1' % PA, of l akutood R inch, 1 for id t 1 ACI 1, o atonic% in -I act, to in Ike. e.\e*ute sial and deli%*r tor toil on its behalf as uuU% and as its act and deed tnv an undettakings and the _‘__kinin of such bonds at undeitaktngs In pursuance of these presents shall be is binding l lull) Ind unph to 111 intuits ind purposes Is tl the.) hid bLin dui) e.\*uned ind ukno\\Iedge.d b% the. tigul irly e.1 /URIC II AMi Ri( \N INSURANCi COMPANY at its of lice in Nov Nen Yolk the regularly elected of lice AMi,R[CAN CASIIAL1Y AND SURi Il COMPANY' at its olfiee in Owings Mills Man land and the tegul irly LI 1 11)1 111t AND Di POST I ( OM PAN) 01 M 1RY1 AND at its Whit. in Owtnbs Mills Mut) 1 ind in then own p I he said Viet. President does liereb% cutlf) that the, exti lel set forth on the louse side hucof is a hue copy of [i) i aws of said C ornp mires ind is now in for u. iN W1 I Ni SS 1\ 111 RI 01 the s mid Viet -President has he.reunto subsea ibed hisrh t n totes and af115id the ARK 11 111F RI( AN INSI R 1N( l ( OMi'A\1, ( 01 ONIAI Mitt RI( \N ( ASI AI 11 AND SUR' IV ( A\I) Ill P05I1 ( OMP 1N1 OF YI ARl 1 1\1) this 7th day ell luIv A 1) 2(122 of SEAL , , , 11 1+7,, 001.731,01 i l'a%" QQ C '�9rtG c%y 1 SEAL.m 4 a 11.14 By Robiri 1) Mir, ay I- /cc Piesident By L)alin1 8,0111? Sccrerary St tit, oI M utiland ( aunty of [I tlhmot c /U1ICl1 AAiF Ri( AN 1 (010\IAI NW, 121( 1\(ASIiAI (Vitt 1 111E 1111 AND UFI'OSI r (nil otporation of the State of boots and the. 111)1 i 111 ontpante.s ) b) Rahn t 1) v%hick ari set forth on Cans( mite and eau_ uiil i,n%ful a�un toil all bonds Ind pan said Companies as out oflleers of the. s of thl. C01 ONiAI *ted of fliers of the. °pct pea sons inch_ V Section 1) of the orporate Sells of the said 111'AN1' and 1 IDl 1111 Al1ISr SURANC F ( 0\ll'AN1 1) SURF rY ( 0\(PA\1 i'1N1 0111ARY1 %ND On this 71 h d r, of luly \ i) 2022 be.tori thi subunhu r Not Iry Public of the Stair. 01 Alar) land duly conunlssi mid and qu inurid Raba 1 I) llurrav Vice President and 1) ruin 1 (3rottrt Sect etan of the Compantea to nu lassonail' known to he. the mdniduals i id ollieus disci -Mid in and oho executed the prccedmt, 1nstrununt old ackno\tIm d ,id the 7\cuiuun of Stine ind bemb by nit. duly scorn deposuh ands nh that he/she is the s lid otlto.r of the. Cumpan) aforesaid and that rhe seals aftired w the, precidtn . instrument are the Cotpot'ttc Seals of said ( 11111)101_% and that the said Corpor at. Seals and the stf.naltue as such mints acre duly iftiNid ind subsinbed to the slid instruntint by the tuthortt) and du*Uutn 01 the Sud Cot nor pions IN II SI iMON'r wi II It l Ot I have helium() sea 1M h Ind ind mixed m) 011171 11 Si 11 1117 d iy ind yi tr lir t Muni un min (n Const ince A Dunn Notary Pt bile Ms Commission I \pies July ) 2023 EXTRACT FROM BY LAWS OF THE COMPANIES 'Article V Section 8 Attain s in 1 au the Chief I xecutive 011ieu the PI4stdent or any I XLLUII\t. Viet. Prusl Lnt or Vicc Pteslduu may b) WAIL n instrument under tilt. attLs1Ld eotpOl tie SL11 appoint alto,ne)s In tact ssnh maim tty to cmc uti bonds policies recognlvanLLs stipulations, undertakings, 01 other like instruments on belt dl of the Comp 10) and in 1) uuthort/L tit y ofIILU 01 til) such atonic) in fact to afire the cotporlte se tl thLtcto and m iv with (u without cause nnodtfv of revoke ans sump tppointmunt 01 autholit) at tiny time CERTIFICATE 1 the undu signed V1ce Ples: den t of the /URIC II AMI RIC AN INSURAN(1 COMPANY the C01 CASUAI 1 Y AND SUM I Y COMPANY and the 1 AUL 1 11 l ANI) U1 P0511 ( OMPANY 01 MARY1 ANI) the foregoing Pow 01 Attonu\ 15 still 10 full lot cc. and efIcct 00 the slate 01 this eettihL tie Ind f do further certify till of the 13y I ails of the Companies is still in Lou. this Powu of Attorney and Certthelte m ly he signed hs laesuude undo and b) ulthout) of the lollownl6 !CSC I)ItLLlals of tilt. /URIC' I Aril RICAN INSURANC I COMPANY at a meeting duly e illed and held 00 the 15th d w of ONIAI AMI RICAN lo hereby evilly that Article V Section 8 lotion of the [3o u d of 1)u Liber 1998 RI SOI VI 1) 1 hat the signature of the Iiesldent 01 a Viet. Picsident ind the 'testing signature of a SLeLL II) 01 an Assistant Secretary ind the Seal of the Comp un) nn 1) be al11(Ld h) facsimile on any Power 01 Attorney An) such Pow et 01 any eertilILate thereof heat ing such I icsimile signatulL Ind seal shall be salid and htnitnt on the( ompany ' Ibis Posner of Attonus and CLrtlfIL ne in l), be signed b} InesmulL under Ind 11) mthorn} of the following ILS( UnLLlols of the COI ONIAI AMI RICAN CASUAL 1Y AND SUR! 1Y ( OMP ANY at 1 meeting dulv called ind M 1) 1994 and the following resolution of the I3uald of Directors of the 1 IDI 111Y AND DI POSIT ( OMPANY meeting dui) L died ind held on the 10t11 d i} of M iv 1990 Mum 01 the Bo u d of old on the 5th d of )1 MARY!. ANI) at RI SOI VI I) I" I hat the Iasi mile or meth tnnLalls it -produced seal of the comp10)r tnd facsimile or meth leall) ri produced signature of all) VOA. I'1LsidLnt LlLULint or \'sl,tlnt Secretuy of the (.onipans whether lil'lde herctotoie or ht.rcaltu whereser Ippca11115 Upon u Looped Lop\ of my power 01 anoint.), issued b) the C onlpInv shall her tlld and binding upon the ( ompanv ss 'h the same toffee and el feet is though mann 111v at!l Ll IN I 1 511MONY W111_1(1 01 1 1111 e hereunto subsu toed my n tie and a111\Ld the corpoi lie se tis of fill, S ud Lui titin 29tb d ty 01 July _, 2026 ,� L,15LLd11y 1/ ' .d7'r aP O� "1 SEAL ''hill I .111 ‘ 1111111L5, x`149 (r.-GtiCL iffy Mary Jean Pethick Vice President 10 REPOR I A CLAIM WITH REGARD ro A SURF TY BOND, PLEASE SUBMIT A COMPLF1EDFSCR1P1ION OF 1 HL CLAIM INCLUDING THF PRINCIPAL ON 7111E BOND, 1 H[ BOND NUMBER, AND YOUR CON FACT IN FORMAT ION TO Auld.' Surety Claims 1299 Zut ich \Vay Schaumbuib, IL 60196-1056 '111\ Jvim Wel i 111SY11 /UIIelinatLem 800-626-4577 SECTION V—Contract Documents PROPOSAL (1) TO THE CITY OF CLEARWATER, FLORIDA, for 25 -0019 -PR Edgewater Drive Park Renovation and doing such other work incidental thereto, all in accordance with the contract documents, marked 25 -0019 -PR Edgewater Drive Park Renovation !, 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 authonzed to do so o behalf of the City of Clearwater, Florida, that no such award or signing shall be considered a binding con ract without a certificate from the Finance Director that funds are available to cover the cost of the work o be done, or without the approval of the City Attorney as to the form and legality of the contract and aft the pertinent documents relating thereto having been approved by said City Attorney, and such bidder is hbreby charged with this notice The signer of the Proposal, as bidder, also declares that the only person, peisons, comp ny or parties interested in this Proposal, are named in this Proposal, that he has carefully examined the dvertisement, instructions to Bidders, Contract Specifications, Plans, Supplemental Specifications, Gener 1 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 If the foregoing Proposal shall be accepted by the City of Clearwater, Florida, and the un ersigned shall fail to execute a satisfactory contract as stated in the Advertisement herein attached, then th City may at its option determine that the undersigned has abandoned the contract, and thereupon this Pr posal 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 retain4d by the City, or if the Proposal Bond be given, the full amount of such bond shall be paid to the City a 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 SECTION V Page 11 of 16 UF5dated 7/9/2025 A. General _ _ w 1 Bond 2 Survey, Construction Layout 3 Survey, As -Built Requirements 4-Mobdrzaattort 5 Maintenance of Traffic 6 Sediment Trap at Curb Inlet 7 Sediment Barrer 8 Staked Filter Fabric Silt Fence 9 Erosion Control Diversion Berm 10 Tree Bancade _ 9 B Demolition _ 11 Clearing and Grubbing 12 Tree, to be removed (13 24") 13 Tree to be removed (Greater than 36') 14 Tree, to be removed (stump dead, etc) 15 Tree to be removed (Palm) 16 Landscape Material, to be removed 17 Concrete to be removed 18 Curb to be removed 19 Asphalt, to be removed 20 Park Furniture bence to relocated 21 Park Furniture trash receptacle to be relocated 22 Park Furniture dog waste station to be relocated 23 Water Fountain to be removed 24 Sign single post to be relocated C Proposed Construction_ 25 Grading 26 Root Prune 27 Roadway Base, Crushed Concrete min LBR 100 8 compacted min thickness 28 Superpave Asphalt Concrete Type SP 9 5 Fine Traffic Level C 2' Min Thickness Pavement, Cement Concrete for Sidewalk 6 Min thickness, 3,300 PSI w/ fiber mesh (sidewalk being placed within 29 10' of existing tree canopy shall be reinforced appropriately for tree preservation) 30 Pavement, Cement concrete for pads, 6 min