2281(a) IFB 18/19-36 Park Ave Stormwater ImprovementsS ORD
FINANCE DEPART HENT
PURCHASING DEPARTMENT
TRANSMITTAL MEMORANDUM
TO: City Clerk/Mayor
RE: IFB 18/19-36 Park Ave Stormwater Improvements
The item(s) noted below is/are attached and forwarded to your office for the following action(s):
❑
Development Order
❑
Mayor's signature
❑
Final Plat (original mylars)
❑
Recording
❑
Letter of Credit
❑
Rendering
❑
Maintenance Bond
Z
Safe keeping (Vault)
❑
Ordinance
❑
Deputy City Manager
❑
Performance Bond
❑
Payment Bond
❑
Resolution
❑
City Manager Signature
❑
❑
City Clerk Attest/Signature
❑
City Attorney/Signature
Once completed, please:
❑ Return originals to Purchasing- Department
❑ Return copies
El
Special Instructions Combine with original agreement
I i,�.otye..y 60ja."kZZ46v-
From
SharePoiiit—Finaiice—Purchasiiig_Fornis - 2018.doc
112.71202.0
Date
!=1 /IV// el
SECTION 00617
CONSENT OF SURETY TO FINAL PAYMENT
WE, Arch Insurance Company having heretofore executed Performance
and Paym the Bonds No. SU 1105745 for the Project known as Park Ave. Stormwater
Improvements_, in the amount of $1,514,579.45 -- ` hereby agree that City of Sanford
_ , hereinafter referred to as OWNER may make full payment of the
final estimate, Including the retained percentage, to the CONTRACTOR, Masci General Contractor, Inc.
---. 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,
• o Dollar Value of Issued Performance and Payment Bonds
IN WITNESS WHEREOF, the Arch Insurance Company --_ 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 13th day of January , 2021
Arch Insurance Company��
Surety Attomey-in-Fact & Florida Licensed Resident Agent
Lisa Roseland, (407) 786-7770
(Power of Attorney must be attached if executed by Attorney in Fact)
COUNTY OF ORANGE
STATE OF FLORIDA
Before me, the undersigned Notary Public of the State of Florida, personally appeared Lisa Roseland
-------------------------- as Attomey-in-Fact of Arch Insurance
Company whose name(s) is/are subscribed to the within instrument,
who personally swore or affirmed that he/she is authorized to execute this document and
thereby bind the Corporation.
Subscribed and sworn to before me this 13th day of January , 2021
Signature of Notary Public
Commissioned State of Florida
Anita Navarra
Print, Type or Stamp
Name of Notary Public
Personally Known XXXX Or, Produced Identification N/A
Type of Identification Produced N/A
Park Ave Stormwater Improvements
May 2019
END OF SECTION
00617-1
,.H►'' Notary Public State of Florida
is Anita Navarra
+�o
y* --,
4 My Commission HH 047560
Expires 10131/2024
CONSENT OF SURETY TO FINAL PAYMENT
AIC 0000315317
This Power of Attorney limits the acts of those named herein, and they, have no authority to bind the Company except in fire manner and to the extent herein stated,
Not valid for Note, Loan, Letter of Credit, Currency Rate, Interest Rate or Residential Value Guarantees.
POWER OF ATTORNEY
Know All Persons By These Presents:
That the Arch Insurance Company, a corporation organized and existing under the laws of the State of Missouri, having its principal administrative office in Jersey City,
New Jersey (hereinafter referred to as the "Company") does hereby appoint:
Cheryl Foley, Gloria A. Richards, Jeffrey W. Reich, Kim E. Niv, Lisa Roseland, Robert P. O'Linn, Sarah K. O'Linn, Susan L. Reich and Teresa L. Durham of
Maitland, FL (EACH)
its true and lawful Attomey(s)in-Fact, to make, execute, seal, and deliver from the date of issuance of this power for and on its behalf as surety, and as its act and deed:
Any and all bonds, undertakings, recognizances and other surety obligations, in the penal sum not exceeding Ninety Million Dollars (90,000,000.00).
This authority does not permit the same obligation to be split into two or more bonds In order to bring each such bond within the dollar limit of authority as set forth
herein.
The execution of such bonds, undertakings, recognizances and other surety obligations in pursuance of these presents shall be as binding upon the said Company as fully
and amply to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at its principal administrative office in
Jersey City, New Jersey.
