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EDB CO No 3 to Saratoga Springs contract with PSCC_Board Item-Final (2)
EXECUTIVE SUMMARY AGENDA ITEM: Proposed Change Order No. 3 to Saratoga Springs Water Treatment Plant, Reclaimed Pump Station, and Potable and Reclaimed Water Distribution Main Agreement with Petticoat-Schmitt Civil Contractors, Inc. (PSCC) CCUA Job File No. 1128-002 CCUA Financial Project No. 03118RP Date: April 25, 2023 BACKGROUND: PSCC has provided construction services for the Saratoga Springs Water Treatment Plant, Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project.The project Engineer of Record(EOR) is CDM Smith. ca a The Contractor's electrical gear supplier began to experience supply issues from its material supply vendors during the peak of the COVID-19 era. On February 24, 2023, the electrical gear supplier ° submitted a letter to the contractor explaining their difficulties in supplying the reclaimed water c c and water electrical gears on the third revised shipping date, which was on March 24, 2023. The Ce letter cited supply chain (electronics, metals, resins, etc.), logistics, and continued supplier labor disruptions. The EOR and Staff have several existing projects experiencing the same concerns herein. Sub-Article 4.04, Incentive-Disincentive for the Reclaimed Portion of the Project, of the Agreement specifies that the reclaimed portion of the project should be substantially completed within 425 days or by April 24, 2023. The contract provided up to $6000 per day incentive or disincentive pay for early or late delivery up to 60 days(i.e.,+/-$360,000.00). Because of reasons beyond the contractor's control regarding the electrical equipment,CCUA Staff and the Contractor agree that this incentive/disincentive provision (article 4.04) is no longer applicable and propose to remove it formally from the contract terms. The contract also provides provisions to extend contract times for events beyond the Contractor's control. Staff intends to extend the contract time based on the actual gear delivery dates when those are known. The electrical gear contractor indicated that the new electrical shipping date for the reclaim system and water system would be May 19, 2023, and July 29, 2023, respectively. If these delivery dates hold, substantial completion for the reclaimed plant would approximately be July 31, 2023, and substantial completion for the water plant would approximately be September 30, 2023. Change Order No. 3 consists of recommendations to delete Sub-Article 4.04 from the Agreement and allow Staff to amend the project contract time once the electrical gear is delivered to the project. BUDGET: The project contract construction budget was $13,480,000.53. The project construction budget with Change Order No.3 remains $13,480,000.53. RECOMMENDATION: Staff respectfully recommends the Board of Supervisors approve Change Order No. 3 to the Saratoga Springs Water Treatment Plant, Reclaimed Pump Station, and Potable and Reclaimed Water Distribution Main Contract with Petticoat-Schmitt Civil Contractors, Inc. ATTACHMENTS: Fully Executed Agreement -Amended Contractor's CO Request and Back-up Documentation EOR's Recommendation SECTION 005000 STANDARD FORM OF AGREEMENT BETWEEN OWNER AND CONTRACTOR ON THE BASIS OF A STIPULATED PRICE THIS AGREEMENT is by and between CLAY COUNTY UTILITY AUTHORITY (Owner) and PETTICOAT-SCHMITT CIVIL CONTRACTORS, INC. (Contractor) Owner and Contractor, in consideration of the mutual covenants set forth herein, agree as follows: ARTICLE 1 - WORK 1.01 Contractor shall complete all Work as specified or indicated in the Contract Documents. The Work is generally described as follows: Saratoga Springs Water Treatment Plant,Reclaimed Pump Station, and Potable and Reclaimed Water Distribution Main Project The Saratoga Springs Plant Site (SSPS) is located in an area south and west of Orange Park and Fleming Island. The work will consist of one Water Treatment Plant (WTP), one Reclaimed Water Pumping Station and potable and reclaimed water main extensions to the service area. Both of these facilities will be located on the same site and owned and operated by Owner. The mains will be located on the plant site and in easements along Feedmill Rd. out to the Owner's service area. All potions are collectively referred to as the "Project". The following process additions will be completed for the WTP and are referred to as the WTP Portion of the Project: • Two 1,800-gallon per minute (gpm) capacity production wellheads, SS-1 and SS-2. • One High Service Pump (HSP) building housing one (1)pump capable of pumping 1,600 gpm, two (2) 800-gpm jockey pumps, and room for two (2) additional 1,600-gpm pumps, one of which would replace the jockey pump (total of four pumps in the future). • A chemical feed system and space for up to three 1,550-gallon NaOCI chemical storage tanks (two proposed, one future). • One 0.53-million-gallon (MG)pre-stressed concrete ground storage tank(GST), with space allocated for three additional 0.53-MG GSTs. 005000-1 CCUA Project No: 1128-002 CDM Smith Project No 259164-240363 STANDARD FORM OF AGREEMENT Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project January 2022 • A natural draft aerator for off-gassing the estimated less than 0.6 milligrams per liter(mg/L) hydrogen sulfide in the raw water supply. The aerator will be located on the top of the GST and sized for a minimum flow of 3,600 gpm. • One hydropneumatic tank with associated air lines and compressor for surge suppression. • An emergency generator and fuel storage tank. • Approximately 5,200 feet of finished water main. • This project will also include implementation of a new electrical system including a new motor control center(MCC) and variable frequency drives (VFDs), along with instrumentation and control features designed to include future supervisory control and data acquisition (SCADA). The following process additions will be completed for the reclaimed pump station and are referred to as the Reclaimed Portion of the Project: • One 1,200-gpm augmentation wellhead (J-SS)to provide supplemental water to the reclaimed water storage tank. • One HSP building housing two 1,600-gpm pumps with room available for the addition of two more pumps with a similar capacity. • One 0.75-MG pre-stressed concrete GST. • One hydropneumatic tank with associated air lines and compressor for surge suppression. • Approximately 5,200 linear feet of reclaimed water main. • This Project will also include implementation of a new electrical system including a new MCC and VFDs, along with instrumentation and control features including SCADA. The combined Project will also include site and stormwater improvements, site fencing, landscaping, and driveway access. All materials, methods of construction, and standards must be in accordance with the Owner's approved materials manual, standards, and details. The Reclaimed Portion of the Project, as defined for the purpose of the incentive-disincentive provision in Article 4.04 of this agreement, includes the following: • One HSP building housing two 1,600-gpm pumps with room available for the addition of two more pumps with a similar capacity. • One 0.75-MG pre-stressed concrete GST. • One hydropneumatics tank with associated air lines and compressor for surge suppression. 005000-2 CCUA Project No: 1128-002 CDM Smith Project No.259164-240363 STANDARD FORM OF AGREEMENT Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project January 2022 • Approximately 5,200 linear feet of reclaimed water main. • This Project will also include implementation of a new electrical system including a new MCC and VFDs, along with instrumentation and control features, including SCADA. • All of the above elements and necessary ancillaries, substantially complete and functioning as intended as storage and supply system, online,to serve the Lake Asbury system The 1,200-gpm augmentation wellhead (J-SS)to provide supplemental water to the reclaimed water storage tank remains a part of the combined Project but is not a required component for the incentive- disincentive provision in Article 4.04. ARTICLE 2 - THE PROJECT 2.01 The Project for which the Work under the Contract Documents may be the whole or only a part is generally described as follows: Saratoga Springs Water Treatment Plant,Reclaimed Pump Station, and Potable and Reclaimed Water Distribution Main Project Clay County Utility Authority Project No. CCUA Project No. 1128-002, Bid No. 21/22-A02 ARTICLE 3 - ENGINEER 3.01 The Project has been designed by CDM Smith 4651 Salisbury Road, Suite 420, Jacksonville, Florida, 32256. email sterlinglm(c`iicdmsmith.com, Lisa Sterling P.E. (Engineer), who is to act as Owner's representative, assume all duties and responsibilities, and have the rights and authority assigned to Engineer in the Contract Documents in connection with the completion of the Work in accordance with the Contract Documents. ARTICLE 4 - CONTRACT TIMES 4.01 Time of the Essence A. All time limits for Milestones, if any, Substantial Completion, and completion and readiness for final payment as stated in the Contract Documents are of the essence of the Contract. 4.02 Days to Achieve Substantial Completion and Final Payment A. All Work will be substantially completed within 425 days after the date when the Contract Times commence to run as provided in Paragraph 2.03 of the General Conditions (Contract Commencement) and completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions within 485 days after the date when the Contract Times commence to run. 005000-3 CCUA Project No: 1128-002 CDM Smith Project No.259164-240363 STANDARD FORM OF AGREEMENT Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project January 2022 4.03 Liquidated Damages A. Contractor and Owner recognize that time is of the essence of this Agreement and that Owner will suffer financial loss if the Work is not completed within the times specified in Paragraph 4.02 above, plus any extensions thereof allowed in accordance with Article 12 of the General Conditions. The parties also recognize the delays, expense, and difficulties involved in proving in a legal or arbitration proceeding the actual loss suffered by Owner if the Work is not completed on time. Accordingly, instead of requiring any such proof, Owner and Contractor agree that as liquidated damages for delay (but not as a penalty), Contractor shall pay Owner $200 for each day that expires after the time specified in Paragraph 4.02 for Substantial Completion until the Work is substantially complete. After Substantial Completion, if Contractor shall neglect, refuse, or fail to complete the remaining Work within the Contract Time or any proper extension thereof granted by Owner, Contractor shall pay Owner $100 for each day that expires after the time specified in Paragraph 4.02 for completion and readiness for final payment until the Work is completed and ready for final payment. 4.04 Iu,,rrt v,-DiSirr,,rrlivl, for 1110 R,,1d111,d ILrlivrr of llr, v Recommendation to BOS to delete Article A. The OWNER desir,s to ,ap,,11t, Ge1151f11,t1er1 of 111, Rwl4.04 r vr11011 01 ,11,, Cvrrlra,,l ti 111i11i111ic,,, the ulwu V%,uicucc to 11-3 ,,uJlvul,,r, cmd to pre v ,,ally d.,li',,ry of r,,,,ldulr,,,l waL. by 1,,.1th.ing th,, t1111 of wuSlr u,,lrorl. Irl vi d,,r tv goal, an ur,,,rllr v - to provision is 03lablisl1,,.1 for tll,, Co11tld,,t. Th,, total rrrwrrtiv,,payrrr,,..t yr ,1r5ruwrllrv, ,l,du,lreu 'shall not $360,000.00. B. In the CI,ent th,, CONTRACTOR substantially ,v111Y1,t, th,, Couto...A prior to iln. ,AI/11 ivrr of the time foi Substantial Completion 5u,,h that th,, OWNER.,alr U1ov to 16 ,,ustoncn f1o11i this fd,,ility as i11t,,nd,d,th,,OWNER will Nay tln. CONTRACTOR all iu,,rlliv, pay111,ul in the Darly Vala,, a aou it, $6,000.00, for ,d,h ,,ak1i a1 day tlr,, d,,ludl Substantial Completion dat 1,,,,,,,l,,s 125 days from contract C. for pttrpos,,s of the calculation and the d,,t,,rnrintion of entitlemctrt to tlr,, inc,,nti'e payracrrt ill Huth. 1,,a3v11, circe1115ta11cc vvlrat3v.,v of fault, oav,,aid ,A,,yl ur Ili, of a catastrophic Gent(1.e., lruniearie of a d,,elared 5tat,, of,,ur,rg, 3ta11lial Ce1IINlctierl IN;thin_ th,, Ally J4 abl., Substantial Completion Time (425 days Eon. ,,outlavt celilrn,ru.,.,rrl,,lft), the OWNER shall from the monies due th,, CONTRACTOR 111,,Daily Valu.,, $6,000.00, fv1 day completion exce,,ds the 425 days f1 o11i contract,,eu1111,,u,,,,111,alt. Tl1is d.,duction dua11 b,,t11,, disinc,,ntire for the CONTRACTOR'S failing to tilir,,ly 1i1.,t tl1,, mutually ag1,,,,d upvrr Substantial Completion Time. Liquidated dauiag,,.,,main in ,,ff,,,,t and a.,, applicable. ARTICLE 5 - CONTRACT PRICE 005000-4 CCUA Project No:1128-002 CDM Smith Project No 259164-240363 STANDARD FORM OF AGREEMENT Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project January 2022 5.01 Owner shall pay Contractor for completion of the Work in accordance with the Contract Documents an amount in current funds equal to the sum of the amounts determined pursuant to Paragraphs 5.01.A, and 5.01.B below: A. For all Work other than Unit Price Work, a Lump Sum of: $ 13,469,000.00 (Numerals) Thirteen Million Four Hundred Sixty-Nine Thousand Dollars and Zero Cents (Written) All specific cash allowances are included in the above price and have been computed in accordance with paragraph 11.02 of the General Conditions. B. For all Work, at the prices stated in Contractor's Bid, attached hereto as an exhibit. ARTICLE 6 - PAYMENT PROCEDURES 6.01 Submittal and Processing of Payments A. Contractor shall submit Applications for Payment in accordance with Article 14 of the General Conditions. Applications for Payment will be processed by Engineer as provided in the General Conditions. 6.02 Progress Payments; Retainage A. Owner shall make one progress payment per month on account of the Contract Price on the basis of Contractor's Applications for Payment on or about the 1" or 3rd Wednesday of each month during performance of the Work as provided in Paragraphs 6.02.A.1 and 6.02.A.2 below. All such payments will be measured by the schedule of values established as provided in Paragraph 2.07.A of the General Conditions (and in the case of Unit Price Work based on the number of units completed) or, in the event there is no schedule of values, as provided in the General Requirements: . Prior to Substantial Completion,progress payments will be made in an amount equal to the percentage indicated below but, in each case, less the aggregate of payments previously made and less such amounts as Engineer may determine or Owner may withhold, including but not limited to liquidated damages, in accordance with Paragraph 14.02 of the General Conditions: a. Ninety-five percent (95%) of the Work completed including the cost of materials and equipment stored and secured on the Site, but not incorporated in the Work (with the balance being retainage). 2. Upon Substantial Completion, Owner shall pay an amount sufficient to increase total payments to Contractor to ninety-five percent (95%) of the Work completed, less such amounts as Engineer shall determine in accordance with Paragraph 14.02.B.5 of the 005000-5 CCUA Project No: 1128-002 CDM Smith Project No.259164-240363 STANDARD FORM OF AGREEMENT Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project January 2022 General Conditions and less one hundred percent (100%) of Engineer's estimate of the value of the Work to be completed or corrected as shown on the tentative list of items to be completed or corrected attached to the certificate of Substantial Completion. 6.03 Project Closeout A. Owner shall develop a list of items required to render complete, satisfactory, and acceptable the Work purchased by Owner. The process for the development of the list, including responsibilities of Owner and Contractor in developing and reviewing the list and a reasonable time for developing the list, are as follows: 1. For construction projects having an estimated cost of less than $10 million, within 30 calendar days after reaching substantial completion of the Work; or 2. For construction projects having an estimated cost of $10 million or more, within 30 calendar days, unless otherwise extended by contract not to exceed 60 calendar days, after reaching substantial completion of the Work. B. If this Agreement between Owner and Contractor relates to Work covering more than one building or structure, or involves a multi-phased Project, the list shall contain items required to render complete, satisfactory, and acceptable all of the Work for each building, structure, or phase of the Project within the time limitations provided in subsection 1, above. C. The failure to include any corrective work or pending items not yet competed on the list developed pursuant to subsection 1 or subsection 2, above, does not alter the responsibility of the Contractor to complete all of the Work. D. Upon completion of all items on the list, Contractor may submit a payment request for all remaining retainage withheld by Owner pursuant to Section 255.078, Florida Statutes (2007) or any successor statue thereto. If a good faith dispute exists as to whether one or more items identified on the list have been completed pursuant to this Agreement, Owner may continue to withhold an amount not to exceed one-hundred fifty percent (150%) of the total costs to complete such items. E. All items of the Work that require correction under this Agreement and that are identified after the preparation and delivery of the list remain the obligation of Contractor as defined by this Agreement. F. Warranty items may not affect the final payment of retainage as provided in this section or as provided in this Agreement between Contractor and its subcontractors and suppliers. G. Retainage may not be held by Owner or Contractor to secure payment of insurance premiums under a consolidated insurance program or series of insurance policies issued to Owner or Contractor for the Project or a group of projects,and the final payment of retainage as provided in the section may not be delayed pending a final audit by Owner's or Contractor's insurance provider. 005000-6 CCUA Project No: 1128-002 CDM Smith Project No.259164-240363 STANDARD FORM OF AGREEMENT Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project January 2022 H. If Owner fails to comply with its responsibilities to develop the list required under subsection 1 or subsection 2, above, as defined in this Agreement, within the time limitations provided in subsection 1, above, Contractor may submit a payment request for all remaining retainage withheld by Owner pursuant to Section 255.078, Florida Statutes (2007) or any successor statue thereto. Owner need not pay or process any payment request for retainage if Contractor has, in whole or in part, failed to cooperate with Owner in the development of the list of failed to perform its contractual responsibilities, if any, with regard to the development of the list or if Section 255.078 (6), Florida Statutes (2007) or any successor statue thereto applies. 