thickness 3,000 PSI w/ fiber mesh 31 Pavement cement concrete for driveway apron, 6 min thickness 3 000 P51 w/ fiber mesh and WWF 32 Curb Concrete, Straight per City Index #101 33 Curb, Concrete Drop per FDOT Index #520-001 34 Wheel Stop concrete 6 ft length 1 LS $ 9,500-00 $ 9,500 00 1 LS $ 19,500 00 $ 19 500 00 1 IS $ 5 805 00 $ 5 805 00 1 15 $ _ _ 52,500.00 _ $ 52,501) 00 1 15 $ 18,995 00 $ 18 995 00 1 EA $ 1,125 00 $ 1,125 00 $ 45000 $ 450 00 $ _195 $ 15 697 50 $ 2,850 00 $ 2 850 00 $� 125 00 $ 5 500 00 1 EA 8050 LF 1 EA 44 EA 1 LS 2 EA 2EA 2 EA 12 EA 1 LS 1900 SY 150 LF 445 SY 11 EA 8 EA 2 EA 1 EA 14 EA $ 18 97500 $ 18 975-00 $ 1,220 00 $ 2 440 00 $ 1,850 00 $ 3 700 00 $ 750 00� $ 1 500 00 $ 650 00 $ 7,800 00 $6 500 00 $ 6,500 00 $ _ 13 50 $ 25,650 00 $_1500 $ 2 250 00 $ _ 13 50 $ 6 007 50 $ 795 00 $ 8 745 00 $ 698 00 $ 5 584 00 $ 775 00 $ 1 550 00 $ 50000 $ 500 00 $ 375 00 $ 5,250 00 1 IS $ 12,500 00 $ 12,500 00 430 LF $ 45 00 $ 19,350 00 mm 190 CY $ 55 00 $ 10 450 00 850 SY $ 32 75 $ 27,837 50 26300 SF $1125 $ 295 875 00 450 SF $ _ 1125 $ 5 062 50 280 SF $ _ 1195 $ 3 346 00 320 LF $ 52 00 $ 16 640 00 50 LF $ 52 00 $ 2,600 00 14 EA $ _125_00 $ 1,750 00 35 Wheel Stop concrete 6 -ft length blue ADA 36 Dectable Warning Surface 37 Painted Pavement Marking, STD white solid 6 38 Painted Pavement Marking, STD, white, solid 24" 39 Painted Pavement Marking, STD blue solid, 6 40 Painted Pavement Marking, STD blue solid "Handicap Symbol" (2 7 sf) 41 Sign Single Post 42- Sign- Project Identificatton---•-• 43 Park Furniture, Bench Install 44 Park Furniture, Trash Receptacle Install 45 Park Furniture Dog Waste station install 46 Fence, material & height tbd 47 Water Fountain with pet station (supplied by city install by contractor) 48 Utility Adjustment 49 Landscaping 50 Irrigation 2 EA 1 EA 313 LF 14 LF 72 LF 2 EA 15 EA 1 -EA-- - 10 EA 5 EA 1 EA 100 LF 1 EA 6 EA 1 L5 1 LS $ $ 12500 $ $ 1 295 00 $ $ 1,250 00 $ $ �19 995 00 $ $ 12 000 00 $ 150 00 $ 300 00 450 00 $ 450 00 300 $ 939 00 20 00 $ 280 00 300 $ 21600 350-00 $ 700 00 495 00 $ 7,425 00 1,525 00--$ --- 1525 00- 295 00 $ 2 950 00 250 00 $ 1 250 00 445 00 $ 445 00 12,500 00 1 295 00 7 500 00 19 995 00 12 000 00 Total $693 555 00 1 10% Contingency of above Table 1 LS $ 69 355 50 Grand Total $762 910 50 Ron DeSantis Governor Melanie 5 Griffin Secretary STATE OF FLORIDA DEPARTMENT OF -BUSINESS AND -PROFESSIONAL -REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES TOCCALINO, GEORGE JOHN MTM CONTRACTORS INC 6550 53RD STREET NORTH PINELLAS PARK FL 33781-5630 LICENSE NUMBER CGC1507943 EXPIRATION DATE AUGUST 31, 2028 Always verify licenses online at MyFloridaLicense corn ISSUED 06/03/2026 Do not alter this document in any form This is your license It is unlawful for anyone other than the licensee to use this document Ron DeSantis Governor STATE OF FLORIDA DEPARTMEN-T_OEBUS1NESS._AND P_ROFESSIONAL_REGULATION Melanie S Griffin Secretary CONSTRUCTION INDUSTRY LICENSING BOARD THE UNDERGROUND UTILITY & EXCAVATION CO HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES TOCCALINO, GEORGE MTM CONTRACTORS INC 6550_53RD STREET NORTH PINELLAS PARK FL 33781 LICENSE NUMBER._C00057088 EXPIRATION DATE- AUGUST 31, 2028 Always verify licenses online at MyFloridaLicense corn ISSUED 06/03/2026 Do not alter this document in any form This is your license It is unlawful for anyone other than the licensee to use this document Rlaiu 1ngogh ( 1111 F FINANCIAI 01 FI(.F R Jo not. Rice I)11 [SION 1)1RF (..I OR ( nlhtrint Clirtshtr BLRF \lJ CHIEF Ronald ()Jim Orth SAF El 1 PROGRAM MANAGER I'I,CIRID�1 DFPARr\tt' N I Ok 1.INAN( I \I. SF MI( FS DIVISION 01 S I ATE FIRE NIARSII kL 2001 1`d 611\1 +, � I kt l 1 1 +ll +h+,sw, I lor+cl i VI') 012 Id ',NO 111 11 I (LR riff ICAI L Of COMM I LNCY OFFICIAL COPY 1 ITIS ( [:RI iris S I IIi\I ( oIgt 1 IoLci11no 65')() )111 St N PINI 1. LAS PARK 1 L 11781-5630 BUSINI SS OR(,ANI%AI ION 1111 M Contta(.tol, In(, ( Ju„ n,t0, \ alt - 111`. a 1.o11+1410,0' +'h0,. 1:., 1, ! ai,c.(I 10 tt,t LALta.a.tott of LODUd..i, IC( hur1i g ,I,. ,i, Itty u, I shut ltt Inst 11I ul.ptt.t, Iltct Itpatl and ,tiv Itt tht undt.rglllund piping tot 1 in, hrottult11 .y.tcm uti111 ! watLr a, th_ cvtIng1I1 htng <tgtnt btgtnning It the point 01 .t...rvtLL as dtlult.(1 m thy, ant tnti ending no mots, than 1 loot abovL the finished tlooi I,.ut, I) 1t(. 