This Power of Attorney is executed by authority of resolutions adopted by unanimous consent of the Board of Directors of the Company on September 15, 2011, true and
accurate copies of which are hereinafter set forth and are hereby certified to by the undersigned Secretary as being in full force and effect:
"VOTED, That the Chairman of the Board, the President, or the Executive Vice President, or any Senior Vice President, of the Surety Business Division, or their
appointees designated in writing and filed with the Secretary, or the Secretary shall have the power and authority to appoint agents and attorneys -in -fact, and to authorize
them subject to the limitations set forth in their respective powers of attorney, to execute on behalf of the Company, and attach the seal of the Company thereto, bonds,
undertakings, recognizances and other surety obligations obligatory in the nature thereof, and any such officers of the Company may appoint agents for acceptance of
process."
This Power of Attorney is signed, sealed and certified by facsimile under and by authority of the following resolution adopted by the unanimous consent of the Board of
Directors of the Company on September 15, 2011:
VOTED, That the signature of the Chairman of the Board, the President, or the Executive Vice President, or any Senior Vice President, of the Surety Business Division,
or their appointees designated in writing and filed with the Secretary, and the signature of the Secretary, the seal of the Company, and certifications by the Secretary, may
be affixed by facsimile on any power of attorney or bond executed pursuant to the resolution adopted by the Board of Directors on September 15, 2011, and any such
power so executed, sealed and certified with respect to any bond or undertaking to which it is attached, shall continue to be valid and binding upon the Company. In
Testimony Whereof, the Company has caused this instrument to be signed and its corporate seal to be affixed by their authorized officers, this l0th day; of June, 2020
Attested and CertifiedArch Insurance Company
4(j SEAL
Patrick K. Nails, Secretary David M. Finkelstein, Executive Vice President
STATE OF PENNSYLVANIA SS
COUNTY OF PHILADELPHIA SSS
1, Michele Tripodi, a Notary Public, do hereby certify that Patrick K. Nails and David M. Finkelstein personally known to me to be the same persons whose names are
respectively as Secretary and Executive Vice President of the Arch Insurance Company, a Corporation organized and existing under the laws of the State of Missouri,
subscribed to the foregoing instrument, appeared before me this day in person and severally acknowledged that they being thereunto duly authorized signed, sealed with
the corporate seal and delivered the said instrument as the free and voluntary act of said corporation and as their own free and voluntary acts for the uses and purposes
therein set forth.
NOTARIAL $EAL
Y Michele Tripodi, Notary Public
My commission expires 07/31/2021
CERTIFICATION
1, Patrick K. Nails , Secretary of the Arch Insurance Company, do hereby certify that the attached Power of Attorney dated June 10, 2020 on behalf of the person(s)
as listed above is a true and correct copy and that the same has been in full force and effect since the date thereof and is in full force and effect on the date of this
certificate; and I do further certify that the said David M. Finkelstein, who executed the Power of Attorney as Executive Vice President, was on the date of execution of
the attached Power of Attorney the duly elected [Executive Vice President of the Arch Insurance Company. f �y
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal ofthe Arch Insurance Company on this 1 day
20 2,l
Patrick K. Nails, Secretary
This Power of Attorney limits the acts of those named therein to the bonds and undertakings specifically named therein and they have no authorit to (find the Company
except in the manner and to the extent herein stated.
PLEASE SEND ALL CLAIM INQUIRIES RELATING TO THIS BOND TO THE FOLLOWING ADDRESS:► A
Arch Insurance—Surety Division �r
3 Parkway, Suite I500 t7t1K>Rti1StATE
Philadelphia, PA 19102 X 1971
1�
044 d
To verify the authenticity of this Power of Attorney, please contact Arch Insurance Company at SuretyAuthentic@arc rnsurance.com
Please refer to the above named Attorney -in -Fact and the details of the bond to which the power is attached.
AICPOA040120 Printed in U.S.A.
SECTION 00644
CONTRACTOR'S WAIVER AND RELEASE OF LIEN UPON FINAL PAYMENT
The undersigned Lienor, in consideration of Final Payment in the amount of $70,829.07
, hereby waives and releases its lien and right to claim a lien for
labor, services or materials furnished through November 28, 2020 to the City o
Sanford for the Project known as the Park Ave Stormwater lmprovements. The
labor, services or materials furnished relate to improvements to the following property:
Park Ave. and 25h St, Sanford, Seminole County, FL
DATED on �", V I'l 120,7-(
Lienor: Masci General Contractors, Inc.
Address: 5752 S Ridgewood Ave
Port Orange, FL 32127
By: -
Signat
Leo Masci, P.E. - President
Printed Name and Title
COUNTY OF
STATE OF FLORIDA
Before me, the unders, ned Notary Public of the State of Florida, personally appeared
as P.. cte-n+ of
t ne, whose name(s) is/are subscribed to the within instrument,
who personally swore or affirmed that he/she is authorized to execute this document and
thereby bind the Corporation.
