1673 Henkels & McCoy� 1877-
TRArqsmITTAL MEMORANDUM
"TO: Bill Smith, Purchasing
FROM: Migdalia Hernandez
RE: Final Pay Request for Pipe Rehab — P15
The item(s) noted below is /are attached and forwarded to your office for the following action(s):
❑ Development Order '' er . natur�e,�, � a /
F-1 Final Plat (original mylars) e ii "7 �!
❑ Letter of Credit
® Maintenance Bond f Safe keeping (Vault)
❑ Ordinance r❑ City Manager signature
®
Performance Bond
❑
Resolution
®
Final Lien Releases
Once completed, please:
® Return original
® Return copy
Special Instructions:
Bill /Marisol
Attached the following documentations for signature and proper recording:
1. Original Final Lien Releases
2. Original Consent of Surety to Final Payment
3. Original Material and Workmanship Bond
Please advise if you have any questions regarding the above final pay request documentation.
Thank you!
„u
1.0
U.J
PROJECT NO. RFQ 11112 -02
SECTION 00645
CONTRACTOR'S RELEASE OF LIEN (FINAL AND COMPLETE)
Before me, the undersigned authority in said County and State, appeared Cindy D Adamson
who, being first duly sworn, deposes and says that he is
Vice President of Killebrew Inc.
, a company and /or corporation authorized to do business under the laws of the State of _
Florida , and is the CONTRACTOR on the Project known as 1 Water
Quality Improvement Proiects. RFQ 11/12 -02, located in Seminole County, State of Florida,
under an Agreement with the OWNER, 2) City of Sanford, Florida, the date of said Agreement
which is 12/20/13
Sanford P -15 PO# 033677
�1 Project Name: W�Y��IIWN�fhll[ ll��fllfllfAtldk�llllllt4. Nt# ll# IIFANdibYl�ptdllNtYhVQt4l1 (A�IDfplt�BIlllllllll
2) Owner: City of Sanford
Let it be known that the said deponent is duly authorized to make this affidavit by resolution of
the Board of Directors of said company and /or corporation; that deponent knows of his own
knowledge that said contract has been complied with in every particular by said contractor and
that all parts of the work have been approved by the Owner's Engineers; that there are no bills
remaining unpaid for labor, material, or otherwise, in connection with said contract and work,
and that there are no suits pending against the undersigned as contractor or anyone in
connection with the work done and materials furnished or otherwise under said contract.
Deponent further says that the final estimate which has been submitted to the Owner
simultaneously with the making of this affidavit constitutes all claims and demands against the
Owner on account of said contract or otherwise, and the acceptance of the sum specified in said
final estimate will operate as a full and final release and discharge of the Owner from any further
claims, demands or compensation by contractor under the above contract. Deponent further
agrees that all guarantees under this contract shall and be in full force from the date of this
release as spelled out in the Contract Documents.
IN WITNESS WHEREOF, I /we have executed this instrument under seal this 8th day of
July 2014
"4 -- _
Authorized kepresentative (Signature)
Cindy D Adamson
Printed Name and Title
STATE OF Florida
COUNTY OF Polk
(SEAL)
The foregoing instrument was acknowledged before me this 8th day of July
2014 by Cindy D Adamson of
Killebrew, Inc. (corporation), on behalf of the corporation, who is
personall wn to m or has produced (Type
o dentification) as identification and who did did not) gake an oath.
00645 -1
PROJECT NO. RFQ 11/12-02
Sworn to and sub 'bed to before me this. 8th day of MY 2014
Denise Henderson
(Print name) Notary Public in and for the County and State Aforementioned
My Commission Expires:
DENISE HENDERSON
END QFSECTION
EXPIRES December 25,2017
(407) 398-0153 tFloridaNNottalirys-e-rv�ic�e�.c�o,,m,
"II ok, , l G
WAIVER AND RELEASE OF LIEN
UPON FINAL PAYMENT
=The- under- signed- fiener, itreensideretien- of -t 1-payment- 94he-arneante _ .