0710112026 rypt (i() Ia.. I-1 Count} PIIlLlIa4 1 Ittn,t'I>LI mit i lS 19 i-0(10 I -199(9 1 v p11iuon Daft 06'10/2028 A Rd* CERTIFICATE OF LIABILITY INSURANCE j DATE A 7/22/2026 THIS CERTIFICATE I3 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(les) must have ADDITIONAL INSURED If SUBROGATION 1S WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement thls certificate does not confer rights to the certificate holder In lieu of such endorsement(s) provisions or be endorsed A statement on PRODUCER Bowen Miclette & Britt of Florida LLC 850 Concourse Parkway S Suite #105 Maitland FL 32751 CONTACT NAME Rebecca Swain l tcNot, UNITS arra- - a"rc°.a_Ext), 407-6471616 407-628 1635 IL AOf{E3s, rswain@bmbinc com INSURER(S) AFFORDING COVERAGE NAIC 1 INSURERA Amensure Insurance Company ° r 19488 23396 _ INSURED � MTMCONTRAC MTM Contractors Inc 6550 53rd St N Pinellas Park FL 33781-5630 INSURER B Amensure Mutual Insurance Compar INSURER C INSURER D X INSURER E INSURER F E CERTIFICATE NUMB 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 18 SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE "At916C't;OaR' INSD W1/0 POUCY NUMBER PdUCY eta (MM/DD/YYYYL(MMIDp/TYYYI POLIO-Y.1XF` UNITS A X COMMERCIAL GENERAL LIABILITY Y Y CPP21295100001 4/30/2026 4/30/2027 EACH OCCURRENCE 31000000 $ 1 000 000 CLAIMS MADE X OCCUR DAMAGE TO RENTED FAMES (Ea /nonce/, MED EXP (Any ondperaon) $ 10 000 PERSONAL & AOVIINJURY 5 1 000 000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2 000 000 POLICY X JE a 171 LOC PRODUCTS COMP/0P AGO S 2,000 000 OTHER $ 13 AUTOMOBILELIABIUTY Y Y CA40016370002 4/30/2026 4/30/2027 LOM dED1SNGLI UMIT $1 000 000 X ANY AUTO BODILY INJURY (Per person) $ OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY(Peracddent ) $ X HIRED AUTOS ONLY x _ NON -OWNED AUTOS ONLY PROPERTY DAMA-GE , /Per aacdentl $ $ 8 X UMBRELLA LIAR X OCCUR Y Y CW21295110002 4/30/2026 4/30/2027 EACH OCCURRENCE 31 000 000 EXCESS UAB CLAIMS MADE I AGGREGATE $1 000 000 DED RETENT ON $ n # $ A WORKERS COMPENSATIONYIN AND LIABILITY Y WC40O16380001 5/1/2026 5/1/2027 X STA UT ETH EMPLOYERS ANYPROPRIETOR/PARTNER/EXECUTNE(j I NIA E L EACH ACCIDENT 31 000 000 OFrICER/MEMBEREXCLUDED? I i (Mandatory In NH) E L DISEASE EA EMPLOYEE $1 000 000 It yes describe under DESCRIPTION OF OPERATIONS belay 0 L DISEASE POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101 Addldonel Remarks Schedule maybe attached It mars space la required) The following policy provisions and/or endorsements form part of the policies of insurance represented by this certificate of Insurance the policies and/or endorsements supersede the representations made herein Electronic copies of the policy provisions and/or endorsements available by emailing Contact Person as shown above When required by written contract those parties listed In said contract including the Certificate Holder are added as an Additional General Liability Auto Liability and Umbrella Liability as afforded by the policy and/or endorsements When required by written contract a Waiver of Subrogation with respect to the General Liability Auto Liability Worker's Compensation See Attached The terms contained in listed below are Insureds with respect to the and Umbrella is granted CERTIFICATE HOLDER CANCELLATION t Cr of of Clearwater 1Vii S Myrtle AVE Clearwater FL 33756 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATI,VE _ I ACORD 25 (2016/03) m 1988-2015 ACORD CORPORATION Ali rights reserved The ACORD name and logo are registered marks of ACORD 11 ACO DR AGENCY CUSTOMER ID MTMCONTRAC LOC # ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Bowen Mic ette & Bntt of Flonda LLC NAMED INSURED MTM Contractors Inc 6550 53rd St N Pinellas Park FL 33781 5630 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM ISA SCHEDULE TO ACORD FORM FORM NUMBER 25 FORM TITLE CERTIFICATE OF LIABILITY INSURANCE to those parties listed In said contract including the Certificate Holder The General Liability certified herein are primary (and non-contnbutory) to other insurance available but only to the extent required by written contract RE 25-0019 PR Edgewater Dnve Park Renovation ACORD 101 (2008/01) © 2008 ACORD CORPORATION All rights reserved The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY CONTRACTOR'S BLANKET FLEX ADDITIONAL INSURED ENDORSEMENT - FORM A This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Number CPP21295100001 Agency Number Policy Effective 04/30/2026 Date Policy Expiration