Subscribed and sworn to before me this
061,9nature of N ary Public
0 r
Commissioried1tate of Florida
A day of 71U�Lil(u ---,2Q1-
4WSCHNEIDER
.'sq Pilo '71
Commission # GG 150044
WnhAr 10. 2021
Print, TypCOQ, mpmodTlwuB4etNoWy$&-Vkn
Name of Notary Public
Personally Known V/ Or, Produced Identification
Park Ave Stormwater Improvements
May 2019
00644-1
CONTRACTOR'S WAIVER AND RELEASE OF
LIEN UPON FINAL PAYMENT
Type of Identification Produced
END OF SECTION
Park Ave Stormwater Improvements
May 2019 CONTRACTOR'S WAIVER AND RELEASE OF
LIEN UPON FINAL PAYMENT
00644-2
SECTION 00615
MATERIAL AND WORKMANSHIP BOND
(10% of Contract Price)
Bond No. SU 1105745
KNOW ALL MEN BY THESE PRESENTS that:
Masci General Contractor, Inc.
(Name of CONTRACTOR)
5752 S Ridgewood Avenue, Port Orange, FL 32127
(Address of CONTRACTOR)
CONTRACTOR's Telephone Number; 386-322-4500
a Corporation
(Corporation, Partnership, or Individual)
hereinafter called "Principal", and Arch Insurance Company,
(Name of Surety)
Harborside 3 210 Hudson St #300 Jersey City, NJ 07311-1107
(Address of Surety)
Surety's Telephone Number: 201-743-4000
hereinafter called "Surety", are held and firmly bound unto CITY of SANFORD, 300 N. Park
Ave., Sanford, Florida 32771, hereinafter called "CITY", in the sum of ten percent (10%) of the
Contract Price as adjusted under the Contract Documents. The Final Contract Price is $1,514,579.45
. therefore Principal and Surety are held and firmly bound unto CITY the sum of One
Hundred Fifty One Thousand Four * DOLLARS ($151,457.95------) in lawful money of
the United States, for the payment of which sum well and truly to be made, we bind ourselves,
successors, and assigns, jointly and severally, firmly by these presents.
CITY's telephone number Is (407) 688-5028. THE CONDITION OF THIS OBLIGATION is such
that whereas, the Principal entered into a certain Agreement with CITY, dated the 15th day
Of October . 2020_, a copy of which is hereto attached and made a part hereof for
the construction of: Park Ave. Stormwater improvements IFB 18/19-36
Principal is obligated to protect the CITY against any defects resulting from faulty Materials or
Workmanship of said improvements for a period of two (2) years from the date of Final
Completion under the Contract Documents, which is January 12, 2021
The conditions of this obligation are such that if Principal shall promptly and faithfully protect the
CITY against any. Defects resulting from faulty Materials and Workmanship of the aforesaid
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.
Park Ave Stormwater Improvements
May 2019 MATERIAL AND WORKMANSHIP BOND
(10% of Contract Price)
*Hundred Fifty Seven and 95/100 00616-1
The CITY 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.
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 CiTY, 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 cost. Should the Surety fail or
refuse to correct said Defects, the CITY, 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 CITY 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 fall or refuse to do so, and in the event the CITY should
exercise and give effect to such right, the Principal and the Surety shall jointly and severally
hereunder reimburse the CITY the total cost thereof, including, but not limited to, engineering,
legal and contingent cost, together with any damages either direct or consequent which may be
sustained on account of the failure of the Principal to correct said defects.
Park Ave Stormwater Improvements
May 2019
(Signature Pages Follow)
00616-2
MATERIAL AND WORKMANSHIP BOND
(10% of Contract Price)
IN WITNESS WHEREOF, this Instrument is executed this 13th day of January
. 202_1.
ATTEST'
By. Sijik-e—tary
%0111111
�'.Qggj
Name of Secretary
*0
0�
;P
Uj. 1
C15
Z
1�
(i#iA ESFA
ze
FL
Wis
All
to CONT T
a 0
D
.�
Typed Name
(Witness to CONTRACTOR)
Typed Name
PRINCIPAUCONTRACTOR
Masci General Contractor, Inc.
PRINCIPAL / CONTRACTOR
By: CONTRACTOR'Signatory Authority
Typed Name and Title
5752 S. Ridgewood Avenue
Address
Port Orange, FL 32127
City, State, Zip
386-322-4500 386-322-4600
Telephone No. Facsimile No.