6.04 Final Payment A. Upon final completion and acceptance of the Work in accordance with Paragraph 14.07 of the General Conditions, Owner shall pay the remainder of the Contract Price as recommended by Engineer as provided in said Paragraph 14.07. ARTICLE 7 - INTEREST 7.01 All payments due for the Work as provided in Article 14 of the General Conditions and not made within the applicable time limits shall bear interest at the rate specified in Section 255.073 (4), Florida Statutes (2007) or any successor statue thereto. ARTICLE 8—CONTRACTOR'S REPRESENTATIONS 8.01 In order to induce Owner to enter into this Agreement, Contractor makes the following representations: A. Contractor has examined and carefully studied the Contract Documents and the other related data identified in the Bidding Documents. B. Contractor has visited the Site and become familiar with and is satisfied as to the general,local, and Site conditions that may affect cost, progress, and performance of the Work. C. Contractor is familiar with and is satisfied as to all federal, state, and local Laws and Regulations that may affect cost,progress, and performance of the Work. D. Contractor has carefully studied all: (1) reports of explorations and tests of subsurface conditions at or contiguous to the Site and all drawings of physical conditions in or relating to existing surface or subsurface structures at or contiguous to the Site (except Underground Facilities) which have been identified in the Supplementary Conditions as provided in Paragraph 4.02 of the General Conditions and (2) reports and drawings of a Hazardous Environmental Condition, if any, at the Site which has been identified in the Supplementary Conditions as provided in Paragraph 4.06 of the General Conditions. See Appendix for Geotechnical Report. 005000-7 CCUA Project No: 1128-002 CDM Smith Project No.259164-240363 STANDARD FORM OF AGREEMENT Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project January 2022 E. Contractor has obtained and carefully studied (or assumes responsibility for doing so) all additional or supplementary examinations, investigations, explorations,tests, studies, and data concerning conditions (surface, subsurface, and Underground Facilities) at or contiguous to the Site which may affect cost, progress, or performance of the Work or which relate to any aspect of the means, methods, techniques, sequences, and procedures of construction to be employed by Contractor, including any specific means, methods, techniques, sequences, and procedures of construction expressly required by the Bidding Documents, and safety precautions and programs incident thereto. F. Contractor does not consider that any further examinations, investigations, explorations,tests, studies, or data are necessary for the performance of the Work at the Contract Price,within the Contract Times, and in accordance with the other terms and conditions of the Contract Documents. G. Contractor is aware of the general nature of work to be performed by Owner and others at the Site that relates to the Work as indicated in the Contract Documents. H. Contractor has correlated the information known to Contractor, information and observations obtained from visits to the Site, reports and drawings identified in the Contract Documents, and all additional examinations, investigations, explorations, tests, studies, and data with the Contract Documents. I. Contractor has given Engineer written notice of all conflicts, errors, ambiguities, or discrepancies that Contractor has discovered in the Contract Documents, and the written resolution thereof by Engineer is acceptable to Contractor. J. The Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. ARTICLE 9 - CONTRACT DOCUMENTS 9.01 Contents A. The Contract Documents consist of the following: 1. This Agreement(pages 005000-1 to 005000-12, inclusive). 2. Performance bond (pages 006000-I to 006000-2, inclusive). 3. Payment bond (pages 006000-1 to 006000-2, inclusive). 4. General Conditions (C-700 pages 1 to 61 , inclusive). 5. Supplementary Conditions (pages 008000-1 to 008000-12, inclusive). 6. Specifications as listed in the table of contents of the Project Manual. 005000-8 CCUA Project No: 1128-002 CDM Smith Project No.259164-240363 STANDARD FORM OF AGREEMENT Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project January 2022 7. Drawings consisting of 138 sheets with each sheet bearing the following general title: Saratoga Springs WTP and Reclaimed Pump Station 8. Addenda(numbers 1 to 10, inclusive). 9. Exhibits to this Agreement(enumerated as follows): a. Contractor's Bid (pages 1 to 28 , inclusive). b. Documentation submitted by Contractor prior to Notice of Award (pages to , inclusive). 10. The following which may be delivered or issued on or after the Effective Date of the Agreement and are not attached hereto: a. Notice to Proceed (pages to , inclusive). b. Work Change Directives. c. Change Order(s). B. The documents listed in Paragraph 9.01.A are attached to this Agreement(except as expressly noted otherwise above). C. There are no Contract Documents other than those listed above in this Article 9. D. The Contract Documents may only be amended, modified, or supplemented as provided in Paragraph 3.04 of the General Conditions. ARTICLE 10 - MISCELLANEOUS 10.01 Terms A. Terms used in this Agreement will have the meanings stated in the General Conditions and the Supplementary Conditions. 10.02 Assignment of Contract A. No assignment by a party hereto of any rights under or interests in this Agreement will be binding on another party hereto without the written consent of the party sought to be bound; and, specifically but without limitation, moneys that may become due and moneys that are due may not be assigned without such consent(except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to the contrary in any written consent to an assignment, no assignment will release or discharge the assignor from any duty or responsibility under the Contract Documents. 005000-9 CCUA Project No: 1128-002 CDM Smith Project No.259164-240363 STANDARD FORM OF AGREEMENT Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project January 2022 10.03 Successors and Assigns A. Owner and Contractor each binds itself, its partners, successors, assigns, and legal representatives to the other party hereto, its partners, successors, assigns, and legal representatives in respect to all covenants, agreements, and obligations contained in the Contract Documents. 10.04 Severability A. Any provision or part of the Contract Documents held to be void or unenforceable under any Law or Regulation shall be deemed stricken, and all remaining provisions shall continue to be valid and binding upon Owner and Contractor, who agree that the Contract Documents shall be reformed to replace such stricken provision or part thereof with a valid and enforceable provision that comes as close as possible to expressing the intention of the stricken provision. 10.05 Other Provisions A. WAIVER: The failure of either party to exercise any of its rights is not a waiver of those rights. A party waives only those rights specified in writing and signed by the party waiving its rights. Oral modification or rescission of this Agreement by an employee or agent of either party,shall not release either party of its obligations under this Agreement, shall not be deemed a waiver of any rights of either party to insist upon strict performance hereof, or of either party's rights or remedies under this Agreement or by law, and shall not operate as a waiver of any of the provisions hereof. B. Remote Access:The Owner may grant remote access,if required,to complete the Contractor's contractual obligations. The Contractor by accepting remote access, agrees to comply with the following provisions: 1. The Contractor will make a formal request for remote access if needed. The request will contain the following: (a) The names of any employees that will use the remote connection. (b) The scope of access needed(e.g. single machine, server, or service e.g.phone system). (c) The duration that access is needed. This date should not exceed the length of the contract. (d) List of applications that will be employed over the remote connection. 2. The Contractor shall maintain current industry standard anti-virus and anti-malware tools on the Contractor's IT systems. The Contractor shall maintain up-to-date security patches, hotfixes,security patches and other similar software and firmware changes on the system(s) used to access the remote connection. 3. The Contractor shall take reasonable precautions to prevent the transmission of a computer virus, malware, or other malicious code. 4. The Contractor shall take reasonable precautions to prevent an open connection or port that would allow an unauthorized connection to the Owner's computer, server or system. • 005000-10 CCUA Project No: 1128-002 CDM Smith Project No.259164-240363 STANDARD FORM OF AGREEMENT Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project January 2022 5. If the Contractor has suffered a computer virus, intrusion, ransomware, or other cyber- attack that might put Owner's data at risk, the consultant or contractor will notify the Owner, within two (2) hours after discovery. 6. The Contractor shall only use the remote connection for the purposes of fulfilling the Contractor's contractual obligations with the Owner. 7. The Owner reserves the right to change the remote connection application, encryption, or methodology, without prior notice, in order to maintain its secure network. • 8. The Contractor shall not share the remote connection. If a subcontractor or vendor requires remote access,the subcontractor or vendor shall contact Owner and make a formal request for a separate remote connection that contains the same information as the Contractor. 9. The Owner reserves the right to sever the remote connection at any time in order to maintain its secure network. It is the Contractor's responsibility to seek an alternate means to share data. 10. At no time will the contractor attempt to copy,transmit,or store confidential, or Personally Identifiable Information contained in the Owner's computer, server or system. 11. At the conclusion of the contract the Contractor agrees to purge any of the Owner's data that was obtained over the remote connection, and provide a written statement attesting to the data destruction. If the Contractor wishes to retain this data, a formal request must be submitted to the Owner prior to the completion of the contract. 12. The Contractor shall require all its employees, subconsultant(s), vendor(s) and subcontractor(s)to comply with provisions of this paragraph. 005000-11 CCUA Project No: 1128-002 CDM Smith Project No.259164-240363 STANDARD FORM OF AGREEMENT • Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project January 2022 IN WITNESS WHEREOF, Owner and Contractor have signed this Agreement in duplicate. One counterpart each has been delivered to Owner and Contractor. All portions of the Contract Documents have been signed or identified by Owner and Contractor or on their behalf. This Agreement will be effective on 0 ( P`--' (Dna (which is the Effective Date of the Agreement). OWNER: CONTRACTOR: CLA` COUNTY UT i ITY A‘ ' ORITY PETTICOAT-SCHMITT CIVIL CONTRACTORS,INC. By: ,.�--- `t� By: Lauren C.Atwell,COO dpere 4• - n, P.E., MBA xec '� r [CORPORATE SEAL] Attest: til Attest: 1i( _) j-ixiiCAyv U Address for giving notices: Address for giving notices: 3176 Old Jennings Road 6380 Philips Highway Middleburg, Florida 32068 Jacksonville,FL 32216 License No. CGC057651 (Where applicable) Agent for service of process: (If CONTRACTOR is a corporation or a Partnership, attach evidence of authority to sign.) Designated Representative: Designated Representative: Name: Warrick Sams, MBA, CPPO Name: Ryan Schmitt Title: Construction and Inspection Title: President Services Manager Address: 3176 Old Jennings Road Address: 6380 Philips Highway Middleburg, Florida 32068 Jacksonville, FL 32216 Phone: (904)213-2403 Phone: 904-751-0888 Facsimile: (904) 213-2469 Facsimile: 904-751-0988 1 005000-12 CCUA Project No: 1128-002 CDM Smith Project No.259164-240363 STANDARD FORM OF AGREEMENT Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project January 2022 THIS PAGE INTENTIONALLY LEFT BLANK 005000-13 CCUA Project No: 1128-002 CDM Smith Project No 259164-240363 STANDARD FORM OF AGREEMENT Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project January 2022 Bidder's I►►surability: The Bidder confirms that the Bidder has reviewed the current types,amounts,and requirements of insurance coverages included in the Contract Documents including, but not limited to, general liability, workers compensation, bodily injury, personal and advertising injury, property, builders risk, installation floater, excess or umbrella liability,environmental pollution,waiver of subrogation,additional insured,etc. Bidder's current Workers Compensation and Employers Liability Insurance Information: Bidder's current Experience Rating: .087 Bidder's current Experience Modification Factor: 087 The Bidder pledges that all such required coverages, types, requirements, and limits specified in the Contract Documents shall be provided within 15 days of the notice of intent to award or the Owner may consider B.'dder to be in default and annul the Notice of Award and the Bid security of that Bidder will be forfeit d. 12/21/21 alder s Signa a Date LIST OF MAJOR SUBCONTRACTORS The Bidder expressly agrees that: 1. If awarded a Contract as a result of this Proposal, the major Subcontractors used in the prosecution of the work will be those listed below. 2. The following list includes all Subcontractors who will perform work in the amount of approximately$10,000 or more on this Contract. 3. The Subcontractors listed below are financially responsible and are qualified to perform the work required. Category Name of Subcontractor Address Coghurn Brothers Jacksonville,FL Electrical Are-Con C:ainesville EL — Pre-Stressed Tank Jax Mechanical Jacksonville_FL HVAC McKendrep Jacksonville,_.EL Plumbing C R'C Painting Tamn_,a.EL Painting EK Masonary Jacksnnville EL Masons►i 003000-4 CCUA Project No:1128-002 CDM Smith Project No.259164-240363 BID FORM Saratoga Springs wrP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Mains October 2021 SECTION 004000 BID BOND KNOW ALL MEN BY THESE PRESENTS: That we, the undersigned, Petticoat-Schmitt Civil Contractors,Inc. as Principal, and Travelers Casualty and Surety Company of America as Surety, are hereby held and firmly bound unto Clay County Utility_Authority as OWNER in the penal sum of Five Percent of Bid Amount for payment of which, well and truly to be made, we hereby jointly and severally bind ourselves, successors and assigns. Signed, this 10th day of December ,20 21 The Condition of the above obligation is such that whereas the Principal has submitted to Clay County Utility Authority a certain BID,attached hereto and hereby made a part hereof to enter into a contract in writing for the Saratoga Springs WTP,Reclaimed Pump Station, and Potable and Reclaimed Water Distribution Main Project Clay County Utility Authority Bid No. 21/22-A02. NOW,THEREFORE, (a) If said BID shall be rejected, or (b) If said BID shall be accepted and the Principal shall execute and deliver a contract in the Form of Contract attached hereto (properly completed in accordance with said BID)and shall furnish a BOND for his faithful performance of said contract,and for the payment of all persons performing labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said BID, then this obligation shall be void,otherwise the same shall remain in force and effect;it being expressly understood and agreed that the liability of the Surety of all and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated. The Surety,for value received,hereby stipulates and agrees that the obligations of said Surety and its BOND shall be in no way impaired or affected by any extension of time within which the OWNER may accept such BID; and said Surety does hereby waive notice of any such extension. IN WITNESS WHEREOF,the Principal and the Surety have hereunto set their hands and seals,and such of them as are corporations have caused their corporate seals to be hereto affixed and these �.. (. c. 'presents to be signed by their proper officers, the day and year first set forth above. . r1 . BY: QlYU .! ; Principal:Petticoat-Schmitt Civil 'tweeters,In Travelers Casualty and Sur ty Company of America • . • 'r •; ( Surety Benjamin Powell,Attorney-in-Fact 004000-1. • CCUA Project No:1128-002 CDM Smith Project No,259164-240363 131D BOND) Saratoga Springs WTI',Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Mains October 2021 - Travelers Casualty and Surety Company of America AWN Travelers Casualty and Surety Company TRAVELERS ,i St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surely Company, and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (heroin collectively called the"Companies.),and that the Companies do hereby make,constitute and appoint Robert T Theus of JACKSONVILLE , Florida , their true and lawful Allorney(s)-in-Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business Of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused Ibis instrument to be signed, and their corporate seals to be hereto affixed,this 21st day of April, 2021. ��y?w7rry iY'�•Yoo �ttN�Kly�' �) it;••-ii,,,. °ep kWrynvrro�o, � unu . � � asxs,rrc f•c .,w Stale of Connecticut By:.. ' City of Hartford ss. Robert L.Rene , ertier Vice President On this the 21st day of April, 2021, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of each of the Companies, and that he, as such, being authorized so to do, executed lire foregoing Instrument for the purposes therein contained by signing on behalf of said Companies by himself as a duly authorized officer. •11i '1}b , IN WITNESS WHEREOF,I hereunto set my hand and official seal. i' My Commission expires the 30th day of June,2026 a •'ram " 414{/'i,6r Anna P.Nowik,Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of each of the Companies,which resolutions are now in full force and effect,reading as follows: RESOLVED, that the Chairman. the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President,any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys•ln-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of Indemnity, and other writings obligatory In the nature of a bond, recognizance, or conditional undertaking. and any of said officers or the Board of Directors al any lime may remove any such appointee and revoke the power given him or her,and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation Is In writing and a copy!hereof is filed in the office of the Secretary;and it Is FURTHER RESOLVED, that any bond, recognizance, contract of Indemnity, or writing obligatory In the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vico Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and seated with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, If required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority:and ft Is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice Presldenl, any Senior Vice President, any Vice President,any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in- Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company In the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of each of the Companies, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies,which remains in full force and effect. Dated this 10th day of December , 2021 . P7�"�r J�.n+coo �ttw +\ ci �• �'p tY;u0R7, \ t a.l te £ .iIeutcretary To verify thy authenticity of this PowerofAttorney,please call us at1-800.421-3880. Please refer to the above-named Attorney(.