Date 04/30/2027 Date 04/30/2026 Account Number Named Insured MTM Contractors Inc Agency Bowen, Miclette & Britt of Florida, Issuing Company Amensure Insurance Company A SECTION 11- WHO 1S AN INSURED is amended to add as an additional insured 1 Any person ororganization with whom you have agreed in a "written agreement that suci,1 person or organization be added as an additional insured on this policy, and any other person or organization you are required to add as an additional insured under such "written agreement 2 If "your work' began under a written letter of intent or written work order any person or organization who issued the written letter of intent or written work order but a such coverage will apply only for 30 calendar days following the date the written letter of intent or written work order was issued and I E I b the person or organization is an additional insured only for, and to the extent of liability arising out of bodily injury" 'property damage , or personal and advertising injury' caused, in whole or in part by your negligent acts or omissions, or the negligent acts or omissions of others working on your behalf in the performance of your work as specified in the written I?tter of intent or written work order This coverage does not apply to liability arising out of th1e independent acts or omissions of the additional insured i For the purposes of the coverage provided by this endorsement, a written agreement' means a written contract or written agreement that € 1 requires you to include a person or organization as an additional insured for a period of time during the policy period, and 2 is executed prior to the occurrence of "bodily injury , property damage", or "personal and advertising injury that forms the basis for a claim under this policy 1 The insurance provided by this endorsement does not apply to any person or organization that is specifically listed as an additional insured on another endorsement attached to this policy 1 CG 73 24 03 23 Includes copyrighted material of the Insurance Services Office Inc , with its permission Page 1 of 3 Policy Number CPP21295100001 Effective Date 04/30/2026 Expiration Date 04/30/2027 1 B The coverage provided to any person or organization added as an additional insured pursuant to Paragraph A 1 is limited as follows 1 If the "written agreement specifically and exclusively requires you to name the person or organization as an additional insured using the ISO CG 20 10 endorsement with edition dates of 11 85 or 10 01, or the ISO CG 20 37 10 01 endorsement, that person or organization is an additional insured, but only with respect to liability for bodily injury , 'property damage or "personal and advertising injury arising out of ' your work" for that insured by or for you 2 If the written agreement" requires you to name the person or organization as an additional insured using the ISO CG 20 10 and or CG 20 37 endorsements without specifically and exclusively requiring the 11 85 or 10 01 edition dates that person or organization is an additional insured b}it only with respect to liability for bodily injury , "property damage", or 'personal and advertising injury caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf 3 If the written agreement requires you to name the person or organization as an additional insured for operations arising out of your work and does not specify an ISO additional insured endorsement, that person or organization is an additional insured but only with respect to liability for "bodily injury", property damage' or personal and advertising injury' arising out of your acts or omissions or the acts or omissions of others working on your behalf in the performance of your work as specified in the written agreement' This coverage does not apply to liability arising out of the sole negligence of the additional insured unless specifically required in the' written agreement" i 4 If none of the above paragraphs apply then the person or organization is an additional insured only for, and to the extent of liability arising out of "bodily injury' , 'property damage", or ' personal and advertising injury" caused in whole or in part by your negligent acts or omissions or the negligent acts or omissions of others working on your behalf in the performance of your work as specified in the written agreement This coverage does not apply to liability arising out