Hereby waives and releases its lien and right to claim a lien for labor, services, or materials furnished on the
job for
Killebrew, Inc On the job for City of Sanford
for the following described property: SFFL1402 Area P -15
DATED: `° Tt 7 Lienor:
State of f (�_ Address:
County of: ran
By:
Print Name:
Date:
EA Tapping Services LLC
;'or- C.corn( -ce,
lv t l6
The foregoing instrument was acknowledged before me this %'f%4-4l day of -J6JA)6-
2p14
I8R)4'6l, by y3 C_ r. gAa,&rzAt,) who is personally known to me.
Signature of Notary:
Commission Expiration: NUVLM1ZX 1l-f, L12
Note: This is a statutory form prescribed by Section 713.20, Florida
Statutes (1996). Effective October 1, 9996, a person may not require
A fienor to furnish a waiver or release of lien that is different from the
Statutory form.
29
WAIVER AND RELEASE OF LIEN
UPON FINAL PAYMENT
T-he-undersignedAiene"r+eensideratienref the-finaPpaymefit-ir,4he erfleLint,of * 1,370.60
Hereby waives and releases its lien and right to claim a lien for labor, services, or materials furnished on the
job for
Kllebrew, Inc On the job for City of Sanford
for the following described property: SFFL1402 Area P-15
DATED: JAM— JCJ, 7-O)Lf Lienor; HDD of America, Inc.
State of: P6r, oba., Address: 159-75 W101AIle-tW1-h
County of.- &ej�,-s a—k-c� i
'Roe (M 55762.
By.
CAROLYN SUE SPITTLE
MY COMMISSION # EE 867750 Print Name:
EXPIRES: February 20, 2017
Banded ft Budget Notary services Date: 1Lqj1q
The foregoing instrument was acknowledged before me this day of JUW_
e�Jj
A451, by --Zs personally known to me.
Signature of Notary:
CAROLYN SUE SPITTLE
My COMMISSION # EE 867750
Commission Expiration: EXPIRES: February 20, 2017
F Ft 8V4W Th &u* NoWy Services
Note: This is a statutory form prescribed by Section 713.20, Florida
Statutes (1996). Effective October 1, 1996, a person may not require
A lienor to furnish a waiver or release of lien that is different from the
Statutory form.
iml 2 5 201/1-
WAIVER AND RELEASE OF LIEN
UPON FINAL PAYMENT
he- afldersigfled-liene ent -i a -arnea
Hereby waives and releases its lien and right to claim a lien for labor, services, or materials furnished on the
job for
Killebrew, Inc On the job for City of Sanford
for the following described property: SFFL1402 Area P -15
DATED: !'1 Iq Lienor:
State of ( 0 0, t CO-, Address:
County of: .Szo I I'LoLQ ,-
By:
Print Name:
Date:
A Phu¢ Sock Installation
321 c1canap,-
The foregoing instru nt-w acknowledged before me this �_ day of
10401, by who is personally known to me.
Signature of Notary:
Commission Expiration:
Note: This is a statutory form prescribed by Section 713.20, Florida
Statutes (1996). Effective October 1, 1996, a person may not require
A Lienor to furnish a waiver or release of lien that is different from the
Statutory form.
IGA CgSq:.
tssl °"
'
oo�M •.
_- her� ofo�9.:
O+: kEE214707 °
ded 00
STATE S
�ll5•�pj'� ,
2-10-1
WAIVER AND RELEASE OF LIEN
UPON FINAL PAYMENT
' Flae- aAdersig�ed-1 ieflo�in- eeASideraf38n :ef�he�trral= paymefl#�ir�ri#�e� =aria ...... .... .. ....... .
Hereby waives and releases its lien and right to claim a lien for labor, services, or materials furnished on the
job for { /�
Rebrevr, Inc On the job for ily of Sanford
for the following described property: SFFL1402 Area P -15
DATED:
State of
County of
Lienor:
Address:
Sy:
Print Name:
Date:
The foregoing instrument was acknowledged before me this day of 7,-
�I by 177 113 'S,,,,, , who is personally known to me.
Signature of Notary:
Commission Expiration:
Note: This is a statutory form prescribed by Section 713.20, Florida
Statutes (7996). Effective October 1, 1996, a person may not require
A lienor to furnish a waiver or release of lien that is different from the
Statutory form.