(Surety Signature Page Follows)
Park Ave Stormwater Improvements
May 2019
00616-3
MATERIAL AND WORKMANSHIP SONO
(10% of Contract Price)
A7EIS."� �
(SURETY) Secretary
Susan L. Reich
Typed or Printed Name
Witness as to SURETY
Anita Navarra
�ed or Printed Name
Witness as to SURETY
Coralise Medal
Typed or Printed Name
SURETY
Arch Insurance Company
SURETY
Lisa Roseland *
Typed or Printed Name
Attorney -in -Fact and Florida Licensed Resident Agent
Title
Harborside 3, 210 Hudson St., #300_
Address
Jersey City, NJ 07311-1107
City, State, Zip
201-743-4000 866-637-5861
Telephone No. Facsimile No.
NO,: Date of the Bond must not be prior to date of Agreement, if CONTRACTOR is a Joint
venture, all ventures shall execute the Bond. If CONTRACTOR Is a Partnership, all partners shall
execute the Bond.
IMPORTANT: Surety companies executing Bonds must appear on the Treasury Departments
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 CITY.
All bonds shall be originals and issued or countersigned by a local producing agent who is
authorized to operate In the State of Florida. Attorneys -in -fact who sign Bid Bonds or
Performance/Payment Bonds must file with such bond a certified copy of their Power of Attorney to
sign such Bond. Agents of Surety companies must list their name, address, and telephone
number on all Bonds, *Florida Surety Bonds, Inc.
620 N. Wymore Road, Suite 200
END OF SECTION Maitland, FL 32751
407-786-7770
Park Ave Stormwater Improvements
May 4018 MATERIAL AND WORKMANSHIP BOND
(10% of Contract Price)
00615-4
AIC 0000315318
This Power of Attorney limits lite acts of those named herein, and they have no authority to Lind the Companyexcept in the manner and to the extent herein stated
x Not valid for Note, Loan, Letter of Credit, Currency Rate, Interest Rare or Residential Value Guarantees.
POWER OF ATTORNEY
Know All Persons By These Presents:
That the Arch Insurance Company, a corporation organized and existing under the laws of the State of Missouri, having its principal administrative office in Jersey City,
New Jersey (hereinafter referred to as the "Company") does hereby appoint:
Cheryl Foley, Gloria A. Richards, Jeffrey W. Reich, Kim E. Niv, Lisa Roseland, Robert P. O'Linn, Sarah K. O'Linn, Susan L. Reich and Teresa L. Durham of
Maitland, FL (EACH)
its true and lawful Attomey(s)in-Fact, to make, execute, seal, and deliver from the date of issuance of this power for and on its behalf as surety, and as its act and deed:
Any and all bonds, undertakings, recognizances and other surety obligations, in the penal sum not exceeding Ninety Million Dollars (90,000,000.00).
This authority does not permit the same obligation to be split into two or more bonds In order to bring each such bond within the dollar limit of authority as set forth
herein.
The execution of such bonds, undertakings, recogni7ances and other surety obligations in pursuance of these presents shall be as binding upon the said Company as fully
and amply to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at its principal administrative office in
Jersey City, New Jersey.
This Power of Attomey is executed by authority of resolutions adopted by unanimous consent of the Board of Directors of the Company on September 15, 2011, true and
accurate copies of which are hereinafter set forth and are hereby certified to by the undersigned Secretary as being in full force and effect:
"VOTED, That the Chairman of the Board, the President, or the Executive Vice President, or any Senior Vice President, of the Surety Business Division, or their
appointees designated in writing and filed with the Secretary, or the Secretary shall have the power and authority to appoint agents and attorneys -in -fact, and to authorize
them subject to the limitations set forth in their respective powers of attorney, to execute on behalf of the Company, and attach the seal of the Company thereto, bonds,
undertakings, recognizances and other surety obligations obligatory in the nature thereof, and any such officers of the Company may appoint agents for acceptance of
process."
This Power of Attorney is signed, scaled and certified by facsimile under and by authority of the following resolution adopted by the unanimous consent of the Board of
Directors of the Company on September 15, 2011:
VOTED, That the signature of the Chairman of the Board, the President, or the Executive Vice President, or any Senior Vice President, of the Surety Business Division,
or their appointees designated in writing and filed with the Secretary, and the signature of the Secretary, the seal of the Company, and certifications by the Secretary, may
be affixed by facsimile on any power of attorney or bond executed pursuant to the resolution adopted by the Board of Directors on September 15, 2011, and any such
power so executed, sealed and certified with respect to any bond or undertaking to which it is attached, shall continue to be valid and binding upon the Company. In
Testimony Whereof, the Company has caused this instrument to be signed and its corporate seal to be affixed by their authorized officers, this 10th day of June, 2020
Attested and Certified f/
^^^v
,Iry
S EAL
Arch Insurance Company
Patrick K. Nails, Secretary
ilii
David M. Finkelstein, Executive Vice President
STATE OF PENNSYLVANIA SS
COUNTY OF PHILADELPHIA SS
y
lbsod
I, Michele Tripodi, a Notary Public, do hereby certify that Patrick K. Nails and David M. Finkelstein personally known to me to be the same persons whose names are
respectively as Secretary and Executive Vice President of the Arch Insurance Company, a Corporation organized and existing under the laws of the State of Missouri,
subscribed to the foregoing instrument, appeared before me this day in person and severally acknowledged that they being thercunto duly authorized signed, sealed with
the corporate seal and delivered the said instrument as the free and voluntary act of said corporation and as their own free and voluntary acts for the uses and purposes
therein set forth.