of the independent acts or omissions of the additional insured i i However the insurance afforded to such additional insured only applies to the extent permitted by law C The insurance provided to an additional insured under this endorsement does not apply to 1 Bodily injury" or' property damage' included in the 'products -completed operations hazard" unless the "written agreement" specifically requires such coverage (including by specifically requiring the CG 20 10 11 85) To the extent the written agreement requires such coverage for 1p specified amount of time the coverage provided by this endorsement is limited to the amount of time required for such coverage by the' written agreement" 2 Bodily injury property damage or personal and advertising injury arising out of an architect s engineer's, or surveyor's rendering of, or failure to render, any professional services including but not limited to a The preparing, approving, or failing to prepare or approve (1) Maps, (2) Drawings (3) Opinions, (4) Reports, (5) Surveys (6) Change orders CG 73 24 03 23 Includes copynghted material of the Insurance Services Office Inc with its permission Page 2 of 3 Policy Number CPP21295100001 Effective Date 04/30/2026 Expiration Date 04/30/2027 (7) Design specifications, and b Supervisory, inspection, or engineering services D The limits of insurance that apply to the additional insured are the least of those specified in the "written agreement" or declarations of this policy Coverage provided by this endorsement for any additional insured shall not increase the applicable Limits of Insurance shown In the Declarations The limits of insurance that apply to the additional nsured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations E With respect to the coverage provided by this endorsement, SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4 Other Insurance Is deleted and replaced with the following 4 Other Insurance a Coverage provided by this endorsement Is excess over any other valid and collectible insurance available to the additional insured whether (1) Primary, (2) Excess (3) Contingent, or (4) On any other basis In addition this insurance is excess over any self-insured retentions deductibles or captive retentions payable by the additional insured or payable by any person or organize ion whose coverage is available to the additional insured However, if the 'written agreement" requires primary and non-contributory coverage, this Insurance will be primary and non-contributory relative only to the other insurance available to the additional insured which covers that person or organization as a Named Insured and we will not; share with that other insurance For any other insurance available to the additional insured where that person or organization is not a Named Insured this policy will share coverage with that other insurance based on the terms specified in Paragraph b Method of Sharing below i b Method of Sharing If all the other insurance permits contribution by equal shares we will follow this method also Under this method, each insurer contributes equal amounts until it has paid its applicable limit orr Insurance or none of the loss remains whichever comes first I If any of the other insurance does not permit contribution by equal shares, we will contribute by limits Under this method each insurers share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers CG 73 24 03 23 Includes copyrighted material of the Insurance Services Office, Inc , with its permission Page 3 of 3 Contractor Pre -Qualification (CPQ) go- Vendor Number F591724558003 Application Status: COMPLETED Expiration Date 6(30/2026 Applzcattcan Summa Name MTM CONTRACTORS INC Fiscal Year End Dtte 12131/2024 NOTE The Capacity shown below will be reduced by your Work Underway to determine your Available Bidding Capacity Adjusted Current Ratio 0 86 Ability Score 93 Surety Multiplier 0 Ability Factor 12 Calculated Maximum Bid Capacity $ 15 000,000 00 Adjusted Net Worth S 1,452 354 00 Form W-9 (Rev November 2017) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification P. Go to www irs gov/FormW9 for instructions and the latest Information Give Form to the requester Do not send to the IRS 1 Name (as shown on your income tax return) Name is required on this line do not leave this line blank MTM CONTRACTORS INC 2 Business name/disregarded entity name, If different from