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R16-078RESOLUTION NO. R16 -078 A RESOLUTION OF THE CITY OF BOYNTON BEACH, FLORIDA, APPROVING THE AWARD OF A CONTRACT TO FLORIDA DESIGN DRILLING CORP FOR MASTER LIFT STATION 309 IMPROVEMENTS, 033 - 2821- 16 /TP, IN THE AMOUNT OF $1,832,000 PLUS A 10% CONTINGENCY IN THE AMOUNT OF $183,200 FOR A TOTAL BUDGET APPROPRIATION OF $2,015,200; AUTHORIZING THE CITY 1 MANAGER TO SIGN THE CONTRACT; AND PROVIDING AN 1 EFFECTIVE DATE. 1 1 1 WHEREAS, on May 17, 2016, bid proposals were received and publicly opened for 1$1 the Master Lift Station No. 309 Improvements project, Bid No. 033 - 2821- 16 /TP. Five (5) 141 bids were received, and Florida Design Drilling Corp. was identified as the apparent low 1TI bidder; and 1$1 WHEREAS, the City's staff and the City's Construction Manager for the project, 1 f I Mathews Consulting, reviewed and evaluated the bid proposals as a result of the bid evaluation -due diligence performed staff is recommending the award of the contract to 2 FLORIDA DESIGN DRILLING CORP who was the lowest, most responsive, 2 responsible bidder who met all qualifications; and 2$I WHEREAS, the City Commission of the City of Boynton Beach upon recommendation of staff, deems it to be in the best interest of the citizens of the City of 2 fl Boynton Beach to award a contract to FLORIDA DESIGN DRILLING CORP for master lift station 309 improvements, Bid Number 033 - 2821- 16 /TP, in the amount of 2tJ $1,832,000.00 plus a 10% contingency in the amount of $183,200.00 for a total budget appropriation of $2,015,200 361 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF {00135767.1 306-9001821) THE CITY OF BOYNTON BEACH, FLORIDA, THAT: Section 1. The foregoing "Whereas" clauses are hereby ratified and confirmed as being true and correct and are hereby made a specific part of this Resolution upon adoption hereof. Section 2. The City Commission of the City of Boynton Beach, Florida does hereby award a contract for MASTER LIFT STATION 309 IMPROVEMENTS, bid number 033 - 2821 -16 /TP to FLORIDA DESIGN DRILLING CORP in the amount of $1,832,000 plus a 10% contingency in the amount of $183,200 for a total budget appropriation of $2,015,200. A copy of the contract is attached hereto as Exhibit "A ". 1� 1 1 1 1 Section 3. The City Manager is authorized to execute the contract on behalf of the City Commission. Section 4. This Resolution shall become effective immediately upon passage. {REMAINDER OF PAGE INTENTIONALLY LEFT BLANK} {00135767.1 306 - 90018211 PASSED AND ADOPTED this 21 day of June, 2016. CITY OF BOYNTON BEACH, FLORIDA YES NO Mayor — Steven B. Grant Vice Mayor — Mack McCray Commissioner — Justin Katz Commissioner — Christina L. Romelus 1� Commissioner — Joe Casello VOTE 5 ATTEST: d '// Ju 'th A. Pyle, CMC Interim City Clerk (Corporate Seal) {00135767.1 306 - 9001821} \ (C::> - c�'A 9 CONSTRUCTION CONTRACT MASTER LIFT STATION 309 IMPROVEMENTS THIS AGREEMENT is entered into between the CITY OF BOYNTON BEACH, a municipal corporation, hereinafter referred to as "CITY', and _Florida Design Drilling Corp._, a corporation authorized to do business in the State of Florida, hereinafter referred to as the "CONTRACTOR ". WHEREAS, the CITY has awarded to the CONTRACTOR the work of performing certain construction services. WHEREAS, at its meeting of _June 21 , 2016, by Resolution No.: , the CITY Commission authorized the proper CITY officials to execute this Contract hereinafter referred to as Contract No.: 033 - 2821 -16/TP , and; NOW, THEREFORE, CITY and CONTRACTOR, in consideration of the mutual covenants hereinafter set forth, agree as follows: Article 1. SCOPE OF WORK CONTRACTOR shall furnish all plant, labor, materials, and equipment and perform all the necessary WORK in the manner and form provided in the Contract Documents entitled: MASTER LIFT STATION NO. 309. Invitation to Bid #033 - 2821- 16/TP. Article 2. CONSULTANT Mathews Consulting, Inc. ( "CONSULTANT ") has designed the Project and will assume all duties and responsibilities and will have the rights and .authority assigned to CONSULTANT in connection with completion of the WORK in accordance with the Contract Documents. Article 3. CONTRACT TIME; LIQUIDATED DAMAGES. 3.1 The WORK will be substantially completed within 270 calendar days from the date when the Contract Time commences to run as provided in paragraph 2.3 of the General Conditions, and completed and ready for final payment in accordance with paragraph 14.9 of the General Conditions within 30 calendar days from the date of Substantial Completion. 