"WAVY PWk
Cky of �* MichelcTripodi, Notary Public
tAty E�ykes Atty 3i, L92t My commission expires 07/31/2021
CERTIFICATION
I, Patrick K. Nails , Secretary of the Arch Insurance Company, do hereby certify that the attached Power of Attorney dated June 10. 2020 on behalf of the person(s)
as listed above is a true and correct copy and that the same has been in full force and effect since the date thereof and is in full force and effect on the date of this
certificate; and 1 do further certify that the said David M. Finkelstein, who executed the Power of Attorney as Executive Vice President, was on the date of execution of
the attached Power of Attorney the duly elected Executive Vice President of the Arch Insurance Company.1
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the Arch Insurance Company on this5 day ofTAv4APCU
20
Patrick K. Nails, Secretary
This Power of Attorney limits the acts of those named therein to the bonds and undertakings specifically named therein and they have no authorit ` to hind the Company
except in the manner and to the extent herein stated.
+e
PLEASE SEND ALL CLAIM INQUIRIES RELATING TO THIS BOND TO THE FOLLOWING ADDRESS:
Arch Insurance—Surety Division 10000"y1f 4
3 Parkway, Suite 1500
1
Philadelphia, PA 1 1071.9102 ri
To verify the authenticity of this Power of Attorney, please contact Arch Insurance Company at SuretyAuthentic@arcfiris
Please refer to the above named Attorney -in -Fact and the details of the bond to which the power is attached.
AICPOA040120 Printed in U.S.A.
WAIVER AND RELEASE OF LIEN FOR FINAL PAYMENT
The undersigned lienor ... C- ef. consideration of the Final
payment in the amount of with check 91.9.0. Y?—.. Hereby
waives and releases its lien and right to claim a lien for labor, services, or materials
furnished on the job of:
PARK AVE. STORMWATER IMPROV, (IFB 18/19/36)
To the following described property:
CITY OF SANFORD
300 N. PARK AVE.
SANFORD, Fl, 32771
To the General Contractor:
MASCI GENERAL CONTRACTOR INC
5752 S. RIDGEWOOD AVE
PORT ORANGE, FL 32127
To the Insurance Company:
ARCH INSURANCE COMPANY
BOND SU 1105745-1-1
Dated this day of...I:L�'? 20:)
I
Lienor's Name.."�1.-le C-1 r rre
Address:
Signed by:
(Print Name and Tittle)
er
STATE OF'i a"' t ,..
COUNTY OF....
The 'I Lfollowing instrument was acknowledged before me this.. day of...
20'��J; by. 7 11KY0
..
6-e ....
of. ..................... ... ................................. o ................
(st I com on behalf of the corp-onkCoplcomgfifiy�,e/She is
'Oedoo U d•....4 . ................ As identification
MY COMMISSION# HH 008555
EXPIRES: July 29, 2024
Notary
BMW Dru ftv NW;c UwWflbm . .......
State of ....�, 'I.e." =.. .- -.-
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
WAIVER AND RELEASE OF LIEN FOR FINAL PAYMENT
The undersigned lienor... ... in consideration of the Final
I �y .... :/"*, . .............
payment in the amount of 4 .... M-6; R.... with check Hereby
waives and releases its lien and right to claim a lien for labor, services, or materials
furnished on the job of:
PARK AVE. STORMWATER IMPROV. (IF13 18/19/36)
To the following described property:
CITY OF SANFORD
300 N. PARK AVE.
SANFORD, FL 32771
To the General Contractor:
MASCI GENERAL CONTRACTOR INC
5752 S. RIDGEWOOD AVE
PORT ORANGE, FL 32127
To the Insurance Company:
ARCH INSURANCE COMPANY
BOND SU 1105745-1-1
Dated this .24—day ofJ9.QY.QMtiJQf 20 Lienor's Name: Of Florida
Address: 11.42.MMr-.TQWVr-RQPA....
Signedby . .. ... .. ..............
Q mi. lmq -Q.qEpplAt� Secretary
(Print Name and Tittle)
STATE OF.ELQ!3P& ......