above 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1 Check only one o1 the following seven boxes. ❑ Individual/sole proprietor or 0 C Corporation 0 S Corporation 0 Partnership 0 Trust/estate single member LLC ❑ Limited liability company Enter the tax classification (C=C corporation S=S corporation P=Partnership) ► Note Check the appropriate box in the line above for the tax classification of the single -member owner Do not check LLC if the LLC is classified as a single member LLC that is disregarded from the owner unless the owner of the LLC Is another LLC that Is not disregarded from the owner for U S federal tax purposes Otherwise a single -member LLC that is disregarded from the owner should check the appropriate box for the tax classification of Its owner ❑ Other (see instructions) ► 4 Exemptions (codes apply only to certain entities, not individuals see Instrucjions on page 3) Exempt payee code (11 any) Exemption from FATCA reporting code (i any) fappMes to accounts maintained *IN* No 1/ S.J 5 Address (number street and apt or suite no) See instructions 6550 53RD STREET NORTH 6 City state and ZIP code PINELLAS PARK, FL 33781 Requester s name and address (optional) 7 list account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box The TIN provided must match the name given on line 1 to avotd backup withholding For individuals this is generally your social security number (SSN) However for a resident alien sole proprietor or disregarded entity see the instructions for Part I later For other entities it is your employer identification number (EIN) If you do not have a number, see How to get a TiN, later Note If the account is in more than one name see the Instructions for line 1 Also see What Name and Number To Give the Requester for guidelines on whose number to enter Social security number or Employer Identification number 5 9 1 q 2 4 5 5 8 Part II Certification Under penalties of perjury I certify that 1 The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be Issued to me) and 2 I am not subject to backup withholding because (a) I am exempt from backup withholding or (b) I have riot been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3 I am a U S citizen or other U S person (defined below) and 4 The FATCA code(s) entered on this form (If any) indicating that I am exempt from FATCA reporting is correct Certification Instructions You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax retum For real estate transactions, item 2 does not apply For mortgage interest paid, acquisition or abandonment of secured property cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than Interest and dividends you a 9 not required to sin the cep ligation but you must provide your correct TIN See the Instructions for Part II later Sign Here Signature of U S. person ► ./1 r• General Instructions Section references are to the Internal Revenue Code unless otherwise noted Future developments For the latest information about developments related to Form W 9 and its Instructions such as legislation enacted after they were published go to www !rs gov/FormW9 Purpose of Form An individual or entity (Form W 9 requester) who Is required to file an Information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN) individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN) or employer identification number (EIN) to report on an information return) the amount paid to you, or other amount reportable on an Information r,eturn Examples of Information retums include but are not limited to, the following • Form 1099 -INT (interest earned or paid) Date ► 7/1. 3. I/2 • Form 1099 -DIV (dividends, Including thosefromstocks or mutual funds) • Form 1099-MISC (various types of income pnzes, awards or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1090 S (proceeds from real estate transactions) • Form 1099 K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098+ (student loan interest) 1098-T (tuition) • Form 1099 C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only If you are a U S person (including a resident alien) to provide your correct TiN if you do not retum Form W 9 to the requester with a TiN you might be subject to backup withholding See What is backup withholding later Cat No 10231X Form W-9 (Rev 11 2017) Form W-9 (Rev November2017) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification ► Go to www Its gov/FormW9 