3.2 Liquidated Damages. The CITY and CONTRACTOR recognize and acknowledge that time is of the essence of this Contract and that the CITY will suffer financial loss if the WORK is not completed within the times specified in paragraph 3.1 above, plus any extensions thereof allowed in accordance with Article 12 of the General Conditions. Each of the parties acknowledges that it has attempted to quantify the damages which would be suffered by the CITY in the event of the failure of CONTRACTOR to perform in a timely manner, but neither one has been capable of ascertaining such damages with a certainty. CITY and CONTRACTOR also recognize and acknowledge the delays, expense and difficulties involved in proving in a legal preceding the actual loss suffered by the CITY if the WORK is not completed on time. Accordingly, instead of requiring any such proof, the CITY and CONTRACTOR agree that as liquidated damages for delay (but not as a penalty) CONTRACTOR shall pay the CITY, Twelve Hundred Dollars ($_1,200 ) for each day that expires after the time specified in paragraphs 3.1 for substantial completion until Boynton Beach Utilities — Master LS309 Improvements C -1 Revised 03/22/2016 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 the CITY, CONTRACTOR shall pay CITY _Three Hundred Dollars ($_300.00 ) for each day that expires after the time specified in paragraph 3.1 for completion and readiness for final payment. Article 4. CONTRACT PRICE. CITY shall pay CONTRACTOR, for faithful performance of the Contract, in lawful money of the United States of America, and subject to the additions and deductions as provided in the Contract Documents, a total sum as follows: Based on the Contract prices shown in the Bid Form submitted to the CITY as subsequently revised and as stated herein, a copy of such Bid Form being a part of the Contract Documents, the aggregate amount of this Contract (obtained from either the lump sum price, the application of unit prices to the quantities shown in the Bid Form or the combination of both) not to exceed: One Million Eight Hundred Thirty -Two Thousand Dollars and -0- cents (Written) $1,832,000 (Numerical) Article 5. PAYMENT PROCEDURES CONTRACTOR shall submit Applications for Payment in accordance with Article 14 of the General Conditions. CITY will process Applications for Payment as provided in the General Conditions. 5.1 Progress Payments. CONTRACT may submit an Application for Payment as recommended by CONSULTANT, for WORK completed during the Project at intervals of not more than once a month. All progress payments will be on the basis of the progress of WORK measured by the schedule of values established in Paragraph 2.9.1 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. 5.2 Prior to Substantial Completion progress payments will be made in an amount equal to 90% of WORK completed, but, in each case, less the aggregate of payments previously made and less such amounts as CONSULTANT shall determine, or CITY may withhold, in accordance with paragraph 14.5 of the General Conditions. 5.3 CONTRACTOR shall submit with each Application for Payment, and updated progress schedule acceptable to the CITY and a Warranty of Title /release of liens relative to the Work that is the subject of the Application. Each Application for Payment shall be submitted to the CITY for approval. The CITY shall make payment to the CONTRACTOR within thirty (30) days after approval by the CITY of CONTRACTOR'S Application for Payment and submission of an acceptable updated progress schedule. 5.4 Ten percent (10) of all monies earned by the CONTRACTOR shall be retained by CITY until fifty (50) percent completion of the construction services purchased (defined as that point at which fifty (50) percent of the construction of the work as defined in the Contract Schedule of Values has been performed under the contract by the CONTRACTOR) has been reached. Boynton Beach Utilities — Master LS309 Improvements C -2 Revised 03122/2016 5.5 After fifty (50) percent completion of the construction work purchased under the Contract has been reached, five (5) percent of all monies earned by the CONTRACTOR shall be retained by the CITY until Final Completion and acceptance by CITY. 5.6 The CITY may withhold, in whole or in part, payment to such extent as may be necessary to protect itself from loss on account of: a. Defective Work not remedied. b. Claims filed or reasonable evidence indicating probable filing of claims by other parties against CONTRACTOR. c. Failure of CONTRACTOR to make payments properly to SUBCONTRACTORS or for material or labor. d. Damage to another CONTRACTOR not remedied. e. Liquidated damages and costs incurred by the CITY for extended construction administration. When the above grounds are removed or resolved or CONTRACTOR provides a surety bond or consent of Surety, satisfactory to the CITY, which will protect the CITY in the amount withheld, payment may be made in whole or in part. 5.7 Final Payment. Upon final completion and acceptance of the WORK in accordance with