COUNTY OF. RALMOKAU-1
The following instrument was acknowledged before me this. 4 day of. ,grnber
2020, by ..tAqQW!.ft.X1RriQR ........................(Officer) - -
of.. ft9lirn9yAr Pqjjqrite of F. [9 00 ............ a ... Elorida .......................................
(state) corporation/ company, on behalf of the corporation/company. He/She is
personally known tome / has producied o o .... o ........... As identification
Notary Public. ---'-
State ofi. FLQri;W .................
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 -
,AV P& Notary Public State ofTlonda
4°%` Frederica Lipman
•
Wc my commission HH 036245 MAS004
Expires 0812512024
I,ql �4
WAIVER AND RELEASE OF LIEN FOR FINAL PAYMENT
The undersigned lienor ..14 M.- J
n considpration of the Final
payment in the amount of $.�..................... .with check Hereby
waives and releases its lien and right to claim a lien for labor, services, or materials
furnished on the job of:
PARK AVE. STORMWATER IMPROV. (IFB 18/19/36)
To the following described property:
CITY OF SANFORD
300 N. PARK AVE.
SANFORD, FL 32771
To the General Contractor:
MASCI GENERAL CONTRACTOR INC
5752 S. RIDGEWOOD AVE
PORT ORANGE, FL 32127
To the Insurance Company:
ARCH INSURANCE COMPANY
BOND SU 1105745-1-1
Ram Tool Construction Supply Co
4500 . 5th Avenue South
Building A
Dated this .day of.:..... 20 'Lienor's Name: .... Birmingham, AL 35222
...........
Address: ................................
........... .. ....
Signed by:A
. . . ..Eta
(Print Nam*e and Tittle)
STATE OF aPXW*,.A..
COUNTY OF...
Thi� �olowingjnstru e was acknowledged before me thiZ$. day of.Nd
20 .........(Officer),
. ........... (Officer),
of.. rK,A4n. 44-ULf .........................a....»*Cdq\
(state) corporation/ company, on behalf of the corporation/company. He/She is
persona n tome / has produced ....................... As identification
Notary
State of:. N ....................
Note: This Is a statutory form prescribed by Section 71310 Florida Statutes (1996). Effective October 1, 1,9K a person may
not require a lienor to furnish a waiver or release of lien that Is different from the statutory form
I All---2—
"�AIIETH ANNE HOLLINGSWORTH
'St te
LNotary Public, Alabama State at Large
Al
MY Commission Expires July 12, 2022
The undersigned lienor4/ye-gI-406--7-h'!r ?.-
....... consideration of the Final
payment in the amount of S.4 90. .... with check #.�Y. 0;F51. Hereby
waives and releases its lien and right to claim a lien for labor, services, or materials
furnished on the job of:
PARK AVE. STORMWATER IMPROV. (IFB 18/19/36)
To the following described property:
CITY OF SANFORD
300 N. PARK AVE.
SANFORD, FL 32771
To the General Contractor:
0►�.Ct ;� ► � �$
5752 S. RIDGEWOOD AVE
PORT ORANGE, FL 32127
To the Insurance Company:
ARCH INSURANCE COMPANY
BOND SU 1105745-1-1
Dated this .......day of. .............. 202-11 Lienor's N4me: ...........................
Address: ... 11 7)
rc
Signed by: i
(Print Name and Tittle)
STATE OF ....0 6 r I.
COUNTY AJOVO- in kv
The f9liowing instrurqent was acknowledged before me this..... day of ........
299," by ..... G. b. t n... VA. ly 4 F:.......(Office r')
of .. .. ..... 4
........ .....................
(state) corporation/ company, on behalf of the corporation/company. He/She is
personally known tome / has produced ...................... As identification
Notary Public:\J;1',A
Stateof .......................
Note: This is a statutory form prescribed by Section 71310 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
DARCYUCILRAVY
Commission tHH017443
ExposNovmber Z 2024
fAP 4P 8W4dWnM&4*xQWySWd=
WAIVER AND RELEASE OF LIENYOR FINAL PAYMENT
-17- •�
C. .1 consideration of the Final
The undersigned lienor.... .7 ... 1 ... ..........
payment in the amount of I ................ .with check #1.qP2Z Hereby
waives and releases its lien and right to claim a lien for labor, services, or materials
furnished on the job of:
PARK AVE. STORMWATER IMPROV. (1FB 18/19/36)
To the following described property:
CITY OF SANFORD
300 N. PARK AVE.
SANFORD, FL 32771
To the General Contractor:
MASCI GENERAL CONTRACTOR INC
5752 S. RIDGEWOOD AVE
PORT ORANGE, FL 32127
To the Insurance Company:
ARCH INSURANCE COMPANY
BOND SU 1105745-1-1
14 L4N
Dated this.