$)-in-Fact and the details of the bond to which this PowerofAttorney is attached. SWORN STATEMENT PURSUANT TO SECTION 287.133 (3) (A), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL, AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement is submitted to Clay County Utility Authority (print name of public entity) By Kimberly S.Bryan,Vice President (print individual's name and title) whose business address is 6380 Philips Hwy.,Jacksonville,FL 32216 And (if applicable)its Federal Employer Identification Number(FEIN) is 26-1293750 (If the entity has no FEIN, include Social Security Number of the individual signing this sworn statement: 2. I understand that a"public entity crime"as defined in Paragraph 287.133 (1) (G), Florida Statutes means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including,but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133 (1) (B), Florida Statutes means finding of guilt or a conviction of public entity crime, with or without an adjudication of guilt, in any federal or state trail court of record relating to charges brought by indictment, or information after July 1, 1989, as a result of juiy verdict, nonjury trial, or entry of a plea of guilty or nolo contendere. 4. I understand that an"affiliate" as defined in Paragraph 287.133 (1) (A),Florida Statutes, means: 1. A predecessor or successor of a person convicted of a public entity crime; or 2. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 004200-1 CCUA Project No: 1128-002 CDM Smith Project No.2 5 9 1 64-2403 63 PUBLIC ENTITY CRIMES Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Mains October 2021 II 5. I understand that a "person" as defined in Paragraph 287.133 (1) (E), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which aids or applies to bid on contracts for the provision of goods or services led by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives,partners, shareholders, employees, members, and agents who are active in management of an entity. 6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. [Indicate which statement applies.] n Neither the entity submitting this sworn statement nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. n The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. n The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or and affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However,there has been a subsequent proceeding before a Hearing Officer of the State of Florida Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. (Attach a copy of final order) 1 I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT ' PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRE HOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR C T' 1 TW0 F An ANGE N TF �J INFORMATION CONTAINED IN THIS FORM.12/16/21 ( gna tire) (date) STATE OF FLORIDA COUNTY OF DWAL PERSONALLY APPEARED BEFORE ME, the undersigned authority Kimberly S.Bryan who after first being sworn by me, affixed his/her (name of individual signing) signature in the space provided above on this 16th day of December , 20 21. Mycoil i .s.c ne 'Ili •e•:O ' s 3 o'it-��--- r,►•+ Notary Public State of Florida NOTARY PUBLIC Jodi Marie Marlon N My Commission GG 336481 4,wwdr Expires08/01/2023 004200-2 CCUAI' .. . . ,. CDM Smith Project No.259164-240363 PUBLIC ENTITY CRIMES Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Mains October 2021 SECTION 004300 TRENCH SAFETY AFFIDAVIT Trench excavations on Projects authorized under this Contract are expected to be in excess of 5 feet deep, The Occupational Safety and Health Administration excavation safety standards, 29 CFR 1926.650 Subpart P trench safety standards will be in effect during the period of construction of the Project. Bidderacknowledges that included in the Bid Price are costs for complying with the Florida Trench Safety Act (90-96, Laws of FL) effective October I, 1990, and hereby gives assurance that, if awarded the Contract,the Contractor or Subcontractor performing trench excavation work on the Project will comply with the applicable trench safety standards. The Bidder further identifies the costs as follows: Trench Safety Units of Item Unit Measure Unit Extended (Description) Quantity (LF,SY) Cost Cost BASE BID ITEMS: 0 A. Slope Trench 12,000 1.F 1,00 12,000.00 13. Trench Shield 600 SF 10.00 6,000.0.0 C. ALTERNATE NO. I ITEMS: N/A 'I'O'I'AL$ 18,000.00 FAILURE TO COMPLETE THE ABOVE SHALL RESULT IN THE BID BEING DECLARED NON-RESPONSIVE. COM A I NAME: Petticoat-Schmitt Civil Contractors,Inc. DATE: 12/21/21 BY. a 004300-z CCt1A Project No:1128-002 COM Smith Project No.2 59 1 64-2403 63 'TRENCH SAFETY AFFADAVIT Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Mains October 2021 Form 11Y r.9 Request for Taxpayer Give Form to the (Rev.October2010) Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. Internal Revenue Service iie Go to www.irs.gov/FormW9 for Instructions and the latest information. 1 Name(as shown on your Income tax return).Name Is required on this lino:do not leave this line blank. Petticoat-Schmitt Civil Contractors Inc 2 Business name/disregarded entity name,If different from nbove m 3 Check appropriate box for federal tax classification of theperson whose name is entered on line 1.Check onlyone of the 4 Exemptions(codes apply onlyto � P PP Y yr following seven boxes, certain entitles,not individuals;see Q. instructions on page 3): o ❑ Individual/sole proprietor or ❑ C Corporation El S Corporation El Partnership ❑Trust/estate ai G single-member LLC Exempt payee code(f any) 0 ' ❑ Limited liability company.Enter the tax classification(C=C corporation,5=S corporation,P=Partnership)I o 2 Note:Check the appropriate box In the line above for the lax classification of the single-member owner. Do not check Exemption from FATCA reporting F t.LC if the LLC is classified as a single-member LLC that Is disregarded from the owner unless tire owner of the LLC is code(If any) another LLC that Is not disregarded from the owner for US.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. y ❑ Other(see Instructions)e. (App5os ro accounts mavda'nod oWs do the 1).9J (� 0 Address(number,street,and apt.or suite no.)See Instructions. Requester's name and address(optional) in 6380 Philips Highway 6 City,state,end ZIP code Jacksonville, FL 32216 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 fine i to avoid I Sociai security number 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. or Note:If the account is In more than one name,see the instructions for line 1.Also see What Name and I Employer Identification number I Number To Give the Requester for guidelines on whose number to enter, 2 6 — 1 2 9 3 7 5 0 Part Ii Certification Under penalties of perjury,I certify that: 1.The number shown on this farm is my correct taxpayer identification number(or!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 intorest and dividends on your tax return,For real estate transactions,Item 2 does not apply.For mortgage interest paid, acquisition or abandonment of secured.roperty,as I atien of debt,co ' utlons to an Individual retirement arrangement(IRA),and generally,payments other than Interest and dividends,ye • not uire� Ign thg.aer'ti cello , Ut you must provide your correct TIN,See the Instructions for Part II,later. SignSignature of 0 Here U.B.person). _ bate - /-eX—, ?Ue2/ General Instructions • Form 1099-DIV(dividends,Including those from stocks or mutual funds) Section references ere to the Internal Revenue Code unless otherwise •Form 1099-MiSC(various types of income,prizes,awards,or gross noted. proceeds) Future developments.For the latest information about developments •Form 1099-B(stock or mutual fund sales and certain other related to Form W-9 and its Instructions,such as legislation enacted transactions by brokers) after they were published,go to www.frs,gov/FormW9. •Form 1099-S(proceeds from real estate transactions) Purpose of Form •Form 1099-K(merchant card and third party network transactions) An individual or entity(Form W-9 requester)who Is required to file an •Form 1098(home mortgage interest),1098-E(student loan interest), Information return with the IRS must obtain your correct taxpayer 1098-T(tuition) identification number(TIN)which may be your social security number •Form 1099-C(canceled debt) (SSN),individual taxpayer identification number(ITIN),adoption •Form 1099-A(acquisition or abandonment of secured property) taxpayer identification number(ATIN),or employer identification number (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(Including a resident amount reportable on an information return.Examples of Information alien),to provide your correct TIN. returns include,but are not limited to,the following. if you do not return Form W-9 to the requester with a TiN,you might •Form 1099-iNT(interest earned or paid) be subject to backup withholding.See What is backup withholding, later, Cat.No.10231X Form W-9(Rev.10-2018) Form W-5(Rev.10-2010) Page 2 By signing the filled-out form,you: Example.Article 20 of the U.S.-China income tax treaty allows an 1.Certify that the TIN you are giving is correct(or you are waiting for a exemption from lax for scholarship Income received by a Chinese number to be issued), student temporarily present in the United States.Under U.S.law,this student will become a resident alien for tax purposes if his or her stay in 2.Certify that you are not subject to backup withholding,or the United States exceeds 5 calendar years.However,paragraph 2 of 3.Claim exemption from backup withholding if you are a U.S.exempt the first Protocol to the U.S.-China treaty(dated April 30,1984)allows payee.If applicable,you are also certifying that as a U.S.person,your the provisions of Article 20 to continue to apply even after the Chinese allocable share of any partnership income from a U.S.trade or business student becomes a resident alien of the United States.A Chinese is not subject to the withholding tax on foreign partners'share of student who qualifies for this exception(under paragraph 2 of the first effectively connected income,and protocol)and Is relying on this exception to claim an exemption from tax 4.Certify that FATCA code(s)entered on this form(if any)Indicating on his or her scholarship or fellowship income would attach to Form that you are exempt from the FATCA reporting,Is correct.See What is W-9 a statement that includes the information described above to FATCA reporting, later,for further information. support that exemption. Note:If you are a U.S.person and a requester gives you a form other If you are a nonresident alien or a foreign entity,give the requester the than Form W-9 to request your TIN,you must use the requester's form if appropriate completed Form W-8 or Form 8233. it is substantially similar to this Form W-9. Backup Withholding Definition of a U.S.person.For federal tax purposes,you are considered a U.S.person if you are: What is backup withholding?Persons making certain payments to you •An individual who Is a U.S.citizen or U.S.resident alien; must under certain conditions withhold and pay to the IRS 24%of such payments.This is called"backup withholding." Payments that may be •A partnership,corporation,company,or association created or subject to backup withholding include interest,tax-exempt interest, organized in the United States or under the laws of the United States; dividends,broker and barter exchange transactions,rents,royalties, •An estate(other than a foreign estate);or nonemployee pay,payments made In settlement of payment card and •A domestic trust(as defined in Regulations section 301.7701-7). third party network transactions,and certain payments from fishing boat operators.Real estate transactions are not subject to backup Special rules for partnerships.Partnerships that conduct a trade or withholding. business in the United States are generally required to pay a withholding You will not be subject to backup withholding on payments you tax under section 1446 on any foreign partners'share of effectively receive if you give the requester your correct TIN,make the proper connected taxable income from such business.Further,in certain cases certifications,and report all your taxable interest and dividends on your where a Form W-9 has not been received,the rules under section 1446 tax return. require a partnership to presume that a partner is a foreign person,and pay the section 1446 withholding tax,Therefore,if you are a U.S.person Payments you receive will be subject to backup withholding if: that Is a partner in a partnership conducting a trade or business in the 1.You do not furnish your TIN to the requester, United States,provide Form W-9 to the partnership to establish your 2.You do not certify your TIN when required(see the instructions for U.S.status and avoid section 1446 withholding on your share of Part II for details), partnership income. In the cases below,the following person must give Form W-9 to the 3.The IRS tells the requester that you furnished an Incorrect TIN, partnership for purposes of establishing its U.S.status and avoiding 4.The IRS tells you that you are subject to backup withholding withholding on Its allocable share of net income from the partnership because you did not report all your interest and dividends on your tax conducting a trade or business In the United States. return(for reportable Interest and dividends only),or •In the case of a disregarded entity with a U.S.owner,the U.S.owner 5.You do not certify to the requester that you are not subject to of the disregarded entity and not the entity; backup withholding under 4 above(for reportable Interest and dividend •In the case of a grantor trust with a U.S.grantor or other U.S.owner, accounts opened after 1983 only). generally,the U.S.grantor or other U.S.owner of the grantor trust and Certain payees and payments are exempt from backup withholding. not the trust;and See Exempt payee code,later,and the separate Instructions for the •In the case of a U.S.trust(other than a grantor trust),the U.S.trust Requester of Form W-9 for more information. (other than a grantor trust)and not the beneficiaries of the trust. Also see Special rules for partnerships, earlier. Foreign person.If you are a foreign person or the U.S.branch of a What is FATCA Reporting? foreign bank that has elected to be treated as a U.S.person,do not use Form W-9.Instead,use the appropriate Form W-8 or Form 8233(see The Foreign Account Tax Compliance Act(FATCA)requires a Pub,515,Withholding of Tax on Nonresident Aliens and Foreign participating foreign financial Institution to report all United States Entities). account holders that are specified United States persons.Certain Nonresident alien who becomes a resident alien.Generally,only a payees are exempt from FATCA reporting.See Exemption from FATCA nonresident alien Individual may use the terms of a tax treaty to reduce reporting code,later,and the Instructions for the Requester of Form or eliminate U.S.tax on certain types of Income.However,most tax W-9 for more information. treaties contain a provision known as a"saving clause."Exceptions Updating Your Information specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise You must provide updated information to any person to whom you become a U.S.resident alien for tax purposes. claimed to be an exempt payee if you are no longer an exempt payee If you are a U.S.resident alien who is relying on an exception and anticipate receiving reportable payments in the future from this contained in the saving clause of a tax treaty to claim an exemption person.For example,you may need to provide updated information if from U.S.tax on certain types of Income,you must attach a statement you are a C corporation that elects to be an S corporation,or if you no to Form W-9 that specifies the following five items. longer are tax exempt.In addition,you must furnish a new Form W-9 if 1.The treaty country.Generally,this must be the same treaty under the name or TIN changes for the account;for example,if the grantor of a which you claimed exemption from tax as a nonresident alien. grantor trust dies. 2.The treaty article addressing the Income. Penalties 3.The article number(or location)in the tax treaty that contains the saving clause and its exceptions. Failure to furnish TIN.If you fail to furnish your correct TIN to a 4.The type and amount of income that qualifies for the exemption requester,you are subject to a penalty of$50 for each such failure from tax. unless your failure is due to reasonable cause and not to willful neglect. 5.Sufficient facts to justify the exemption from tax under the terms of Civil penalty for false information with respect to withholding.If you the treaty article. make a false statement with no reasonable basis that results in no backup withholding,you are subject to a$500 penalty. Form W-9(Rev.10-201 a) Page 3 Criminal penalty for falsifying information.Willfully falsifying IF the entity/person on line 1 is THEN check the box for... certifications or affirmations may subject you to criminal penalties a(n)... including fines and/or imprisonment. Misuse of TINs.If the requester discloses or uses'Ms in violation of • Corporation Corporation federal law,the requester may be subject to civil and criminal penalties. • Individual Individual/sole proprietor or single- • Sole proprietorship,or member LLC Specific Instructions • Single-member limited liability company(LLC)owned by an Line 1 individual and disregarded for U.S. You must enter one of the following on this line;do not leave this line federal tax purposes. blank.The name should match the name on your tax return. • LLC treated as a partnership for Limited liability company and enter If this Form W-9 Is for a joint account(other than an account U.S.federal tax purposes, the appropriate tax classification. maintained by a foreign financial Institution(FFI)),list first,and then • LLC that has flied Form 8832 or (P=Partnership;C.C corporation; circle,the name of the person or entity whose number you entered in 2553 to be taxed as a corporation, or S=S corporation) Part I of Form W-9. If you are providing Form W-9 to an FFI to document or a joint account,each holder of the account that Is a U.S.person must • LLC that is disregarded as an provide a Form W-9. entity separate from Its owner but a. Individual.Generally,enter the name shown on your tax return.If the owner Is another LLC that is you have changed your fast name without informing the Social Security not disregarded for U.S.federal tax Administration(SSA)of the name change,enter your first name,the last purposes. name as shown on your social security card,and your new last name. -- Note:MN applicant Enter your individual name as it was entered on • Partnership Partnership your Form W-7 application,line 1 a.This should also be the same as the • Trust/estate Trust/estate name you entered on the Form 1040/1040A/1040EZ you tiled with your Line 4, Exemptions application. b. Sole proprietor or single-member LW.Enter your individual If you are exempt from backup withholding and/or FATCA reporting, name as shown on your 1040/1040A/1040EZ on line 1.You may enter enter In the appropriate space on line 4 any code(s)that may apply to your business,trade,or"doing business as"(DBA)name on line 2. you. c. Partnership,LW that Is not a single-member LLC,C Exempt payee code. corporation,or S corporation.Enter the entity's name as shown on the • Generally,individuals(including sole proprietors)are not exempt from entity's tax return on line 1 and any business,trade,or DBA name on backup withholding. line 2. • Except as provided below,corporations are exempt from backup d. Other entities.Enter your name as shown on required U.S.federal withholding for certain payments,including Interest and dividends. tax documents on line 1.This name should match the name shown on the • Corporations are not exempt from backup withholding for payments charter or other legal document creating the entity.You may enter any made in settlement of payment card or third party network transactions. business,trade,or DBA name on line 2. • Corporations are not exempt from backup withholding with respect to e. Disregarded entity.For U.S.federal tax purposes,an entity that is attorneys'fees or gross proceeds paid to attorneys,and corporations disregarded as an entity separate from its owner is treated as a that provide medical or health care services are not exempt with respect "disregarded entity." See Regulations section 301.7701-2(c)(2)(lii).Enter to payments reportable on Form 1099-M1SC. the owner's name on line 1.The name of the entity entered on line 1 should never be a disregarded entity.The name on line 1 should be the The following codes identify payees that are exempt from backup name shown on the income tax return on which the income should be withholding.Enter the appropriate code in the space in line 4. reported.For example,If a foreign LLC that is treated as a disregarded 1—An organization exempt from tax under section 501(a),any IRA,or entity for U.S.federal tax purposes has a single owner that Is a U.S. a custodial account under section 403(b)(7)if the account satisfies the person,the U.S.owner's name is required to be provided on line 1.If requirements of section 401(0(2) the direct owner of the entity is also a disregarded entity,enter the first 2.