11�\\tk 11 #ih)JI /I l
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#FF 075296 J
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Q
BOND NO.: 54- 192177
Owner: City of Sanford
Project Name: Water Quality Improvement Project
PROJECT NO. RFQ 11/12 -02
SECTION 00617
CONSENT OF SURETY TO FINAL PAYMENT
WE, the United Fire & Casualty Company , having heretofore
executed Performance and Payment Bonds for P.O. No. 033677, Sanford P -15 Only
in the sum of One Hundred Ninety Four Thousand Two Hundred Forty Six and 20/100
Dollars ($ 194,246,20 ), hereby agree that the OWNER may make full payment of
the final estimate, including the retained percentage, to said CONTRACTOR. The Surety
concurs that full payment to the CONTRACTOR is appropriate and the Surety expressly
releases the OWNER from all liability to Surety resulting from full payment to CONTRACTOR. It
is fully understood that the granting of the right to the OWNER to make payment of the final
estimate to said contractor and /or his assigns, shall in no way relieve this surety company of its
obligations under its bond, as set forth in the specifications, contract and bond pertaining to the
above project.
IN WITNESS WHEREOF, the Killebrew, Inc. has
caused this instrument to be executed on its behalf by its Representative
and its duly authorized attorney in fact, and its corporate seal to be
hereunto affixed, all on this 27th day of�Au p,st 2014
/4
United Fire &Casualty Company
Surety Attorney -in -Fact Gloria A. Richards
& FL Licensed Resident Agent (407) 786 -7770
(Power of Attorney must be attached if executed by Attorney in Fact)
STATE OF Florida
COUNTY OF Orange
The foregoing instrument was acknowledged before me this 27th day of August
2014 by Gloria A. Richards o'f `.
United Fire & Casualty Company (corporation , on behalf of the corporation, who is
personally known to me or has produced /A (Type
of Identification) as identification and who did (did not) take an oath.
Sworn to and subscribed to before me this 27th day of August 2014
(Signature)
Patricia L. Slaughter
(Print name) Notary Public in and for the County and State Aforementioned
My Commission Expires: 3/31/17
END OF SECTION
00617 -11,xr Notary Public State of Florida
Patricia L Slaughter
+� My Commission EE 888174
Expires 03/31/2017
UNITED FIRE & CASUALTY COMPANY, CEDAR RAPIDS, IA Inquiries: Surety Department
UNITED FIRE &INDEMNITY COMPANY, GALVESTON TX 118 Second Ave SE
FINANCIAL PACIFIC INSURANCE COMPANY, ROCKLIN, CA Cedar Rapids, 1A 52401
CERTIFIED COPY OF ATTORNEY
(original on file at Home Office of Company — See Certification)
KNOW ALL PERSONS BY THESE PRESENTS, ThatUNITED FIRE;& CASUALTY COMPANY, a corporation duly organized and existing under
the laws of the State of Iowa; UNITED FIRE & INI7EMNJTY COMPANY, a corporation duly organized and existing under the laws of the State of
Texas; and FINANyyCIAL PACIFIC INSURANCE ! COMPANY, a corporati�on duly organized and existing under the laws of the State of Capplifornia
rnLESLIEcollective M bONAHUE tOR KIMaEeNIV ORa.iEFEREl!o REICH dOR SUSAN L REIpCHs� DReTf IQw -Le DURHAMon ORuPATRICIAint
L SLAUGHTER, OR GLORIA 'A RICHARD$; OR ORDON BRAMLAGE, OR LISA ROSELAND, OR`'CHERYL FOLEY, ALL
INDIVIDUALLY of MAITLAND FL
their true and lawful Attorney(s) -in -Fact with power and authority hereby conferred to sign, seal and execute in its behalf all lawful bonds, undertakings
and other obligatory instruments of similar nature provided that no single obligation shall exceed $35,000,000.00
and to bind the Companies thereby as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Companies
and all of the acts of said Attorney, pursuant to the authority limby given and hereby ratified and confirmed.
The Authority,hereby granted is continuous and shall remain in full force acid effect until revoked by UNITEi7 FIRE & CASUALTY COMPANY,
UNITED FIRE & INDEMNITY COMPANY, AND FINANCIAL PACIFIC INSURANCE COMPANY.