. day of...-..1ALL20
Central Florida Transport, LLC
PO Box 700
Coleman, FL
33521
Lienor's Name: ..........................
Address: .................................
Signed by:
(Print Name and Tittle)
�'-L-
STATE OF ...... ............
COUNTY day of.
The following instrument was acknowledged before me this., .
20 '?A; by7........... I ............ (Officer) 7—
of .............
............„.......................,a............................. o ....................
(state) corporation/ company, on behalf of the corporation/company. He/She is
personally known tome / has produced ...................... As identification
Notary
Stateof ..........................
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,
SUSAN M. CORDLE
Commission #GG 222610.
Expires July 12, 2022
ffS�` Bonded Thru Troy Fain Insurance 80WO-36s.7olq
Depart
e NATIONAL POLLUTANT DISCHARGE
44 ELIMINATION SYSTEM (NPDES) STORMWATER
NOTICE OF TERMINATION
01('e 0 (RULE 62-621.300(6), F.A.C.)
�r'nxal pr
YOU must Use this form to terminate coverage Under the Generic Permit for Stormwater Discharge from Large and Small Construction
Activities provided in subsection 62-621.300(4), F.A.C., the Multi -Sector Generic Permit for Storrnwatcr Discharge Associated with
Industrial Activity provided in subsection 62-621.300(5), F.A.C. as well as the conditional exclusion fior-no exposure'" o1' industrial
activities and materials to stormwater provided in paragraph 62-620.100(2)(o), F.A.C.
All information provided on this form shall be typed or printed in ink.
1. TERMINATION INFORMATION:
A. Facility ID/Project Number: FLR20DI12
B. Reason tbrT
Check al I that apply:
F]
No longer operator o I'the faci I ity/project.
D. State: FL
Final stabilization criteria is met and all stormwater discharges associated with construction activity including dewatering
F. Responsible Authority: Leticia Masci
operations have ceased (for construction activity only).
I.I. Responsible Authority's E-mail Address: leticiamasci@cfl.rr.com
All stormwater discharges associated with industrial activity have ceased (for industrial activity only).
F-1
No longer meet the condition of'"no exposure'" (forindustrial activity only).
ff. OPERATOR INFORMATION:
A.Operator Name: MASCI GENERAL CONTRACTORS INC
Park Ave Stormwater
13. Address: 5752 S Ridgewood Ave
2454 S Park Ave
C. City: Port Orange
D. State: FL
11-. Zip Code: 32127 6442
F. Responsible Authority: Leticia Masci
G. Responsible Authority's Phone No.: (386) 322-4500
I.I. Responsible Authority's E-mail Address: leticiamasci@cfl.rr.com
1. Responsible Authority's Fax No.:
Ill. FACILITY/PROJECT INFORMATION:
A. Name:
Park Ave Stormwater
B. Address/Location:
2454 S Park Ave
C. City:
Sanford
D. State: FL
E. Zip Code: 327714420
F. County:
Seminole
Page I of 4
DEI' Fonn 62-621.300((;)
Effective Date: 02/2015
IV. CERTIFICATION':
I certify under penalty of law that all stormwater discharges associated with industrial or construction activity from the identified
facility or project that are authorized by the referenced State of Florida generic permit have been eliminated; the facility no longer
meets the conditional exclusion for "no exposure" outlined in paragraph 62-620.100(2)(0), F.A.C.; or that I am no longer the operator
of the facility or pr(jcct. I understand that by submitting this Notice of Termination, I am no longer authorized to discharge
stormwater associated with industrial or construction activity under a generic permit, and that discharging pollutants in stormwater
associated with industrial or construction activity to surface waters of the State is unlawful unless authorized by a permit issued
pursuant to Section 403.0885. F.S. I also understand that the submittal of this Notice of Vermination does not release an operator from
liability for any violations of their generic permit or conditional exclusion for "no exposure" from NPDES stormwater permitting for
industrial activities.
Responsible Autbority Name and Official Title (Type or Print):
Leticia Masci, PM Assistant
Letts vMa4oi
Responsible Authority Signature:
' Signatory requirements are contained in Rule 62-620.305. F.A.C.