--The United States or any of Its agencies or Instrumentalities owner that Is not disregarded for federal tax purposes.Enter the 3—A state,the District of Columbia,a U.S.commonwealth or disregarded entity's name on line 2,"Business name/disregarded entity possession,or any of their pollticaf subdivisions or instrumentalities name."If the owner of the disregarded entity is a foreign person,the owner must complete an appropriate Form W-8 instead of a Form W-9. 4—A foreign government or any of its political subdivisions,agencies, This Is the case even if the foreign person has a U.S.TIN. or instrumentalities Line 2 5—A corporation If you have a business name,trade name,DBA name,or disregarded 6—A dealer in securities or commodities required to register in the entity name,you may enter it on line 2. United States,the District of Columbia,or a U.S.commonwealth or possession Line 3 7--A futures commission merchant registered with the Commodity Check the appropriate box on line 3 for the U.S.federal tax Futures Trading Commission classification of the person whose name Is entered on line 1.Check only 8—A real estate investment trust one box on line 3. 9—An entity registered at all times during the tax year under the investment Company Act of 1940 10—A common trust fund operated by a bank under section 584(a) 11—A financial institution 12—A middleman known in the investment community as a nominee or custodian 13—A trust exempt from tax under section 664 or described in section 4947 Form W-9(Rev.10-2018) Page 4 The following chart shows types of payments that may be exempt M—A tax exempt trust under a section 403(b)plan or section 457(g) from backup withholding.The chart applies to the exempt payees listed plan above,1 through 13. Note:You may wish to consult with the financial Institution requesting 1F the payment is for... THEN the payment is exempt this form to determine whether the FATCA code and/or exempt payee for... code should be completed. Interest and dividend payments All exempt payees except Line 5 for 7 Enter your address(number,street,and apartment or suite number). Broker transactions Exempt payees 1 through 4 and 6 This is where the requester of this Form W-9 will mail your information through 11 and all C corporations. returns.If this address differs from the one the requester already has on S corporations must not enter an fife,write NEW at the top.If a new address is provided,there is still a exempt payee code because they chance the old address will be used until the payor changes your are exempt only for sales of address in their records. noncovered securities acquired Line 6 prior to 2012. Enter your city,state,and ZIP code. Barter exchange transactions and Exempt payees 1 through 4 patronage dividends Part 1. Taxpayer Identification Number (TIN) Payments over$600 required to be Generally,exempt payees Enter your TIN in the appropriate box.If you are a resident alien and reported and direct sales over 1 through 52 you do not have and are not eligible to get an SSN,your TIN is your IRS $5,0001 individual taxpayer identification number(ITN).Enter it in the social security number box.If you do not have an ITIN,see How to get a TIN Payments made in settlement of Exempt payees 1 through 4 below. payment card or third party network If you are a sole proprietor and you have an EiN,you may enter either transactions your SSN or EIN. 1 See Form 1099-MISC,Miscellaneous Income,and its instructions. If you are a single-member LLC that is disregarded as an entity 2 separate from its owner,enter the owner's SSN(or EIN,if the owner has • However,the following payments made to a corporation and one). Do not enter the disregarded entity's EIN.If the LLC is classified as reportable on Form 1099-MISC arenot exempt from backup a corporation or partnership,enter the entity's EIN. withholding:medical and health care payments,attorneys'fees,gross Note:See What Name and Number To Give the Requester,later,for proceeds paid to an attorney reportable table under section 6045(t),and payments for services paid by a federal executive agency, further clarification of name and TIN combinations, Exemption from FATCA reporting code.The following codes identify How to get a TIN.If you do not have a TIN,apply for one immediately. payees that are exempt from reporting under FATCA.These codes To apply for an SSN,get Form SS 5,Application for a Social Security apply to persons submitting this form for accounts maintained outside Card,from your local SSA office or get this form online at of the United States by certain foreign financial institutions.Therefore,if www.SSA.gov.You may also get this form by calling 1-800-772-1213. you are only submitting this form for an account you hold in the United Use Form W-7,Application for iRS Individual Taxpayer Identification States,you may leave this field blank.Consult with the person Number,to apply for an ITIN,or Form SS 4,Application for Employer requesting this form if you are uncertain if the financial institution is Identification Number,to apply for an EIN.You can apply for an EIN subject to these requirements.A requester may indicate that a code is online by accessing the IRS website at www.irs.gov/Businessos and not required by providing you with a Form W-9 with"Not Applicable"(or clicking on Employer Identification Number(EiN)under Starting a any similar indication)written or printed on the line for a FATCA Business.Go to www.irs.gov/Forms to view,download,or print Form exemption code. W-7 and/or Form SS-4. Or,you can go to www.irs.gov/OrderForms to A—An organization exempt from tax under section 501(a)or any place an order and have Form W-7 and/or SS-4 mailed to you within 10 business days. individual retirement plan as defined in section 7701(a)(37) If you are asked to complete Form W-9 but do not have a TIN,apply 13--The United States or any of its agencies or instrumentalities for a TIN and write"Applied For"in the space for the TIN,sign and date C—A state,the District of Columbia,a U.S.commonwealth or the form,and give it to the requester.For interest and dividend possession,or any of their political subdivisions or instrumentalities payments,and certain payments made with respect to readily tradable D—A corporation the stock of which is regularly traded on one or instruments,generally you will have 60 days to get a TIN and give it to more established securities markets,as described in Regulations the requester before you are subject to backup withholding on section 1.1472-I(c)(1)(i) payments.The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until E---A corporation that is a member of the same expanded affiliated you provide your TiN to the requester. group as a corporation described in Regulations section 1.1472 1(c)(i)() Note:Entering"Applied For"means that you have already applied for a F—A dealer in securities,commodities,or derivative financial TIN or that you intend to apply for one soon. instruments(including notional principal contracts,futures,forwards, Caution:A disregarded U.S.entity that has a foreign owner must use and options)that is registered as such under the laws of the United the appropriate Form W-8. States or any state G—A real estate investment trust Part I1. Certification H—A regulated Investment company as defined In section 851 or an To establish to the withholding agent that you are a U.S.person,or entity registered at all times during the tax year under the investment resident alien,sign Form W-9.You may be requested to sign by the Company Act of 1940 withholding agent even If Item 1,4,or 5 below Indicates otherwise. 1—A common trust fund as defined in section 584(a) For a joint account,only the person whose TIN is shown in Part I J—A bank as defined in section 581 should sign(when required).In the case of a disregarded entity,the K—A broker person identified on line 1 must sign.Exempt payees,see Exempt payee _ code,earlier. a 1 trust exempt from tax under section 664 or described in section 4947 Signature requirements.Complete the certification as indicated In ( )( ) items 1 through 5 below. Form W-9(Rev,10-2018) Page 5 1.Interest,dividend,and barter exchange accounts opened For this type of account: Give name and EIN of: before 1984 and broker accounts considered active during 1983. 14.Account with the Department of The public entity You must give your correct TIN,but you do not have to sign the Agriculture in the name of a public certification. entity(such as a stale or local 2.Interest,dividend,broker,and barter exchange accounts government,school district,or opened after 1983 and broker accounts considered inactive during prison)that receives agricultural 1983.You must sign the certification or backup withholding will apply.If program payments you are subject to backup withholding and you are merely providing your correct TIN to the requester,you must cross out Item 2 in the 15.Grantor trust filing underthe Form The trust certification before signing the form. 1041 Filing Method orthe Optional 3.Real estate transactions.You must sign the certification.You may Form 1099 Filing Method 2(see cross out Item 2 of the certification. Regulations section 1:671 4(h)(2)(l)(13)} 4.Other payments.You must give your correct TIN,but you do not ' List first and circle the name of the person whose number you furnish. have to sign the certification unless you have been notified that you If only one person on a joint account has an SSN,that person's number have previously given an incorrect TIN."Other payments"include must be furnished. payments made in the course of the requester's trade or business for 2 Circle the minor's name and furnish the minor's SSN. rents,royalties,goods(other than bills for merchandise),medical and health care services(including payments to corporations),payments to 3 You must show your Individual name and you may also enter your a nonemployee for services,payments made In settlement of payment business or DBA name on the"Business name/disregarded entity" card and third party network transactions,payments to certain fishing name line.You may use either your SSN or EIN(if you have one),but the boat crew members and fishermen,and gross proceeds paid to IRS encourages you to use your SSN. attorneys(including payments to corporations). "List first and circle the name of the trust,estate,or pension trust.(Do 5.Mortgage Interest paid by you,acquisition or abandonment of not furnish the TIN of the personal representative or trustee unless the secured property,cancellation of debt,qualified tuition program legal entity itself Is not designated In the account title.)Aiso see Special payments(under section 529),ABLE accounts(under section 529A), rules for partnerships,earlier. IRA,Coverdell ESA,Archer MSA or HSA contributions or *Note:The grantor also must provide a Form W-9 to trustee of trust. distributions,and pension distributions.You must give your correct Note;If no name is circled when more than one name is listed,the TIN,but you do not have to sign the certification. number will be considered to be that of the first name listed. What Name and Number To Give the Requester Secure Your Tax Records From Identity Theft For this type of account: Give name and SSN of: Identity theft occurs when someone uses your personal information 1.Individual The individual such as your name,SSN,or other identifying information,without your 2.Two or more individuals(joint The actual owner of the account or,If permission,to commit fraud or other crimes.An identity thief may use account)other than an account combined funds,the first individual on your SSN to get a job or may file a tax return using your SSN to receive maintained by an FFI the account' a refund. 3.Two or more U.S.persons Each holder of the account To reduce your risk: (joint account maintained by an FFI) •Protect your SSN, 4.Custodial account of a minor The minor2 •Ensure your employer Is protecting your SSN,and (Uniform Gift to Minors Act) •Be careful when choosing a tax preparer. 5.a.The usual revocable savings trust The grantor-trustee' If your tax records are affected by identity theft and you receive a (grantor is also trustee) 1 notice from the IRS,respond right away to the name and phone number b.So-called trust account that is not The actual owner printed on the IRS notice or letter. a legal or valid trust under state law If your tax records are not currently affected by identity theft but you 6.Sole proprietorship or disregarded The owner think you are at risk due to a lost or stolen purse or wallet,questionable entity owned by an Individual credit card activity or credit report,contact the IRS Identity Theft Hotline 7.Grantor trust filing under Optional The grantor' at 1-800-908-4490 or submit Form 14039. Form 1099 Filing Method 1(see For more information,see Pub.5027,Identity Theft Information for Regulations section 1.671-4(b)(2)(i) Taxpayers. (A)) Victims of identity theft who are experiencing economic harm or a For this type of account: Give name and EIN of: systemic problem,or are seeking help in resolving tax problems that 8.Disregarded entity not owned by an The owner have not been resolved through normal channels,may be eligible for individual Taxpayer Advocate Service(TAS)assistance.You can reach TAS by calling the TAS tell free case Intake line at i 877 777-4778 or TTY/TDD 9.A valid trust,estate,or pension trust Legal entity" 1-800-829-4059. 10.Corporation or LLC electing The corporation Protect yourself from suspicious emalls or phishing schemes. corporate status on Form 8832 or Phishing is the creation and use of email and websites designed to Form 2553 mimic legitimate business emails and websites.The most common act 11.Association,club,religious, The organization Is sending an email to a user falsely claiming to be an established charitable,educational,or other tax- legitimate enterprise in an attempt to scam the user Into surrendering exempt organization private information that will be used for identity theft. 12.Partnership or multi-member LLC The partnership 13.A broker or registered nominee The broker or nominee Form W-9(Rev.10-2018) Page 6 The IRS does not Initiate contacts with taxpayers via emails.Also,the Privacy Act Notice IRS does not request personal detailed Information through email or ask taxpayers for the PIN numbers,passwords,or similar secret access Section 0109 of the Internal Revenue Code requires you to provide your information for their credit card,bank,or other financial accounts, correct TIN to persons(including federal agencies)who are required to If you receive an unsolicited email claiming to be from the IRS, file Information returns with the IRS to report interest,dividends,or forward this message to phishing@irs.gov.You may also report misuse certain other income paid to you;mortgage Interest you paid;the of the IRS name,logo,or other IRS property to the Treasury Inspector acquisition or abandonment of secured property;the cancellation of General for Tax Administration(TIGTA)at 1-800-366-4484.You can debt;or contributions you made to an IRA,Archer MSA,or toff The forward suspicious emalls to the Federal Trade Commission at person collecting this form uses the information on the form to file spam@uce.gov or report them at www.ftc.gov/complaint.You can information returnswith the IRS,reporting the above information, i contact the FTC at www.ftc.govlidtheft or 877-I0THEFT(877-438-4338). Routine uses of this nformation include giving it to the Department of If you have been the victim of Identity theft,see www.ldentltyTheft.gov Justice for civil and criminal litigation and to cities,states,the District of Columbia,and U.S.commonwealths and possessions for use in administering their laws.The information also may be disclosed to other countries under a treaty,to federal and state agencies to enforce civil and Pub.5027. Visit www.irs.gov/ldentityTheft to learn more about identity theft and how to reduce your risk, and criminal laws,or to federal law enforcement and Intelligence agencies to combat terrorism.You must provide your TIN whether or not you are required to file a tax return.Under section 3406,payers must generally withhold a percentage of taxable interest,dividend,and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent Information. SECTION 004400 BONDING CAPACITY CERTIFICATION LETTER OWNER: Clay County Utility Authority 3176 Old Jennings Road Middleburg,FL 32068 904-213-2400 Bidder: Firm Name: Petticoat-Schmitt Civil Contractors,Inc. Address: 6380 Philips Highway City,State,Zip: Jacksonville,FL 32216 Phone: (904)751-Q8.88 _ This letter serves as a certified statement that the Surety Company's authorized bonding Capacity for the referenced Bidder will not be exceeded by the inclusion of Bidder's Submitted Bid for Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project The present limits on bonding for the referenced Contractor are as follows: $ I5,000,0n0 each occurrence $ 50,nnn,nnn aggregate Percentage of bonding capacity expended with inclusion of this Bid 5 Bidder's Bonding Rate l. S Amount of ALL projects that the Bidder is currently preparing bid/proposals and/or have not yet been awarded: $ al FPt L lv 5 f O0U, 00 (Amount indicated above must be representative of all projects inclusive of delivery methods such as the following but not limited to:Competitive Bids,Competitive Sealed Proposals,Design-Build,Construction Manager at Risk,Job Order Contracting etc.,) Issuance and approval of any bond shall be predicated on the most current financial and job information available to the underwriter on the date that the bond is issued.The Surety Company hereby certifies that they are duly authorized by certificate of authority issued by the State of Florida and that they are rated as follows: A.M.Best Rating: A++ Financial Size Category: 15 Notes:This is the only acceptable format for the Surety's Bonding Capacity Certification Letter.This statement must be notarized(on an original document with an embossed stamp). Power of Attorney fonn must be attached. SURETY COMPANY Surety Company Name: Travelers Casualty and Surety Company of America Address: 2420 Lakemont Ave, 2nd Floor City,State,Zip Code: .04 dp, FL 32814 Authorized Signature: LJ, 71\ Date: 12/10/2021 004400-1 CCUA Project No:1128-002 CDM Smith Project No.259164-240363 BONDING CAPACITY CERTIFICATION LETTER Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Mains October 2021 STATE OF`V� _(LL- _ COUNTY O PERSONALLY APPEARED BEFORE ME,the undersigned aulhority�F �C\� `ci1(l��iaiierfitstbeing sworn by me,affixed his/her �.� � (name of individual signing) signature in the space provided above on this 614\day of�f.