This Power of Attorney is made an& executed pursuant to and by authority of the following bylaw duly adopted on May 15, 2013, by the Boards of
Directors of UNITED FIRE & CASUALTY COMPANY, UNITED FIRE & INDEMNITY COMPANY, and FINANCIAL PACIFIC INSURANCE
COMPANY. "Article VI — Surety Bonds and Undertakings"
Section 2, Appointment of Attomey -in -Fact. "The President or any Vice President, or any other officer of the Companies array, from time to
time, appoint by written certificates attorneys -in -fact to act in behalf of the Companies in the execution of policies of insurance,, bonds,
undertakings and other obligatory instruments of like nature. The signature of any officer authorized hereby, and the Corporate seal, may be
affixed by facsimile to any power of attorney or special power of attorney or certification of either authorized hereby; such signature and seal,
When so used, being adopted by the Companies as the original signature of such officer and the original seal of the Companies, to be valid and
binding upon the Companies with the same force and effect as though manually affixed. Such attorneys -in -fact, subject to the limitations set
forth in their respective certificates of authority shall have full power to bind the Companies by their signature and execution of any,such
"instruments and to attach the seal of the Companies thereto. The President or any Vice President, the Board of Directors or any other officer of
the Companies may at any time revoke all power and authority previously given to any attorney -in -fact.
"'„s °j "I?., IN WITNESS WHEREOF, the COMPANIES have each caused these presents to be signed by its
`0 (GN .6IN.... vice resident and its corporate seal to be hereto affixed this 11 t h day of October 2013
COHPfIRATE.�y k Cps 4p,C,OPPOggr. , president Y >
_ coaPOxnrE b q •� G,C, -S UNITED FIRE & CASUALTY COMPANY
aULY 22• : O
aq -o: :g=
SEAL r r; ?; 19aB ;,�; UNITED FIRE & INDEMNITY COMPANY
FINANCIAL PACIFIC INSURANCE COMPANY
�ryR'Ang o `��� �4',irt�srbN rS��C •,, FOF: � `".
"�4rpuu" " mm�munao
By:
State of Iowa, County of Linn, ss: r Vice President
On 11th day of October, 2013, before me personally came Dennis J. Richmann
to me known, who being by me duly sworn, did depose and say; that he resides in Cedar Rapids, State of Iowa; that: he is `a Vice President of UNITED
FIRE & CASUALTY COMPANY, a Vice President of UNITED FIRE & INDEMNITY COMPANY, and a Vice President of FINANCIAL PACIFIC
INSURANCE COMPANY the corporations described in and which. executed the above instrument; that he knows the seal of said corporations; that the
seal affixed to the said instrument is such corporate seal, that it was so affixed pursuant to authority given by the Board of Directors of said corporations
and that he signed his name thereto, pursuant to like >authonty, and acknowledges same to be the act and deed of said corporations.
041 audith k Davis
_4 � Iowa Notariat Seal � Notary Public
•: Commission number 1:73041
' My commission expires: 4I23J20I5
w My Commission Expires 4/23/2015
Bond No. 54- 201992 PROJECT NAME: Water Quality Improvement Project
Effective Dates: 6123114 — 6/23116 P.O. # 033677
Executed in 1 Counterpart
SECTION 00615
MATERIAL AND WORKMANSHIP BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT WE, Killebrew, Inc., hereinafter referred to as "Principal' and United Fire &
Casualty Company, hereinafter referred to as "Surety" are held and firmly bound unto the (1)
City of Sanford, hereinafter referred to as the OWNER in the sum of ten percent (10 %) of the
110% Contract Price of $194,246.20, as adjusted under the Contract Documents which equals
Nineteen Thousand Four Hundred Twenty Four and 62/100 Dollars $19,424.62 is for the
payment of which we bind ourselves, heirs, executors, successors and assigns, jointly and
severally, firmly by these presents.
WHEREAS, Principal has constructed certain improvements, including roadways,
utilities, curbs, storm drains and other appurtenances in that certain Project described as the (2)
Water Quality Improvement Project, (P.O. #033677 — Sanford P -15 Only), and
WHEREAS, the aforesaid improvements were made pursuant to an Agreement dated
September 18th, 2012 and filed with the Purchasing Office of OWNER; and
WHEREAS, the Principal warrants and guarantees to the OWNER that all work, labor,
materials, equipment and services furnished and performed has been done in a good and
workmanlike manner and is of the highest quality, free from defects; and
WHEREAS, Principal is obligated to protect the OWNER against any defects resulting
from faulty Materials or Workmanship of said improvements and to maintain said improvements
for a period of two (2) years from the date of Final Completion under the Contract Documents.