for Instructions and the latest Information Give Form to the requester Do not send to the IRS Pnnt or type See Specific Instructions on page 3 1 Name (as shown on your Income tax retum) Name Is required on thls line do not leave this Zine blank MTM CONTRACTORS INC 2 Business name/disregarded entity name if different from above 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1 Check only one of the following seven boxes • IndividuaVsole proprietor or II C Corporation I' S Corporation • Partnership I♦ Trust/estate single member LLC 4 Exemptions (codes apply only to certain entities, not individuals see instructions on page 3) Exempt payee code (if any) • Limited liability company Enter the tax classification (C=C corporation S=S corporation P=Partnership) P. Note Check the appropriate box In the line above for the tax classification of the single -member owner Do not check LLC If the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U 8 federal tax purposes Otherwise a single -member LLC that Exemption from FATCA reporting code (if any) • is disregarded from the owner should check the appropriate box for the tax classification of its owner Other (see instructions) ► (Applies to scow* mo ntak, d outside the V S1 5 Address (number street and apt or suite no) See instructions 6550 53RD STREET NORTH Requester s name and address (optional) 6 City state, and ZIP code PINELLAS PARK, FL 33781 7 Ust account number(s) here (optional) Part 1 Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box The TIN provided must match the name given on line 1 to avoid backup withholding For individuals, this Is generally your social security number (SSN) However for a resident alien sole proprietor or disregarded entity see the Instructions for Part I later For other entities it is your employer Identification number (EIN) If you do not have a number see How to get a Social security number — — TIN, later Note If the account is in more than one name see the Instructions for line 1 Also see What Name and Number To Give the Requester for guidelines on whose number to enter or Employer identification number 5 9 1 7 2 4 5 5 8 Part 1i Certification Under penalties of perjury I certify that 1 The number shown on this form Is my correct taxpayer Identification number (or I am waiting for a number to be Issued to me) and 2 I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends or (c) the IRS has notified me that I am no longer subject to backup withholding and 3 I am a U S citizen or other U S person (defined below), and 4 The FATCA code(s) entered on this form (if any) Indicating that I am exempt from FATCA reporting is correct Certification Instructions You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax retum For real estate transactions item 2 does not apply For mortgage Interest paid acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA) and generally payments other than interest and dividends you air not required to s gn the cerWfication but you must provide your correct TIN See the Instructions for Part II later Sign Here Signature of U S person ► /-2 General Instructions Section references are to the Internal Revenue Code unless otherwise noted Future developments For the latest information about developments related to Form W 9 and its Instructions such as legislation enacted after they were published, go to www irs gov/FormW9 Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information retum with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN) individual taxpayer identification number (ITIN) adoption taxpayer Identification number (ATIN) or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information etum Examples of information retums include but are not limited to, the following • Form 1099 -INT (Interest eamed or paid) Date O. 7/i. a/7 o • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • Form 1099 MISC (various types of Income prizes awards or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099 K (merchant card and third party network transactions) • Form 1098 (home mortgage interest) 1098-E (student loan interest) 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U S person (including a resident alien), to provide your correct TIN if you do not return Form W 9 to the requester with a TIN you might be subject to backup withholding See What is backup withholding later Cat No 10231X Form W-9 (Rev 11 2017)