�� ,2Aj My commission expires: NOTARY PUBLIC ANNETTE EVANS END OF SECTION Notary Public,State of Florida My Comm. Expires 04/29/2022 Commission No. GG182968 004400-2 CCUA Project No: 1128-002 CDM Smith Project No.259164-240363 BONDING CAPACITY CERTIFICATION LETTER Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Mains October 2021 It shall be the Contractor's responsibility to ensure conformance with contract requirements, coordinate ordering,deliveries,submit Shop Drawings,receive and verify accuracy of such shipments and,unload such shipments as if Contractor had purchased the materials direct. Any Shop Drawings received directly by the AUTHORITY from the suppliers will be forwarded by the AUTHORITY to the Contractor for the Contractor's review of accuracy and correctness of the Shop Drawings, and the Contractor shall provide an approval action on each product. Contractor then shall submit Shop Drawings to the Design Engineer for review and approval action. After the Contractor and Engineer have reviewed and approved the Shop Drawings,they then shall be submitted to the Clay County Utility Authority for review. The Contractor shall include all risk of loss and bear the cost of insurance on all materials purchased tax exempt. Once the AUTHORITY's Purchase Order is prepared,then it will be returned to the Contractor for proofing and mailing to the vendor. The Bidder further proposes and agrees to commence work under the Bidder's contract on a date to be specified in the Notice-to-Proceed and shall complete all work there under within the time schedule in the Agreement. Addendum Receipt: Bidders shall acknowledge below the receipt of all addenda, if any, to plans and specifications. ADDENDUM NO.7 DATED 12/2/21 ADDENDUM NO.9 DATED 12/16/21 ADDENDUM NO.8 DATED 12/6/21 ADDENDUM NO. 10 DATED 12/20/21 ADDENDUM NO. I DATED 1I/I/21 ADDENDUM NO, _2 DATED 11/3/21 ADDENDUM NO. 3 DATED 11/8/21 ADDENDUM NO. 4 _ DATED 11/12/21 ADDENDUM NO. 5 DATED 11/17/21 ADDENDUM NO. 6 DATED 11/30/21 MBE/WBE Utillization: Total MBE/WBE percent utilization on this project: 0 List MBE/WBE firms utilized an this project: Prime Sub Supplier 1. N/A ❑ ❑ ❑ 2. ❑ ❑ ❑ 3. 0 ❑ ❑ 4. ❑ 0 ❑ 5. ❑ ❑ ❑ 6. ❑ ❑ ❑ 7. ❑ ❑ U 8. ❑ ❑ ❑ Document any good faith efforts: Please see attached legal ad 003000-3 CCUA Project No:1128-002 CDM Smith Project No.259164-240363 RID FORM Saratoga Springs\VTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Mains October 2021 CONFLICT OF INTEREST CERTIFICATE Soliciatation No. ITB 2122-A02 Vendor must execute eitherSection 1 or Section II hereunder,as required by Florida Statutes 112.Failure to execute either section may result in the rejection of this bid/proposal. SECTION I I hereby certify that no officialor employee of the Clay County Utility Authority(Authority),a special district in the State of Florida,requiri g the good or services described in these specifications has a material financial interest in this company. Sa.4s � Petticoat-Schmitt Civil Contractors, Inc. Sign re Company Name Kimberly S. Bryan 6380 Philips Highway Name of Official(Type or Print) Business Address Jacksonville, FL 32216 City,State,Zip Code SECTION Il I hereby certify that the following named public official(s)and/or employee(s) of the Authority having material financial interest(s)(in excess of 5 percent)in this company have filed a Conflict of Interest Statement with the Clay County Utility Authority,3176 Old Jennings Road,Middleburg,Florida 32068,priorto the time of bid opening. Name Title of Position Date of Filing Signature Company Name Name of Official(Type or Print) Business Address City,State,Zip Code Public Official Disclosure The Authority requires that a public official who has financial interest in a bid or contract make a disclosure atthe time that the bid or contract is submitted or atthe time thatthe public official acquires a financial interest in the bid or contract.Please provide disclosure,if applicable,with bid. N/A Public Official Position Held Position or Relationship with Bidder DRUG FREE WORKPLACE COMPLIANCE FORM IDENTICAL TIE BIDS Preference shall be given to businesses with drug-free workplace programs. Whenever two or more bids which are equal with respect to price,quality, and service are received by the state or by any political subdivision for the procurement of commodities or contractual services, a bid received from a business that certifies that it has implemented a drug-free workplace program shall be given preference in the award process. Established procedures for processing tie bids will be followed if none of the tied Offerors have a drug-free workplace program. To have a drug-free workplace program,a business shall: 1) Publish a statement notifying employees that the unlawful manufacture, distribution,dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2) Inform employees about the dangers of drug abuse in the workplace,the business's policy of maintaining a drug-free workplace, any available drug counseling,rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3) Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4) In the statement specified in subsection (1),notify the employees that, as a condition of working on the commodities or contractual services that are under bid,the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than 5 days after such conviction. 5) Impose a sanction on or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community by, any employee who is so convicted. 6) Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement,I certify that this firm complies fully with the above requirements. Offer r' Signatur NON--COLLUSION AFFIDAVIT The undersigned being first duly sworn as provided by law, deposes, and says: 1. This Affidavit is made with the knowledge and intent that it is to be filed with the Clay County Utility Authority, Clay County, Florida and that it will be relied upon by said County, in any consideration which may give to and any action which it may take with respect to this Bid. 2. The undersigned is authorized to make this Affidavit on behalf of, Petticoat-Schmitt Civil Contractors,Inc. (Name of Corporation,Partnership,Individual,etc.) A Corporation , formed under the laws of Florida of which he is Sole Owner (Sole Owner,partner, president,etc.) 3. Neither the undersigned nor any other person, firm or corporation named in above Paragraph 2, nor anyone else to the knowledge of the undersigned,have themselves solicited or employed anyone else to solicit favorable action for this Bid by the Authority, also that no head of any department or employee therein, or any officer of the Authority,is directly interested therein. 4. This Bid is genuine and not collusive or a sham; the person,firm or corporation named above in Paragraph 2 has not colluded, conspired,connived or agreed directly or indirectly with any bidder or person, firm or corporation,to put in a sham Bid, or that such other person, firm or corporation, shall refrain from bidding,and has not in any manner, directly or indirectly, sought by agreement or collusion, of communication or conference with any person, firm or corporation, to fix the prices of said proposal or proposals of any other bidder; and all statements contained in the proposal or proposals described above are true; and further, neither the undersigned,nor the person, firm or corporation named above in Paragraph 3,has directly or indirectly submitted said proposal or the contents th reof, or divulged information or data relative thereto,to any association or to any rnef er or agent thereof. ,,A • (A 1 Z� TAKEN,SWORN,AND SUBSCRIBED TO BEFORE ME this 21st day of December___,20 21 . Nola ubl Ic ��Y►r Rota Public state of Florida • • Jedl Marie Maroon \N1\(-Af'EcAJ a MSy Commieelon GG 336481 • �4 dP explcesi16101/2e23 (Print,Type or Stamp Commissioned Name of ' • PUBLIC RECORDS COMPLIANCE ACKNOWLEDGEMENT Bid No. ITB 2122-A02 Vendor must execute this form. Failure to submit this form shall result in rejection of this bid. I hereby agree that our firm or organization,employees, subcontractors and for those I am legally liable shall comply with Chapter 119.071(3), Florida Statutes, and will not divulge, furnish or make available to any third person, firm or organizations hereunder, or in the course of judicial or legislative proceeding where such information has been properly subpoenaed,any non-public information concerning the services to be rendered by the firm or organization,any sub-vendor(s), or subcontractor(s),pursuant to this Agreement. Subject to the foregoing provisions and law applicable to confidential information, Petticoat-Schmitt Civil Contractors, Inc. shall keep and maintain public records required by the Authority, which is a public agency, in order for the firm or organization to perform services and the work required by the Scope, and upon request from the Authority's custodian of public records,firm or organization shall provide the Authoritywith 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 in Chapter 119.07, Florida Statutes, or as otherwise provided by law. The firm or organization shall require all its employees, sub vendors(s) and subcontractor(s)to comply with provisions of this paragraph. C-AU Petticoat-Schmitt Civil Contractors, Inc. nature Company Name Kimberly S. Bryan 6380 Philips Highway Name of Certifying Official Business Address (Type or Print) Jacksonville, FL 32216 City,State, Zip Code Bidder's Insurability: The Bidder confirms that the Bidder has reviewed the current types, amounts,and requirements of insurance coverages included in the Contract Documents including, but not limited to, general liability, workers compensation, bodily injury, personal and advertising injury, property, builders risk, installation floater, excess or umbrella liability,environmental pollution,waiver of subrogation, additional insured, etc. Bidder's current Workers Compensation and Employers Liability Insurance Information: Bidder's current Experience Rating: o47 Bidder's current Experience Modification Factor: 087 The Bidder pledges that all such required coverages, types, requirements, and limits specified in the Contract Documents shall be provided within 15 days of the notice of intent to award or the Owner may consider Bidder to be in default and annul the Notice of Award and the Bid security of that Bidder will be forfeited, COL) 12/21/21 Bid is Signature Date LIST OF MAJOR SUBCONTRACTORS to The Bidder expressly agrees that: 1. If awarded a Contract as a result of this Proposal, the major Subcontractors used in the prosecution of the work will be those listed below, 2. The following list includes all Subcontractors who will perform work in the amount of approximately$10,000 or more on this Contract. 3. The Subcontractors listed below are financially responsible and are qualified to perform the work required. Category Name of Subcontractor Address ,,, Sktsfii Soby i'‘ g Qta —\64, tech(la «Y Pc-Q- L-14 C M>Vs rir,) -_- - 003000-4 CCUA Project No:1128.002 CUM Smith Project No.2591M-240363 BID FORM Saratoga Springs WTP,Reclaimed PumpStation,and Potable and Reclaimed Water Distribnliait Mains October 2021 `, ,1 Mt H, n 41 f.-r Ill - J ���`'� 1 .1Wit 406 • 10 I .01 I . AARON BROWNING, ESTIMATOR/PROJECT MANAGER BACKGROUND SELECTED EXPERIENCE As an Estimator/Project Manager, Aaron has an St. Johns River Power Park Blowdown Pipe established career that spans over 20 years in construction Replacement with the majority of that time spent working on water and Estimator&Project Manager wastewater treatment facilities. In his current position for Jacksonville, FL-$1.6 Million Petticoat-Schmitt, he is responsible for producing accurate estimates, that when awarded, produce winning projects for both our clients and our company. JEA Main Street WTP—Orange Street Reservoir Project Manager EDUCATION Jacksonville, FL-$11 Million Bachelors of Science, Construction Science & Management- Glynn County Water Pollution Control Plant Expansion Kansas State University Project Manager MCAA Institute for Project Management Brunswick, GA-$20 Million KEY SKILLS Winter Haven Wastewater Treatment Plant Expansion Estimating Project Manager Cost and Labor Forecasting Winter Haven, FL-$16 Million Planning Coordination District II WWII' Clarifier 2 & 3 Quality and Safety Project Manager Customer Relations Jacksonville, FL-$3.4 Million PROFESSIONAL AFFILIATIONS NYDEP Combined Sewer Overflow(CSO) Facility Assistant Project Manager Association for the Advancement of Cost Engineering New York, NY-$22 Million International. , , PETTICOAT-SCHMITT IIMIEFE-stfiriL CONTRACTORS INC_ „ ,:..... . . .„, ..__:, ,. .,,,:,,,_ ,,, _,0 , -r* .'il 's 44Ri.A A* . , 1 ---- ” . ' 1. rf rji "s I - /,' . 41 .1--lialri ‘iit • iii' _ , , ...,. ,, . .., ...... .._ ..._, ir, . . . _ . 11,, ,ar,... . ,. ____ .,• :,;„ s.„. ,-sr s � .. of*II . for , . -,4 1, ,. Iliti.--_;__:..... .. t \ kiusemithei -All, r1j Ielf ILI' ': , , _ , ....,,,, 7 I , ' „....411,,, , :,.,Llia. -...,LINfilec.it:4 •w " r ' _ , II x � CHRISTOPHER MCCARTHY, SUPERINTENDENT BACKGROUND SELECTED EXPERIENCE Chris is a highly skilled superintendent with over 20 Pipeline Stennis Space Center years of experience in the water and wastewater Superintendent industry. He is well versed in all aspects of plant Stennis Space Center, MS -$18.0 Million construction including civil, mechanical, structural, electrical, instrumentation, start-up, and project Hood Road WTP— New RO/Nano Filtration turnover. Excelling at planning, sequencing and Plant executing work Chris safely completes projects on Superintendent Palm Beach Gardens, FL-$50.0 Million time and within budget. CERTIFICATIONS Arlington East WWTP—BNR Rehab Superintendent Jacksonville, FL-$25.0 Million Competent Person for Trenching and Shoring Confined Space Entry Piscataway WWTP—BNR Upgrades Crosby Master Riggers Superintendent OSHA 5-10 Training Accokeek, MD-$13.0 Million OSHA Process Safety Management JEA Safety Leadership Montebello WTP—Clarifier Upgrades JEA Safety Orientation Superintendent NASA Site Specific Safety Baltimore, MD-$11.0 Million REFERENCES Leesburg WWTP—New RAS Pump Station &Storage Basins Superintendent Bruce Mathias B Hill Leesburg,VA-$51.0 Million 2M703.779.0166 Kenneth B Rollins WFP Superintendent Thomas Bold, PE Leesburg,VA-$16.0 Million 0' Brien &Gere 607.936.1375 Towaliga WTP Upgrade Superintendent Dennis Martin McDonough, GA-$12.0 Million Clay County Utility Authority 904.272.5999 Fredrick P Griffith WTP-New 120MGD Superintendent Lorton,VA-$120.0 Million rPETTItD T-SCHIP1ITT NINIFICIIVEL CONTRACTORS,. a'NC SECTION 00300 BID FORM PROJECT NO. CCUA Project No. 1128-002 BID NO.21/22-A02 Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Mains CLAY COUNTY UTILITY AUTHORITY SUBMITTED BY: Petticoat-Sch►nittCi.vil Contractors.Inc. DATE: 12/21/21 6380 Philips Hwy. _Jackson il lc,Ft.32216 Email: kbry2tt a pctticoalschmitt.com DUNS No.: _NM Sunbiz Document No.: P07000116469 or 0 N/A (for FL Corporal ions,Limited liability Companies,Limited Partnerships) Fed,Employer ID No. (EIN): 26-1293750 ❑ Check box if taxpayer identification number is a social security number and leave the EIN blank. The undersigned, as Bidder, hereby declares that the only person or persons interested in the proposal as Principal(s) is (or are) named herein and that no other person who is herein mentioned has any interest in this proposal or in the contract to be entered into; that this proposal is made without connection with any other person, company, or parties making a bid or proposal; and that it is in all respects fair and in good faith,without collusion or fraud. The Bidder further declares that the Bidder has examined the site of the work and is fully informed in regard to all conditions pertaining to the places where the work is to be performed; that the Bidder has examined the plans and specifications for the work and contract documents relative thereto, that the Bidder has read all special provisions furnished prior to the opening of bids,and that the Bidder is satisfied as to the work to be performed. The Bidder further understands that the AUTHORITY reserves the right to waive formalities in any Bid, to reject any or all bids with or without cause, and/or to accept the Bid or any portion thereof that, in the AUTHORITY'S sole and absolute judgment,will be in the best interest of the AUTI-IORITY. The Bidder proposes and agrees, if this proposal is accepted,to contract with the AUTHORITY in the form of contract specified, to furnish all necessary materials, equipment, machinery, tools, apparatus, means of transportation and labor necessary to complete the contract in full and complete it in accordance with the shown, noted, described and reasonable intended requirements of the plans and specifications and contract documents to the full satisfaction of the contract with the AUTHORITY with a definite understanding that no money will be allowed for extra work except as set forth in the attached General Conditions and contract documents,as follows: 003000-1 CCUA Project No:1128-002 CDM Smith Project No.259164-240363 DID FORM Saratoga Springs WTP,Reclaimed Pump Sinnott,and Potable and Reclaimed water Distribution Mains October 2021 BID SCHEDULE Total Lump Sum Bid Price is to be the sum of the amounts shown for all items listed below and are to include all labor, materials, equipment and incidentals necessary to perform the work as indicated in the contract documents. Work includes, but is not necessarily limited to, all the items listed in the specification and shown on the Drawings, based upon the Bidder's own estimate of the quantities and costs. The Successful Bidder shall reach Substantial Completion within four hundred twenty-seven(427)calendar days after receipt of a Notice to Proceed and shall reach Final Completion within four hundred fifty-seven(457) calendar days after receipt of Notice to Proceed, The Total Bid consists of items I through 7 as follows: Item Description Qty Unit Unit Price Total Price General and Administrative 1 LS 886.000.00 886.000.00 2 Water Treatment Plant 1 LS 6,864,500.00 6,864,500.00 3 Reclaimed Pump Facility 1 LS 4,157,000.00 4.157.000.00 4 Potable Water Main(includes all valves,fittings, and appurtenances) 4a 12 inch DR 18 PVC 5200 LF 100.00 520,0_010.0, 4b 16 inch DR 18 PVC 1300 LF 151.00 196.300.00 5 Reclaimed Water Main(includes all valves, fittings,and appurtenances) 5a 12 inch DR 18 PVC 5200 LF 100.00 520,000.00 51s 16 inch DR 18 PVC 1300 LF 154.00 200,200.00 O 6 Horizontal Directional Drill Allowance 1 LS $80,000 (2@ l6 inch DR18 PVC,2@4"HDPE) Does not include pipe material,maintenance of traffic,transition fittings or testing of the conduit pipe. 7 Clay Electric Allowance I LS $45,000 Total Lump Sum Bid Items 1-7 $ 13,469,000.00 (Numerals) $ Thirteen million four hundred sixty nine thousand dollars and no cents (Written) Total Bid dollar amount must be in numeric and written format. In the event of discrepancies, the written entry will take precedence over the numeric entry. At the AUTHORITY's option, the Contractor shall be required to provide the AUTHORITY with the details of Contractor's Purchase Order, including vendor quote(s), vendor name, address, and quantity and type of materials being ordered, The AUTHORITY may choose to order the major materials and/or equipment direct. Should the AUTHORITY choose to do this, any payment that is made direct by the AUTHORITY (plus an amount equal to the sales tax that would have been paid by the Contractor) for the materials shall be a direct deduct from the Contractor's contract as if the payment were made direct to the Contractor. The whole purpose of this provision is to save the amount of sales taxes that would be otherwise assessed to the Contractor for the major material purchases. 