NOW THEREFORE, the conditions of this obligation is such that if Principal shall
promptly and faithfully protect the OWNER against any Defects resulting from faulty Materials
and Workmanship of the aforesaid improvements and maintain said improvements for a period
of two (2) years from the date of Final completion, then this obligation shall be null and void,
otherwise it shall remain in full force and effect.
9) Name of Owner- City of Sanford
2) Name of Project identified in Instructions to Bidders - Water Quality Improvement Proiect,
(P.O. #033677 — Sanford P -15 Only)
The OWNER shall notify the Principal in writing of any Defect for which the Principal is
responsible and shall specify in said notice a reasonable period of time within which Principal
shall have to correct said Defect.
00615 -1
Bond No. 54- 201992 PROJECT NAME: Water Quality Improvement Project
Effective Dates: 6/23/14 — 6/23/16 P.O. # 033677
Executed in 1 Counterpart
The Surety unconditionally covenants and agrees that if the Principal fails to perform, within the
time specified, the Surety, upon thirty (30) days written notice from OWNER, or its authorized
agent or officer, of the failure to perform will correct such Defect or Defects and pay the cost
thereof, including, but not limited to engineering, legal and contingent costs. Should the
Surety fail or refuse to correct said Defects, the OWNER, in view of the public interest, health,
safety, welfare and factors involved, shall have the right to resort to any and all legal remedies
against the Principal and Surety and either, both at law and in equity, including specifically,
specific performance to which the Principal and Surety unconditionally agree.
The Principal and Surety further jointly and severally agree that the OWNER at its option, shall
have the right to correct said Defects resulting from faulty Materials or Workmanship, or,
pursuant to public advertisement and receipt of Bids, cause to be corrected any Defects or said
Defects in case the Principal shall fail or refuse to do so, and in the event the OWNER should
exercise and give effect to such right, the Principal and the Surety shall jointly and severally
hereunder reimburse the OWNER the total cost thereof, including, but not limited to,
engineering, legal and contingent costs, together with any damages either direct or consequent
which may be sustained on account of the failure of the Principal to correct said defects.
IN WITNESS WHEREOF, this instrument is executed this the 27th day of August, 2014.
Killebrew Inc.
ATTEST: Principal (Contracto
L' .' a
Secretary (Principal) By (Signature)
Jul
0'-A ruti
Typed Name
(C ?RPORATE-.SEAL)
(Witness to Principal)
Typed Name
00615 -2
1. Q (,. -Mu,vcu I/
Typed Name and Title Wcs- .
2830 Winter Lake Road
Address
Lakeland, FL 33803
City, State, Zip
(863) 701 -0273 (863) 701 -9204
Telephone No. Facsimile No.
Bond No. 54- 201992
Effective Dates: 6/23114 — 6/23/16
Executed in 1 Counterpart
ATTEST:
(S (rety) Secretary
Susan L. Reich
Typed Name
(CORPORATE SEAL)
Witness as to Suret
Patricia L. Slaughter
Typed Name
a a`ll,
Witness as to Surety
Teresa L. Durham
Typed Name
PROJECT NAME: Water Quality Improvement Project
P.O. # 033677
United Fire & Casualty Company
Surety
(319) 399 -5700 (319) 399 -5425
Telephone No. Facsimile No.
By: (JL)r2t,;.c
-1
Attorney- in- Fact/FL Licensed Resident Agent
Gloria A. Richards
Typed Name
PO Box 73909
Address
Cedar Rapids, IA 52407 -3909
City, State, Zip
(319) 399 -5700 (319) 399 -5425
Telephone No. Facsimile No.
NOTE: Date of the Bond must not be prior to date of Agreement. If CONTRACTOR is a joint
venture, all venturers shall execute the Bond. If CONTRACTOR is Partnership, all partners
shall execute Bond.
IMPORTANT: Surety companies executing Bonds must appear on the Treasury Department's
most current list (Circular 570 as amended) and be authorized to transact business in the State
of Florida, unless otherwise specifically approved in writing by OWNER.
ATTACH a certified Power -of- Attorney appointing individual Attorney -in -Fact for execution of
Performance Bond on behalf of Surety.
END OF SECTION
00615 -3