Page 2 of 4
DEP Fonn 62-621.300(6)
Effective Date: 02/2015
November 03, 2020
Date Signed:
INSTRUCTIONS —DEP FORM 62-621.300(6)
NPDES STORMWATER NOTICE OF TERMINATION (NOT)
Who May File an NOT:
Permittees who presently are covered under the Generic Permit for StorrnwaterDischarge from Large and Small Construction
Activities provided in subsection 62-621.300(4). F.A.C., the MUlti-Sector Generic Permit for StornoNvater Discharge Associated with
Industrial Activity provided in subsection 62-621.300(5� F.A.C. or the conditional exclusion for -no exposure" of industrial activities
and materials to stormwater provided in paragraph 62-620.100(2)(o), F.A.C. shall submit a Notice ofTermination (NOT) when their
I'aci|i/;o,pncjjootnolonger has any xmrmnaw,discharges associated with industrial activity undefined ioRule 62-62020UP.A.C.;
uw,mvmte,diuchurp associated with construction activity as defined in DEP Document 62-621.300(4)(a), no longer meets the
condition of`'uoexposure" defined inparagraph 02'62O.|00(2)(o),F.A.C.;n,when they are nnlonger the operator o[the facility o,
project.
For construction activities, elimination ofal|gomnvatc discharges associated with industrial activity occurs when disturbed soils at
the construction site have been finally stabilized and temporary erosion and sediment control measures have been removed or will be
removed at an appropriate tirne. and all ston-riNvater discharges associated with construction activity from the construction site that are
authorized under the generic permit have been eliminated. Final stabilization means that all soil -disturbing activities at the site have
been completed and that a uniflorril (e.g., evenly distributed, without large bare areas) perennial vegetative cover with a density ofat
least 70% for all unpaved areas and areas not covered by permanent structures has been established, or equivalent permanent
stabilization measures (u.g.,gnwoxd|ua)have been employed.
Where mFile auNOT:
The Department encourages the electronic submission of NOTs through the NPDES Stormwater Program's electronic
permddnguppbcubon,avoi/uhleotbt4?:6/www.Odu»porm|.com/go/. Asunalternative, NOTomay hosubmitted bypaper copy m
the |N|owiugaddress:
NPDE9SmnmwutexNotices Center, Kx8#3585
Florida Department ofEnvironmental Protection
20O0Blair Stone Road
Tallahassee.. Florida 32399-2400
Permit Fee:
There ionoapplication fee for Submitting uNOT.
Additional Notification:
l[m^nnwuterassociated with industrial v,c*numcivnuudvi,y discharged maMunicipal Separate Storm Sewer System (MS4).u
copy n[the completed NOT shall hcprovided Wthe operator nfUuWS4.
For construction activities, ifother contractors/subcontractors arc covered under the permittee's Notice of Intent (NOI) and/or
Stormwater Pollution Prevention Plan (SWPPP), a cop), of the completed NOT shall be provided to each additional
con /mcmr/subuontmowrknown mthe purmiLtectohocovered orclaiming coverage under the purmiuec'oNO|and/or 8\YPPP.
Contractors/subcontractors o|aiming coverage under a pert-nittee's NOI must assure proper permit coverage for the duration of their
regulated activity. Failure of the permittee to provide a cop), of the NOT as provided herein shall not relieve the
contractor/subcontractor relying upon the permittee's NOI from the required permit coverage or any potential enforcement action
arising from the regulated activity.
Po/t [ —Tnrmminmtioa Information:
Item LA.:Enter the DEP Facility ID/Project Number for the fan|ky/pro�fcct.
&m B.:Indicate the reason for termination o[mveragubycheck the appropriate box.
Part Il—Operator Information:
Item A.:Provide the legal name n[d,centity (opo,um,)tnwhich coverage was granted.
Items 13. — E.: Provide tile complete mailing address ofthe operator, including city, state and zip code.
Items F. —G.: Provide the narne and telephone number (including area code) ofthe person authorized to submit this NOT on behalf of
the operator. This must bothe emrperson as indicated in tile ocni5cudon in Part |Y.
Page 3o[4
DEP mnnaz'az/.mo(«)
Items HA.: Provide the email address and fax number (including area code) of the person authorized to submit this NOT on behalf of
the operator.
Part III — Facility/Project Information:
Items A. — E.: Enter the official or legal name and complete street address, including city, state and zip code of the facility/project
site. Do not provide a P.O. Box number as the street address. Itthe tacility/project lacks a street address, describe the location (e.g.,
intersection of State Road I and Smith Street).
Item F.: Enter the county in which the facility/project site is located.
Part IV — Certification:
Type or print the name and official title of the person signing the certification. Sign and date the certification.
Section 403.161, F.S., provides severe penalties for submitting false information on this NOT or any reports or records required by a
permit. ]'here are both civil and criminal penalties far submitting false information.
Rule 62-620.305, F.A.C., requires that the NOT be signed as follows:
A. For a corporation, by a responsible corporate officer as described in Rule 62-620.30, F.A.C.;
13. For a partnership or sole proprietorship, by a general partner or the proprietor, respectively; or
C. For a municipality, state, Icderal or other public facility, by a principal executive officer or elected official.
Page 4 oto
DEP Fonn 62-621.300(6)
Effective Date_ 02/2015