003000-2 CCUA Project No:1 t 28.002 CDM Smith Project No.259[64-240363 nID FORM Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Mains October 2021 Firefox about:blank • PUBLISHER AFFIDAVIT CLAY TODAY Published Weekly Orange Park,Florida STATE OF FLORIDA MBE/WBE Firms COUNTY OF CLAY: Petticoat-Schmitt Civil Contractors, Inc. is seeking qualified MBFJWBE firms to participate In the 2021 Before the undersigned authority personally appeared Saratoga Springs WTP, Reclaimed Jon Cantrell,who on oath says that he is the publisher of the Pump Station and Potable and Reclaimed Water Distribution Mains "Clay Today'a newspaper published weekly at Orange Park in which will bid on Friday,December Clay County,Florida;that the attached copy of advertisement 10, 2021 @ 2:00PM for the Clay Counity. Possible being a tUtilityy subcontracting ullooprportunities include: Site work, Grassing & LEGAL SERVICE Landscape, Erosion Control, Masonry, Roofing, Doors, Finishes, Plumbing,HVAC.Quotations must be in the matter of received by December 8, 2021 @ 12:00 pm. Interested bidders should contact: 11'IBE/WBE FIRMS Joe Fisher Petticoat Schmitt Civil Contractors,Inc. 6380 Philips Highway Jacksonville,FL 32210 Phone(904)751-0888 LEGAL:48750 ORDER:331482 Fax(004)751-09a8 Or e-mail to: jnsher@ petticoatschm rtt.com was published in said newspaper in the issues: Petticoat Schmitt Civil Contractors, Inc. Is an Equal Opportunity 11/25/2021 Employer 12/02/2021 Legal 48750 published Nov 25 and Dec 2, 2021 In Clay County's Clay Today newspaper Affiant further says that said"Clay Today"is a newspaper published at Orange Park,in said Clay County,Florida,and that the said newspaper has heretofore been continuously published in said Clay County,Florida, weekly,and has been entered as Periodical material matter at the post office in Orange Park,in said Clay County,Florida,for period of one year next proceeding the first publication of the attached copy of advertisement;and affiant further says that he has neither paid nor promised any person,firm or corporation any discount,rebate,commission or refund for the purpose of securing this advertisement for publication in the said newspaper. - Sworn to me and subscribed before me 12/02/2021. +'yQ^ CH RISTlli LOU 1VA YNE 1 AMY COMMISSION fl HH34426 W-03ZSI EXPIRES:September 20,2024 .PUBLIC,S TP,OF FLORIDA 3515 US HWY 17 Suite A,Fleming Island FL 32003 Telephone(904)264-3200-FAX(904)264-3285 E-Mail:ChristieQnopcfla.coni 1 of 1 11/16/2021,9:28 AM Unanimous Action of the Board of Directors of Petticoat-Schmitt Civil Contractors, Inc. Taken without a meeting by written consent The following action Is taken by the President of PETTICOAT-SCHMITT CIVIL CONTRACTORS,INC.A Florida Corporation, by written consent without a meeting,as of November 21,2017, pursuant to Section of the 607.134 of the General Corporation Act of the State of Florida permitting such action to be taken. RESOLVED,that Kimberly S Bryan be and hereby is named Director of the Corporation,to serve until her successor shall by dully qualified and elected,and can sign legal documents on behalf of Petticoat-Schmitt Civil Contractors, Inc. The undersigned,being the President of PETTICOAT-SCHMITT CIVIL CONTRACTORS,INC.does hereby consent to the foregoing action as of the date first above written. --autt11.r Ryan S hmitt— Psdent T/ x E IZABERI LEE SIEVA Notarized by: Comrolubr�S00442295 '".'- Ezpiroi Seplembor23;421 .,K 16/ d04�r1ii:n7r r11k111rtsct ) • o • . ,` Ron DeSantis,Governor Halsey Beshears,Secretary ��;�� Florida. r .„ STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION U4DUSTR ENSING BOARD THE GENERAL CONTRACT-OR.HERI S:CERTIFIED UNDER THE PROVISIONS OF CHAPTER4&9FLORiDA-STATUTES SCH MITI, BAN-MA. _ - PETTICOAT-SCHMITT MIL CONTRACTORS INC 6380,PH ILIPS HWY ^ JACKSONVILLE FL 32216 . - LICENSE NUM B'ER GC057651 EXPIRATION DATE: AUGUST 31, 2022 { Always verify licenses online at MyFloridaLicense.com �•� Do not alter this document in any form. T 'a This is your license. It is unlawful for anyone other than the licensee to use this document. ❑ S. - 0 , ';`:r' . Ron DeSantis,Governor Halsey Beshears,Secretary , Florida ,4 r . ._____„....„.„,... * _ F .a ST4TEOFFLORIDA. DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION t CONSTRUCTION.1SCENSING BOARD ' THE UNDERGROUND UTILI P IEREI ,IS CERTIFIED UNDER THE '. PROVISIONS Q ER 4 9'.: 4 QA—S' ATUTES 1 • a 1;VAN t ' (I','.''-4(*41 '' 51 pgrihr p t c PErik°P*2SC ITT > OON # .1C } r ' - 6 tL -T—I ''"' A r,i KSO I3t6 $. err • J1 � — r �`.- ._- - �� 1 1 CICERSr IE3 irr-00C05/440 P J - [ EXPIRATION DATE: AUGUST 31,2022 Always verify licenses online at MyFloridaLicense.com pr 1 ' _ 1-•�. • Do not alter this document in any form. i EI,`` - i This is your license. It is unlawful for anyone other than the licensee to use this document. i SECTION 00510 NOTICE OF AWARD Date: January 10,2021 _ Project: Saratoga Springs WTP, RPS, and Potable and Reclaimed Water Distribution Main Project Owner: Clay County Utility Authority Owner's Bid No.: 21/22-A02 Owner Contract No.: Engineer's Project No.: 1128-002 Bidder: Petticoat-Schmitt Civil Contractors, LLC. Bidder's Address: 6380 Philips Highway Jacksonville, FL 32216 You are notified that your Bid dated December 16, 2021, for the above Contract has been considered. You are the Successful Bidder and are awarded a Contract for the Saratoga Springs Water Treatment Plant, Reclaimed Pump Station, and Potable and Reclaimed Water Distribution Mains. The Contract Price of your Contract is Thirteen Million Four Hundred Sixty-Nine Thousand Dollars and Zero Cents($13,469,000.00). You must comply with the following conditions precedent within [15] days of the date you receive this Notice of Award. 1. Deliver to the Owner [3] fully executed counterparts of the Contract Documents. The Contract agreement is attached to the Notice of Award for your execution. 2. Deliver with the executed Contract Documents the Contract security [Bonds] as specified in the Instructions to Bidders(Article 20), and General Conditions(Paragraph 5.01). 3. Deliver with the executed Contract Documents the Certificates of Insurance as specified in the Instructions to Bidders(Article 20), and General Conditions(Paragraph 5.03 and 5.04). Failure to comply with these conditions within the time specified will entitle Owner to consider you in default, annul this Notice of Award, and declare your Bid security forfeited. Within ten days after you comply with the above conditions, Owner will return to you one fully executed counterpart of the Contract Documents. Clay County Utili a •it caner k, By: _ 1` 2y2,-2..— c_1 ---10 o ' .ed S = iP ature M.B.A._ :4 ve Copy to Engineer Itxecu Directorti END OF SECTION 03742-002-02 00510-1 NOTICE OF AWARD January 2022 ,nc,':`znfILL.0 CFN#2022005466 OR BK: 4563 PG: 855 Pages1 of 3 Recorded:1/25/2022 9:43 AM Doc: BD Tara S Green, Clerk and Comptroller, Clay County, FL Rec:$27.00 Deputy Clerk DIXONL SECTION 006000 Bond#107561834 PUBLIC CONSTRUCTION PERFORMANCE AND PAYMENT BOND BY THIS BOND, We Petticoat-Schmitt Civil Contractors Inc. , as principal and Travelers Casualty and Surety Company of America , a Corporation, as Surety, are bound to Clay County Utility Authority, an independent special district existing under Chapter 94- 491, Laws of Florida, Special Acts of 1994,herein called Owner, in the sum of $13,469,000.00 , for performance, and the separate and additional sum of$ 13,469,000.00 , for payment, for the payment of each of which we bind ourselves, our heirs, personal representatives, successors and assigns,jointly and severally. THE CONDITION OF THIS BOND is that if Principal: 1. Performs the contract dated jar'1Lt/{ 0/4 , 2Q23, between Principal and Owner for construction of Saratoga Springs-Water Treatment Plant, Reclaimed Pump Station, and Potable and Reclaimed Water Distribution Main Project the contract being made a part of this Bond by reference, at the times and in the manner prescribed in the contract; and 2. Promptly makes payment to all claimants, as defined in Section 255.05 (1), Florida Statutes, supplying Principal with labor, materials or supplies, used directly or indirectly by Principal in the prosecution of the work provided for in the contract; and 3. Pays Owner all losses, damages, expenses, costs, and attorney's fees, including appellate proceedings, that Owner sustains because of a default by Principal under the contract; and 4. 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. This Bond is to be deemed a Statutory Bond under Section 255.05,Florida Statutes,the provisions of which are hereby incorporated by reference and made a part hereof. All interested parties are specifically directed to the following provisions regarding time and notice limitations as set out in Section 255.05(2), Florida Statutes: A claimant, except a laborer, who is not in privity with the Contractor and who has not received payment for his labor, materials, or supplies, shall within 45 days after beginning to furnish labor, materials, or supplies for the prosecution of work, furnish the Contractor with a notice that he intends to look to the Bond for protection. A claimant who is not in privity with the Contractor and who has not received payment for his labor, materials or supplies shall, within 90 days after performance of the labor or after complete delivery of the materials or supplies or, with respect to rental equipment, within 90 days after the date that the rental equipment was last on the job site 006000-1 CCUA Project No: 1128-002 CDM Smith Project No 259164-240363 PUBLIC CONSTRUCTION PERFORMANCE AND PAYMENT BOND Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Mains October 2021 available for use,deliver to the Contractor and to the Surety written notice of the performance of the labor or delivery of the materials or supplies and of the nonpayment. No action for labor,materials, or supplies may be instituted against the Contractor or the Surety unless both notices have been given. No action shall be instituted against the Contractor or the Surety on the Payment Bond or the payment provisions of a combined Payment and Performance Bond after one (1) year from the performance of the labor or completion of delivery of the materials or supplies. Any changes in or under the contract documents and compliance or noncompliance with any formalities connected with the contract or the changes does not affect Surety's obligation under this Bond.Dated On:,icti-11ut I I.�v211 c.2t Principal's Address: Surety's Address: 6380 Phillips Highway One Tower Square Jacksonville, FL 32216 Hartford CT 06183 Project Description and Location: Saratoga Springs WTP and Reclaimed Pump Station Potable and Reclaimed Water Distribution Main Project Clay County Utility Authority CCUA Project No. 1128-002 CCUA Bid.No. TBD Petticoat- h 1 Civil ' intractors Inc. B Travelers Casualty and Surety Company of America tS nety) By: J� Benja in Powell (Attorney-in-Fact)' . f`-, -• END OF SECTION ,•`''•P`j11; 006000-2 CCUA Project No: 1128-002 CDM Smith Project No 259164-240363 PUBLIC CONSTRUCTION PERFORMANCE AND PAYMENT BOND Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Mains October 2021 U Travelers Casualty and Surety Company of America 41111110► Travelers Casualty and Surety Company TRAVELERS J St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint BENJAMIN K POWELL of JACKSONVILLE , Florida , their true and lawful Attorney(s)-in-Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this instrument to be signed,and their corporate seals to be hereto affixed,this 21st day of April, 2021. <OP*smny RTF03\ •,.c'I,•tie F J aA t MAIITFOR) e• come ilk t CCfik Y cows +F46. fru State of Connecticut By: City of Hartford ss. Robert L.Rane , enior Vice President On this the 21st day of April, 2021, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of each of the Companies, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of said Companies by himself as a duly authorized officer. aroz4 IN WITNESS WHEREOF, I hereunto set my hand and official seal. f. liy// e My Commission expires the 30th day of June,2026 � Now �. PUBLI° Anna P.Nowik,Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of each of the Companies,which resolutions are now in full force and effect,reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority;and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in- Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of each of the Companies, do hereby certify that the above and foregoing is a true and correct copy of the Power of AttornQy,p cited by said Companies,which remains in full force and effect. r I Dated this 24th day of January, ��..., W ■ loardb.�. y • 'e Kevin E.Hughes,Assi tant Secretary To verify the authheratkltyofthis Power of Attorney,please call usat1-800-421-3880. Please refer to the above-named Attomeyfs)-ln-Pact and the details of the bond to which this Power of Attorney is attached. we' SECTION 004000 BID BOND KNOW ALL MEN BY THESE PRESENTS: That we, the undersigned, Petticoat-Schmitt Civil Contractors, Inc. as Principal, and Travelers Casualty and Surety Company of America as Surety, are hereby held and firmly bound unto Clay County Utility_Authority as OWNER in the penal sum of Five Percent of Bid Amount for payment of which, well and truly to be made, we hereby jointly and severally bind ourselves, successors and assigns. Signed, this 10th day of December ,20 21 The Condition of the above obligation is such that whereas the Principal has submitted to Clay County Utility Authority a certain BID, attached hereto and hereby made a part hereof to enter into a contract in writing for the Saratoga Springs WTP,Reclaimed Pump Station, and Potable and Reclaimed Water Distribution Main Project Clay County Utility Authority Bid No. 21/22-A02. NOW, THEREFORE, (a) If said BID shall be rejected, or o (b) If said BID shall be accepted and the Principal shall execute and deliver a contract in the Form of Contract attached hereto (properly completed in accordance with said BID)and shall furnish a BOND for his faithful performance of said contract,and for the payment of all persons performing labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said BID, then this obligation shall be void, otherwise the same shall remain in force and effect;it being expressly understood and agreed that the liability of the Surety of all and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated. The Surety,for value received,hereby stipulates and agrees that the obligations of said Surety and its BOND shall be in no way impaired or affected by any extension of time within which the OWNER may accept such BID; and said Surety does hereby waive notice of any such extension. IN WITNESS WHEREOF,the Principal and the Surety have hereunto set their hands and seals,and such of them as are corporations have caused their corporate seals to be hereto affixed and these presents to be signed by their proper officers, the day and year first set forth above. BY: gYY1 LOA Cp/YIJ Principal:Petticoat-Schmitt Civil ,mtractors,Ini Travelers Casualty and Sur ty Company of America �r Surety Benjamin Powell,Attorney-in-Fact 004000-1 CCUA Project No: 1128-002 CDM Smith Project No 259164-240363 BID BOND Saratoga Springs WTP,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Mains October 2021 Travelers Casualty and Surety Company of America Travelers Casualty and Surety Company TRAVELERS J St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: Thal Travelers Casually and Surely Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the"Companies"),and that the Companies do hereby make.constitute and appoint Robert T Theus of JACKSONVILLE , Florida , their true and lawful Attorney(s)-in-Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed,this 21st day of April, 2021. (C-177 FOf - A c State of Connecticut By City of Hartford ss. Robert L.Rane , enior Vice President On this the 21st day of April, 2021, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of each of the Companies, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of said Companies by himself as a duly authorized officer. P up IN WITNESS WHEREOF, I hereunto set my hand and official seal. NQTAAY t 2 My Commission expires the 30th day of June,2026 * ++• ` , 4 U G rustiio Anna P.Nowik,Notary Public O This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of each of the Companies,which resolutions are now in full force and effect,reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority;and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in- Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company In the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of each of the Companies, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies,which remains in full force and effect. Dated this 10th day of December , 2021 r� � AWE ntmaa 4 NMIFORD, oawan a oaca c CONN • •\ es �4` •�t 's srAt r Kevi Hu s,Assistant Secretary To verify the authenticity of this Power of Attorney,please call us at 1-800-411-3880. Please refer to the above-named Attorney(s)-in-Fact and the details of the bond to which this Power of Attorney is attached. 1401:C [: 7 Z021 rJ --.4, PETTCIV-01 SBRUNSON AC( RL.) DATE(MMIDDIYYYY) `�_ CERTIFICATE OF LIABILITY INSURANCE 1/13/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Susan Brunson,CIC,CLCS,ACSR PRODUCER NAME: Cecil W.Powell&Company 219 N.Newnan Street (A/C,No,Ext):(904)353-3181 (a c,Ne):(804)353-5722 Jacksonville,FL 32202 1�I ss:SBRunson�CWpowellins.Com INSURER(S)AFFORDING COVERAGE NAIL# INsuRERA;Travelers Indemnity Co of Am 25666 INSURED wsuRERB;The Phoenix Insurance Co 25623 Petticoat-Schmitt Civil Contractors,Inc. INsuRERc:Travelers Prop Cas Co of Am 25674 6380 Philips Highway INsuRERD:Bridgefield Casualty Ins Co 10335 Jacksonville,FL 32216 INSURERE:St.Paul Surplus Lines Insurance Company 30481 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE ADDL SUBR1 POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMMIDD/YYYY) IMM/DDLYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X x DTCO1R245713TIA21 11/12/2021 11/12/2022 Wirna ea rrencel $ 300,000 _ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 Gill AGGREGAT LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- OT 2,000,000 POLICY X LOC PRODUCTS-COMP/OP AGG $ _ OTHER: $COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE LIABILITY (Ea accident) $ X ANY AUTO X X 8101R2462972126G 11/12/2021 11/12/2022 BODILY INJURY IPerperson) $ OWNED SCHEDULED — AUTOS ONLY AUTOS SSy �E BODILY INJURY(Per accident) $ HIREDTS ONLY AUTOS ONLY (P OF'EftJY Il AMAGE S aacccclmde0+nt $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE CUP5R0754342126 11/12/2021 11/12/2022 AGGREGATE $ 5,000,000 _ DED I X RETENTION$ 10,000 $ D WORKERS COMPENSATION X[PER TE I I EH- AND EMPLOYERS'LIABILITY 019638457 2/1/2021 2/1/2022 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE YIN X EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N NIA (Mandatory In NH) i EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POI ICY LIMIT $ E Pollution Liability ZCD-16P20811 1/12/2022 1/12/2023 Per Claim 1,000,000 E Pollution Liability ZCD-16P20811 1/12/2022 1/12/2023 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is respired). Project:Saratoga Springs Water Treatment Plant,Reclaimed Pump Station,and Potable and Reclaimed Water Distribution Main Project Clay County Utility Authority is an Additional Insured with respects to General Liability for On-Going&Completed Operations and Auto Liability on a Primary and Non-Contributory when Required by Written Contract or Agreement per the Attached Endorsements.A Waiver of Subrogation is attached to General Liability,Auto and Workers Compensation when Required by Written Contract or Agreement per the Attached Endorsements. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ClayCountyUtilityAuthorityTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3176 Old Jennings Road Middleburg,FL 32068 AUTHORIZED REPRESENTATIVE • I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule *Blanket Waiver of Subrogation Applies* to This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Date Prepared: December 8, 2020 Carrier: Bridgefield Casualty Insurance Company Effective Date of Endorsement: February 1, 2021 Policy Number: 196-38457 Countersigned by: Insured: Petticoat-Schmitt Civil Contractors, Inc. WC 00 03 13 (Ed. 4-84) "Includes copyright material of the National Council on Compensation Insurance, Inc. used with its permission. Copyright 1984 NCCI" Policy#: DT-CO-1 R245713-TIA-21 COMMERCIAL GENERAL LIABILITY c. Method Of Sharing a. The statements in the Declarations are If all of the other insurance permits contribution accurate and complete; by equal shares,we will follow this method also. b. Those statements are based upon Under this approach each insurer contributes representations you made to us; and equal amounts until it has paid its applicable c. We have issued this policy in reliance upon limit of insurance or none of the loss remains, your representations. whichever comes first. The unintentional omission of, or unintentional error If any of the other insurance does not permit in, any information provided by you which we relied contribution by equal shares, we will contribute upon in issuing this policy will not prejudice your by limits. Under this method, each insurer's rights under this insurance. However, this provision share is based on the ratio of its applicable limit does not affect our right to collect additional of insurance to the total applicable limits of premium or to exercise our rights of cancellation or insurance of all insurers. nonrenewal in accordance with applicable insurance d. Primary And Non-Contributory Insurance If laws or regulations. Required By Written Contract 7. Separation Of Insureds If you specifically agree in a written contract or Except with respect to the Limits of Insurance, and agreement that the insurance afforded to an any rights or duties specifically assigned in this insured under this Coverage Part must apply on Coverage Part to the first Named Insured, this a primary basis, or a primary and non- insurance applies: contributory basis, this insurance is primary to a. As if each Named Insured were the only other insurance that is available to such insured Named Insured; and which covers such insured as a named insured, and we will not share with that other insurance, b. Separately to each insured against whom claim provided that: is made or"suit"is brought. o (1) The"bodily injury'or"property damage"for 8. Transfer Of Rights Of Recovery Against Others which coverage is sought occurs; and To Us (2) The "personal and advertising injury' for If the insured has rights to recover all or part of any which coverage is sought is caused by an payment we have made under this Coverage Part, offense that is committed; those rights are transferred to us.The insured must subsequent to the signing of that contract or do nothing after loss to impair them.At our request, agreement by you. the insured will bring "suit" or transfer those rights to us and help us enforce them. 5. Premium Audit 9. When We Do Not Renew a. We will compute all premiums for this Coverage If we decide not to renew this Coverage Part,we will Partin accordance with our rules and rates. mail or deliver to the first Named Insured shown in b. Premium shown in this Coverage Part as the Declarations written notice of the nonrenewal advance premium is a deposit premium only.At not less than 30 days before the expiration date. the close of each audit period we will compute If notice is mailed, proof of mailing will be sufficient the earned premium for that period and send proof of notice. notice to the first Named Insured.The due date for audit and retrospective premiums is the date SECTION V—DEFINITIONS shown as the due date on the bill. If the sum of 1. "Advertisement" means a notice that is broadcast or the advance and audit premiums paid for the published to the general public or specific market policy period is greater than the earned segments about your goods, products or services premium, we will return the excess to the first for the purpose of attracting customers or Named Insured. supporters. For the purposes of this definition: c. The first Named Insured must keep records of a. Notices that are published include material the information we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication; and as we may request. b. Regarding websites, only that part of a website 6. Representations that is about your goods, products or services By accepting this policy,you agree: for the purposes of attracting customers or supporters is considered an advertisement. Page 16 of 21 ©2017 The Travelers Indemnity Company.All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office,Inc.with its permission. Policy Number: DT-CO-1 R245713-TIA-21 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights,duties, and what is and is not covered. A. Who Is An Insured—Unnamed Subsidiaries C. Incidental Medical Malpractice B. Blanket Additional Insured — Governmental D. Blanket Waiver Of Subrogation Entities — Permits Or Authorizations Relating To E. Contractual Liability—Railroads Operations F. Damage To Premises Rented To You PROVISIONS a. An organization other than a partnership,joint A. WHO IS AN INSURED — UNNAMED venture or limited liability company; or SUBSIDIARIES b. A trust; The following is added to SECTION II—WHO IS as indicated in its name or the documents that AN INSURED: govern its structure. Any of your subsidiaries, other than a partnership, B. BLANKET ADDITIONAL INSURED — joint venture or limited liability company, that is GOVERNMENTAL ENTITIES — PERMITS OR not shown as a Named Insured in the AUTHORIZATIONS RELATING TO OPERATIONS Declarations is a Named Insured if: a. You are the sole owner of, or maintain an The following is added to SECTION II—WHO IS AN INSURED: ownership interest of more than 50%in, such subsidiary on the first day of the policy period; Any governmental entity that has issued a permit and or authorization with respect to operations b. Such subsidiary is not an insured under performed by you or on your behalf and that you similar other insurance. are required by any ordinance, law, building code or written contract or agreement to include as an No such subsidiary is an insured for"bodily injury' additional insured on this Coverage Part is an or "property damage" that occurred, or "personal insured, but only with respect to liability for"bodily and advertising injury" caused by an offense committed: injury", "property damage" or "personal and advertising injury" arising out of such operations. a. Before you maintained an ownership interest The insurance provided to such governmental of more than 50% in such subsidiary; or entity does not apply to: b. After the date, if any, during the policy period a. Any "bodily injury', "property damage" or that you no longer maintain an ownership "personal and advertising injury" arising out of interest of more than 50%in such subsidiary. operations performed for the governmental For purposes of Paragraph 1. of Section II—Who entity;or Is An Insured, each such subsidiary will be deemed to be designated in the Declarations as: b. Any "bodily injury' or "property damage"included in the "products-completed operations hazard". CG D3 16 0219 ©2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. COMMERCIAL GENERAL LIABILITY Policy Number: DT-CO-1 R245713-TIA-21 C. INCIDENTAL MEDICAL MALPRACTICE pharmaceuticals committed by, or with the 1. The following replaces Paragraph b. of the knowledge or consent of,the insured. definition of "occurrence" in the 5. The following is added to the DEFINITIONS DEFINITIONS Section: Section: b. An act or omission committed in providing "Incidental medical services" means: or failing to provide "incidental medical services", first aid or "Good Samaritan a. Medical, surgical, dental, laboratory, x-ray services" to a person, unless you are in or nursing service or treatment, advice or the busing or occupation of providing instruction, or the related furnishing of professional health care services. food or beverages; or 2. The following replaces the last paragraph of b. The furnishing or dispensing of drugs or Paragraph 2.a.(1) of SECTION II — WHO IS medical, dental, or surgical supplies or AN INSURED: appliances. Unless you are in the business or occupation 6. The following is added to Paragraph 4.b., of providing professional health care services, Excess Insurance, of SECTION IV — Paragraphs (1)(a), (b), (c) and (d) above do COMMERCIAL GENERAL LIABILITY not apply to "bodily injury" arising out of CONDITIONS: providing or failing to provide: This insurance is excp-ss over any valid and (a) "Incidental medical services" by any of collectible other insurance, whether primary, your "employees" who is a nurse, nurse excess, contingent or on any other basis,that assistant, emergency medical technician is available to any of your "employees" for or paramedic;or "bodily injury" that arises out of providing or (b) First aid or"Good Samaritan services" by failing to provide"incidental medical services" any of your "employees" or "volunteer to any person to the extent not subject to o workers", other than an employed or Paragraph 2.a.(1) of Section II —Who Is An volunteer doctor. Any such "employees" Insured. or "volunteer workers" providing or failing D. BLANKET WAIVER OF SUBROGATION to provide first aid or "Good Samaritan services" during their work hours for you The following is added to Paragraph 8., Transfer will be deemed to be acting within the Of Rights Of Recovery Against Others To Us, scope of their employment by you or of SECTION IV — COMMERCIAL GENERAL performing duties related to the conduct LIABILITY CONDITIONS: of your business. If the insured has agreed in a contract or 3. The following replaces the last sentence of agreement to waive that insured's right of Paragraph 5. of SECTION III — LIMITS OF recovery against any person or organization, we INSURANCE: waive our right of recovery against such person or For the purposes of determining the organization, but only for payments we make applicable Each Occurrence Limit, all related because of: acts or omissions committed in providing or a. "Bodily injury" or "property damage" that failing to provide "incidental medical occurs; or services", first aid or "Good Samaritan services"to any one person will be deemed to b. "Personal and advertising injury" caused by be one"occurrence". an offense that is committed; 4. The following exdusion is added to subsequent to the execution of the contract or Paragraph 2., Exclusions, of SECTION I — agreement. COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE E. CONTRACTUAL LIABILITY—RAILROADS LIABILITY: 1. The following replaces Paragraph c. of the Sale Of Pharmaceuticals definition of "insured contract" in the "Bodily injury' or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or c. Any easement or license agreement; CG D3 16 02 19 ordinance relating to the sale of Page 2 of 3 ©2017 The Travelers Indemnity Company.All rights reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Policy Number: DT-CO-1 R245713-TIA-21 COMMERCIAL GENERAL LIABILITY 2. Paragraph f.(1) of the definition of "insured a. Any premises while rented to you or contract" in the DEFINITIONS Section is temporarily occupied by you with permission deleted. of the owner; or F. DAMAGE TO PREMISES RENTED TO YOU b. The content of any premises while such The following replaces the definition of"premises premises is rented to you, if you rent such damage" in the DEFINITIONS Section: premises for a period of seven or fewer consecutive days. "Premises damage" means"property damage"to: 0 CG D3 16 0219 ©2017 The Travelers Indemnity Company.All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Policy Number: DT-CO-1 R245713-TIA-21 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - AUTOMATIC STATUS IF REQUIRED BY WRITTEN CONTRACT (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION II—WHO IS AN (a) The Additional Insured — Owners, Les- INSURED: sees or Contractors —Scheduled Person Any person or organization that: or Organization endorsement CG 20 10 a. You agree in a written contract or agreement to 07 04 or CG 20 10 04 13, the Additional include as an additional insured on this Coverage Insured — Owners, Lesses or Contrao- Fart, and tors — Completed Operations endorse- ment CG 20 37 07 04 or CG 20 37 04 13, b. Has not been added as an additional insured for or both of such endorsements with either the same project by attachment of an endorse- of those edition dates;or ment under this Coverage Part which includes (b) Either or both of the following: the Addi- such person or organization in the endorsements tional Insured—Owners, LPssPes or Con- schedule; tractors — Scheduled Person Or Organi- is an insured, but: zation endorsement CG 20 10, or the Ad- a. Only with respect to liability for "bodily injury" or ditional Insured — Owners, Lessees or "property damage" that occurs, or for "personal Contractors — Completed Operations en- injury" caused by an offense that is committed, dorsement CG 20 37, without an edition subsequent to the signing of that contract or date of such endorsement specified; agreement and while that part of the contract or the person or organization is an additional in- agreement is in effect; and sured only if the injury or damage is caused, b. Only as described in Paragraph (1), (2) or(3) be- in whole or in part, by acts or omissions of low, whichever applies: you or your subcontractor in the performance (1) If the written contract or agreement specifical- ly requires you to provide additional insured "you-work"to which the written contract or agreement applies; or coverage to that person or organization by the use of: (3) If neither Paragraph(1)nor(2)above applies: (a) The person or organization is an addi- (a) The Additional Insured — Owners, Les tional insured only if, and to the extent sees or Contractors — (Form B) endorse ment CG 20 10 11 85; or (b) Either or both of the following: the Addi- tional Insured—Owners, Lessees or Con- of tractors — Scheduled Person Or Organi- that, the injury or damage is C IrsPd by acts or omissions of you or your subcon- tractor in the performance of "your work' to which the written contract or agree- ment applies; and zation endorsement CG 20 10 10 01, or (b) Such person or organization does not the Additional Insured —Owners, Lessees qualify as an additional insured with re- or Contractors — Completed Operations sped to the independent acts or omis- endorsement CG 20 37 10 01; sions of such person or organization. the person or organization is an additional in- The insurance provided to such additional insured is sured only if the injury or damage arises out subject to the following provisions: of"your work" to which the written contract or a. If the Limits of Insurance of this Coverage Part agreement applies; shown in the Dedarations exceed the minimum (2) If the written contract or agreement specifical- limits required by the written contract or agree- ly requires you to provide additional insured ment, the insurance provided to the additional in- coverage to that person or organization by sured will be limited to such minimum required the use of: limits. For the purposes of determining whether CG D6 04 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY Policy Number: DT-CO-1 R245713-TIA-21 this limitation applies, the minimum limits required result in a claim. To the extent possible, such by the written contract or agreement will be con- notice should include: sidered to include the minimum limits of any Um- (a) How, when and where the "occurrence" brella or Excess liability coverage required for the or offense took place; additional insured by that written contract or (b) The names and addresses of any injured agreement. This provision will not increase the persons and witnesses; and limits of insurance described in Section III—Limits Of Insurance. (c) The nature and location of any injury or b. The insurance provided to such additional insured damage arising out of the"occurrence"or does not apply to: offense. (1) Any "bodily injury', "property damage" or (2) If a claim is made or"suit' is brought against "personal injury" arising out of the providing, the additional insured: or failure to provide, any professional archi- (a) Immediately record the specifics of the tedural, engineering or surveying services, claim or"suit"and the date received; and including: (b) Notify us as soon as practicable and see (a) The preparing, approving, or failing to to it that we receive written notice of the prepare or approve, maps, shop draw- claim or"suit"as soon as practicable. ings, opinions, reports, surveys, field or- (3) Immediately send us copies of all legal pa- ders or change orders, or the preparing, pers received in connection with the claim or approving, or failing to prepare or ap- "suit', cooperate with us in the investigation prove, drawings and specifications; and or settlement of the claim or defense against (b) Supervisory, inspection, architectural or the"suit', and otherwise comply with all policy engineering activities. conditions. (2) Any "bodily injury' or "property damage" (4) Tender the defense and indemnity of any caused by "your work' and included in the claim or "suit" to any provider of other insur- "products-completed operations hazard" un- ance which would cover such additional in- less the written contract or agreement specifi- sured for a loss we cover. However, this con- cally requires you to provide such coverage dition does not affect whether the insurance for that additional insured during the policy provided to such additional insured is primary period. to other insurance available to such additional c. The additional insured must comply with the fol- insured which covers that person or organize- lowing duties: tion as a named insured as described in Par- (1) Give us written notice as soon as practicable agraph 4., Other Insurance, of Section IV — of an "occurrence" or an offense which may Commercial General Liability Conditions. Page 2 of 2 ©2017 The Travelers Indemnity Company.All rights reserved. CG D6 04 02 19 Policy Number: 810-1R246297-21-26-G COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT - FLORIDA This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED H. HIRED AUTO PHYSICAL DAMAGE—LOSS OF USE—INCREASED LIMIT I. PHYSICAL DAMAGE—TRANSPORTATION EXPENSES—INCREASED LIMIT C. EMPLOYEE HIRED AUTO J. PERSONAL EFFECTS D. EMPLOYEES AS INSURED K. AIRBAGS E. SUPPLEMENTARY PAYMENTS—INCREASED L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LIMITS LOSS F. HIRED AUTO — LIMITED WORLDWIDE M. BLANKET WAIVER OF SUBROGATION COVERAGE—INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED This includes any person or organization who you are required under a written contract or The following is added to Paragraph A.1., Who Is agreement between you and that person or An Insured, of SECTION II — LIABILITY organization, that is signed by you before the COVERAGE: "bodily injury" or "property damage" occurs and Any organization you newly acquire or form that is in effect during the policy period, to name during the policy period over which you maintain as an additional insured for Liability Coverage, 50% or more ownership interest and that is not but only for damages to which this insurance separately insured for Business Auto Coverage. applies and only to the extent of that person's or Coverage under this provision is afforded only organization's liability for the conduct of another until the 180th day after you acquire or form the "insured". organization or the end of the policy period, C. EMPLOYEE HIRED AUTO whichever is earlier. 1. The following is added to Paragraph A.1., B. BLANKET ADDITIONAL INSURED Who Is An Insured, of SECTION II — LIABILITY COVERAGE: The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — LIABILITY An "employee" of yours is an "insured" while COVERAGE: operating an "auto" hired or rented under a contract or agreement in that "employee's" CA F2 19 08 17 ©2016 The Travelers Indemnity Company.All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission COMMERCIAL AUTO Policy Number: 810-1R246297-21-26-G name, with your permission, while performing United States of America applies to and duties related to the conduct of your prohibits the transaction of business with or business.2. The following replaces Paragraph b. in B.5., within such country or jurisdiction, for Liability Coverage for any covered "auto" that you Other Insurance, of SECTION IV — BUSINESS AUTO CONDITIONS: lease, hire, rent or borrow without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent or borrow from b. For Hired Auto Physical Damage any of your "employees", partners (if you are Coverage, the following are deemed to be a partnership), members (if you are a limited covered "autos"you own: liability company) or members of their (1) Any covered "auto" you lease, hire, households. rent or borrow; and (a) With respect to any claim made or "suit" (2) Any covered "auto" hired or rented by brought outside the United States of your "employee" under a contract in America, the territories and possessions that individual "employee's" name, of the United States of America, Puerto with your permission, while Rico and Canada: performing duties related to the conduct of your business. (i) You must arrange to defend the However, any "auto" that is leased, hired, "insured" against, and investigate or rented or borrowed with a driver is not a settle any such claim or "suit" and covered "auto". keep us advised of all proceedings and actions. D. EMPLOYEES AS INSURED (ii) Neither you nor any other involved The following is added to Paragraph A.1., Who Is "insured" will make any settlement An Insured, of SECTION II — LIABILITY without our consent. COVERAGE: Any "employee" of yours is an "insured" while (iii)We may, at our discretion, participate using a covered "auto" you don't own, hire or in defending the "insured" against, or borrow in your business or your personal affairs. in the settlement of, any claim or "suit". E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS (iv)We will reimburse the "insured" for 1. The following replaces Paragraph A.2.a.(2), sums that the "insured" legally must of SECTION II—LIABILITY COVERAGE: pay as damages because of "bodily (2) Up to $3,000 for cost of bail bonds injury" or "property damage" to which (including bonds for related traffic law this insurance applies, that the violations) required because of an "insured" pays with our consent, but "accident" we cover. We do not have to only up to the limit described in furnish these bonds. Paragraph C., Limit Of Insurance, of SECTION II — LIABILITY 2. The following replaces Paragraph A.2.a.(4), COVERAGE; of SECTION II—LIABILITY COVERAGE: incurred bythe (v) We will reimburse the"insured"for the (4) All reasonable expenses reasonable expenses incurred with "insured" at our request, including actual our consent for your investigation of loss of earnings up to $500 a day such claims and your defense of the because of time off from work. "insured" against any such "suit", but F. HIRED AUTO — LIMITED WORLDWIDE only up to and included within the COVERAGE—INDEMNITY BASIS limit described in Paragraph C., Limit The following replaces Subparagraph (5) in Of Insurance, of SECTION II — Paragraph B.7., Policy Period, Coverage LIABILITY COVERAGE, and not in Territory, of SECTION IV — BUSINESS AUTO addition to such limit. Our duty to CONDITIONS: make such payments ends when we have used up the applicable limit of (5) Anywhere in the world, except any country or insurance in payments for damages, jurisdiction while any trade sanction, settlements or defense expenses. embargo, or similar regulation imposed by the Page 2 of 4 ©2016 The Travelers Indemnity Company.All rights reserved. CA F2 19 08 17 Includes copyrighted material of Insurance Services Office,Inc.with its permission Policy Number: 810-1R246297-21-26-G COMMERCIAL AUTO (b) This insurance is excess over any valid We will pay up to $50 per day to a maximum of and collectible other insurance available $1,500 for temporary transportation expense to the "insured" whether primary, excess incurred by you because of the total theft of a contingent or on any other basis. covered "auto" of the private passenger type. (c) This insurance is not a substitute for J. PERSONAL EFFECTS required or compulsory insurance in any The following is added to Paragraph A.4., ' country outside the United States, its Coverage Extensions, of SECTION III — territories and possessions, Puerto Rico PHYSICAL DAMAGE COVERAGE: and Canada. Personal Effects You agree to maintain all required or We will pay up to $400 for "loss" to wearing compulsory insurance in any such apparel and other personal effects which are: country up to the minimum limits required by local law. Your failure to comply with (1) Owned by an "insured"; and compulsory insurance requirements will (2) In or on your covered "auto". not invalidate the coverage afforded by This coverage applies only in the event of a total this policy, but we will only be liable to the theft of your covered "auto". same extent we would have been liable had you complied with the compulsory No deductibles apply to this Personal Effects insurance requirements. coverage. K. AIRBAGS (d) It is understood that we are not an admitted or authorized insurer outside the The following is added to Paragraph B.3., United States of America, its territories Exclusions, of SECTION III — PHYSICAL and possessions, Puerto Rico and DAMAGE COVERAGE: Canada. We assume no responsibility for Exclusion 3.a. does not apply to "loss" to one or to the furnishing of certificates of insurance, more airbags in a covered "auto" you own that or for compliance in any way with the inflate due to a cause other than a cause of"loss" laws of other countries relating to set forth in Paragraphs A.1.b. and A.1.c., but insurance. only: a. If that "auto" is a covered "auto" for G. WAIVER OF DEDUCTIBLE—GLASS Comprehensive Coverage under this policy; The following is added to Paragraph D., b. The airbags are not covered under any Deductible, of SECTION III — PHYSICAL warranty; and DAMAGE COVERAGE: c. The airbags were not intentionally inflated. No deductible applies under Specified Causes of Loss or Comprehensive coverage for "loss" to We will pay up to a maximum of $1,000 for any glass used in the windshield. one "loss". H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF L. NOTICE AND KNOWLEDGE OF ACCIDENT OR USE—INCREASED LIMIT LOSS The following replaces the last sentence of The following is added to Paragraph A.2.a., of Paragraph A.4.b., Loss Of Use Expenses, of SECTION IV—BUSINESS AUTO CONDITIONS: SECTION III — PHYSICAL DAMAGE Your duty to give us or our authorized COVERAGE: representative prompt notice of the "accident" or However, the most we will pay for any expenses "loss" applies only when the "accident" or"loss" is for loss of use is $65 per day, to a maximum of known to: $750 for any one"accident". (a) You (if you are an individual); I. PHYSICAL DAMAGE — TRANSPORTATION (b) A partner(if you are a partnership); EXPENSES—INCREASED LIMIT (c) A member (if you are a limited liability The following replaces the first sentence in company); Paragraph A.4.a., Transportation Expenses, of (d) An executive officer, director or insurance SECTION III — PHYSICAL DAMAGE manager (if you are a corporation or other COVERAGE: organization); or CA F2 19 08 17 ©2016 The Travelers Indemnity Company.All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission COMMERCIAL AUTO Policy Number: 810-1R246297-21-26-G (e) Any "employee" authorized by you to give such contract. The waiver applies only to the notice of the"accident" or"loss", person or organization designated in such M. BLANKET WAIVER OF SUBROGATION contract. The following replaces Paragraph A.5., Transfer N. UNINTENTIONAL ERRORS OR OMISSIONS Of Rights Of Recovery Against Others To Us, of The following is added to Paragraph B.2., SECTION IV—BUSINESS AUTO CONDITIONS: Concealment, Misrepresentation, Or Fraud, of 5. Transfer Of Rights Of Recovery Against SECTION IV—BUSINESS AUTO CONDITIONS: Others To Us The unintentional omission of, or unintentional We waive any right of recovery we may have error in, any information given by you shall not against any person or organization to the prejudice your rights under this insurance. extent required of you by a written contract However this provision does not affect our right to signed and executed prior to any "accident" collect additional premium or exercise our right of or "loss", provided that the "accident" or "loss" cancellation or non-renewal. arises out of operations contemplated by Page 4 of 4 ©2016 The Travelers Indemnity Company.All rights reserved. CA F2 19 08 17 Includes copyrighted material of Insurance Services Office,Inc.with its permission Policy Number: 810-1R246297-21-26-G COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE - CONTRACTORS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 2. The following is added to Paragraph B.5., Other 1. The following is added to Paragraph c. in A.1., Insurance of SECTION IV — BUSINESS AUTO Who Is An Insured, of SECTION II — LIABILITY CONDITIONS: COVERAGE: Regardless of the provisions of paragraph a. and This includes any person or organization who you paragraph d. of this part 5. Other Insurance, this are required under a written contract or insurance is primary to and non-contributory with agreement, that is signed by you before the applicable other insurance under which an "bodily injury" or "property damage" occurs and additional insured person or organization is a that is in effect during the policy period, to name named insured when a written contract or as an additional insured for Liability Coverage, agreement with you, that is signed by you before but only for damages to which this insurance the "bodily injury" or "property damage" occurs applies and only to the extent of that person's or and that is in effect during the policy period, organization's liability for the conduct of another requires this insurance to be primary and non- "insured". contributory. CA T4 99 12 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.with its permission. PETTICOAT-SCHMITT IIIIWCIVIL CONTRACTORS, /NC_ 6380 Philips Highway*Jacksonville,FL 32216*(904)751-0888*Fax:(904)751-0988 March 17th, 2023 Via Email Mr. Warrick L. Sams, MBA, CPPO Construction and Inspection Services Manager Clay County Utility Authority 3176 Old Jennings Road Middleburg, Florida 32068 RE: Change Order Request#5—Electrical Gear Delay Saratoga Springs WTP and RPF Dear Mr. Sams, Please allow this letter and supporting documentation to serve as Change Order Request #5 for the above referenced project. Background PSCC was informed of numerous delays to the electrical gear for both the Reclaimed Pump Facility and Water Treatment Plant gear throughout the course of construction. The delays are a result of COVID-19 to and supply chain issues for the manufacturers vendors. The most recent delay has resulted in the electrical gear shipping dates being pushed past the contractual substantial completion date and final completion date of 4/24/23 and 6/24/23 respectively. These supply chain issues are not an isolated incident, and we are currently experiencing these same delays across all projects. In accordance with Article 12.03.A "Delays" of the Contract General Conditions, PSCC is unable to complete work within the contract times due to delays beyond the control of the contractor. PSCC requests an amendment of the Contract and removal of Article 4.04 "Incentive-Disincentive for the Reclaimed Portion of the Project" as a result of these delays out of the control of Petticoat Schmitt. Included below is a letter from Eaton regarding the severe delays experienced as a result of COVID-19 and supply chain issues which have impacted all motor control centers, not just this project. If you have any questions or need additional information, please don't hesitate to contact us. Sincerely, &aided 7 Charles Tofferi Sr. Project Manager PETTICOAT-SCHMITT CIVIL CONTRACTORS, INC. Phone: (904) 647-9774 Email: ctofferi@petticoatschmitt.com Page 1 of 2 CCUA Saratoga Springs WTP&RPF PSCC Project No:22171 Cc: Jonathan Belloit, PSCC Vice President (ibelloit@petticoatschmitt.com) Jim Overton, P.E., CDM Project Manager(overtonii@cdmsmith.com) David Lassetter, P.E., Electrical Engineer(wdlass@bellsouth.net) Paul Steinbrecher, P.E., CCUA Chief Engineer(psteinbrecher@clayutility.org) Brandi Manning, PSCC Project Coordinator(bmanning@petticoatschmitt.com) to Page 2 of 2 Eaton Corporation E N 7000 Highlands Pkwy Suite#101 Powering Business Worldwide Smyrna,GA 30075 February 24, 2023 Tucker Littlepage Cogburn Bros. Inc. 3300 Faye Road Jacksonville, FL 32226 Dear Tucker, As we head into the next quarter of 2023, I'd like to provide you with an update on Eaton's current operational status and what our customers and channel partners can expect from us in the coming months. Supply chain (electronics, metals, resins, allocations in such areas), logistics, and supplier labor disruptions continue to provide challenges for manufacturers across the electrical industry. We expect this to continue for a large part of 2023, which is why we have made significant investments to increase capacity, improve throughput and grow our supply chain elasticity. Eaton continues to qualify new suppliers, utilize "spot buys"for critical material, and employ premium freight and expedited shipping lanes to maximize available product for our partners and customers. These investments and actions are helping, but due to the continuation of challenging conditions, lead times continue to be extended across many Eaton product groups. Our current efforts are focused on delivering product as efficiently as we can under the current circumstances. Because of this, please be aware that we do not have the flexibility to support expedite requests. While Eaton will continue to provide as-accurate-as-possible updates on lead times, unexpected changes are anticipated. We remain committed to providing our sales teams, customers and channel partners with the most up-to-date and available information as we can to while managing expectations that lead times may continue to be extended or changed as the market evolves. Due to the current challenges, there will be revisions of our shipping schedule for your below listed items that were purchased from ANIXTER: ANIXTER PO#SE43503658 (Eaton GO# MJV0011040), Items005-009. • Reason for Extended Lead Times Over the past several months the Fayetteville Plant Operations has continued to see unexpected capacity constraints due to the incoming supply of materials. These constraints have not allowed us to meet the production ramp up we were anticipating. Most recently we have worked through shortages of copper bus that has caused extended delays in our structure assembly line. In addition, we continue to see constrained supply with high usage parts, common across all MCCs, such as molded case circuit breakers, starters, contactors, soft starters, drives, control power transformers, meters and metering disconnects. These material constraints are unfortunately leading to additional rescheduling across our product line. Given the high commonality of parts and raw material challenges, we unfortunately cannot supply a specific list of parts impacting your order. As we see improvements in the supply of raw materials and components, we are committed to evaluating and improving the delivery dates of these orders. We also acknowledge that there may be interest in shipping your MCCs short. Please rest assured that we will reach out and offer ship shorts, if needed, as we get to your order in the scheduled queue. Page 2 of 2 April 1,2022 The latest round of reschedules stems from two main material issues that impacted our plant in December and January. First and probably the most problematic was around copper shortages. We were down for a total of 3-4 weeks due to shortages of 2.5"tin plated copper as well as all 1200A vertical bus. Suppliers increased our lead times from 3 months to 6 months with no notice in November. We have had both suppliers in the plant to work recovery for the balance of 2022 but we started the month of February with 2500 overdue structures, causing a significant push out. The second issue continues to be around starter shortages. There was a laminate shortage impacting AN19 deliveries in January that impacted shipments. Hopefully this detail helps, all customers and orders were impacted in the latest move as we had to have an overall shift in the schedule. • Item006, 007, 008 and 009 are currently showing a ship date of 5/19/23. o The material challenges described above, which cause manufacturing capacity issues, have resulted in the production schedule being moved out/delayed. • Item005 is showing a 7/28/23 ship date. We are requesting that the manufacturing facility improves this date to May. We apologize for the delay. Eaton's recovery plan is focused in the areas above to improve supply across all shorted and allocated material. Please feel free to reach out to me if you have any questions or would like to discuss. Sincerely, to Ervin Beckman Vice President, District Sales— Florida District CDM Smith 75 State Street,Suite 701 Boston,Massachusetts 02109 tel:617 452-6000 March 15, 2023 Warrick L. Sams, MBA, CPPO Construction and Inspection Services Manager Clay County Utility Authority 3176 Old Jennings Road Middleburg, Florida 32068-3907 Subject: Saratoga Springs Water Treatment Plant and Reclaimed Pump Facility Change Order No. 3 - Engineer's Recommendation Dear Warrick: Petticoat Schmitt Civil Contractors (PSCC)was issued a Notice to Proceed on February 23. 2022. Article 4 of the Contract specifies that the Reclaimed Pump Facility(RPF) and associated Reclaimed to Water Main would be substantially completed within 425 days or by April 24, 2023.The Contractor's electrical gear supplier begin to experience supply issues from its material supply vendors during the peak of the COVID-19 era.The supplier submitted a letter to the contractor explaining their difficulties in supplying the electrical equipment on the agreed date.The letter cited supply chain (electronics,metals,resins,etc.),logistics,and continued supplier labor disruptions. CDM Smith has experienced these supply chain issues on recent projects that require electrical gear similar to this project. It is our recommendation that Article 4 of the Contract be removed due to factors outside of the Contractor's control. Please refer any questions regarding this project to me via email at overtonjjCicdmsmith.com or phone (772) 485-7300. Sincerely, James J Overton,PE, PMP Senior Project Manager CDM Smith Inc. cc: File 0 WATER+ENVIRONMENT+TRANSPORTATION+ENERGY+FACILITIES