paragraph 14.10 of the General Conditions, CITY shall pay the remainder of the Contract Price as recommended by CONSULTANT as provided in paragraph 14.10. Article 6. CONTRACTOR GUARANTEE CONTRACTOR warrants all work, materials and equipment shall be free from damages and /or defects owing to faulty materials or workmanship for a period of one (1) year after completion of the WORK covered by this Contract. The CONTRACTOR, free of all costs to the CITY, shall replace any part of the equipment, materials, or work included in this Contract, which proves to be defective by reason of faulty materials, damages, and /or workmanship within twelve (12) month period. Article 7. CONTRACT DOCUMENTS The Documents hereinafter listed shall form the Contract and they are as fully a part of the Contract as if attached hereto: 7.1 Invitation to Bid 7.2 Instructions to Bidders 7.3 Bid Forms (including the Bid, Bid Schedule(s), Information Required of Bidder, Approved Bid Bond, and all required certificates, affidavits and other documentation) 7.4 Contract 7.5 Contractor's Performance and Payment Bond 7.6 General Conditions 7.7 Special Conditions 7.8 Technical Specifications 7.9 Drawings 7.10 Addendum No. 1 Dated _5/5/16 Boynton Beach Utilities — Master LS309 Improvements C -3 Revised 03/22/2016 ARTICLE 8. NOTICE All notices required in this Contract shall be sent by certified mail, return receipt requested and if sent to the CITY shall be mailed to: City of Boynton Beach Attn: Jose Huertas, Project Manager 124 E. Woolbright Road Boynton Beach, FL 33435 Tel (561) 742 - 6487 Copy to: Procurement Services Division Attn: Director of Finance City of Boynton Beach 100 E. Boynton Beach Boulevard Boynton Beach FL 33425 Tel (561) 742 -6310 Fax (561) 742 -6322 And if sent to the CONTRACTOR shall be mailed to: Florida Design Drilling Corp 7733 Hooper Road West Palm Beach, FL 33411 Attn: Jeffrey Holst Tel: (561) 844 -2966 Cell: (561) 818 -3228 Email: jeff @fldrilling.com Article 9. INDEMNITY In consideration of Twenty -Five Dollars ($25.00) in hand paid and other valuable consideration, receipt of which is hereby acknowledged, CONTRACTOR agrees to defend, indemnify and hold harmless the CITY, its agents and employees, in accordance with paragraph 6.17 of the General Conditions which is incorporated herein and made a part hereof as if fully set forth herein. It is the specific intent of the parties hereto that the foregoing indemnification complies with Florida Statutes 725.06. It is further the specific intent and agreement of said parties that all of the Contract Documents on this Project are hereby amended to include the foregoing indemnification and the Specific Consideration. Article 10. REIMBURSEMENT OF CONSULTANT EXPENSES Should the completion of this Contract be delayed beyond the specified or adjusted time limit, CONTRACTOR shall reimburse the CITY for all expenses of consulting and inspection incurred by the CITY during the period between said specified or adjusted time and the actual date of final completion. All such expenses for consulting and inspection incurred by the CITY will be charged to CONTRACTOR and be deducted from payments due CONTRACTOR as provided by this Contract. Said expenses shall be further defined as CONSULTANT charges associated with the construction contract administration, including resident project representative costs. Article 11. FLORIDA'S PUBLIC RECORDS LAW. The City is a public agency subject to Chapter 119, Florida Statutes. The Contractor shall comply with Florida's Public Records Law. Specifically, the Contractor shall: 11.1 Keep and maintain public records required by the CITY to perform the service; 11.2 Upon request from the CITY's custodian of public records, provide the CITY with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in Chapter 119, Florida Statue or as otherwise provided by law; 11.3 Ensure that public records that are exempt or that are confidential and exempt from public record disclosure requirements are not disclosed except as authorized by law for the duration of the contact term and, following completion of the contract, Contractor shall destroy all copies of such confidential and exempt records remaining in its possession once Boynton Beach Utilities — Master LS309 Improvements C -4 Revised 03/22/2016 the Contractor transfers the records in its possession to the City; and, 11.4 Upon completion of the contract, Contractor shall transfer to the CITY, at no cost to the CITY, all public records in Contractor's possession. All records stored electronically by Contractor must be provided to the CITY, upon request from the CITY's custodian of public records, in a format that is compatible with the information technology systems of the CITY. 11.5 IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS: (CITY CLERK) 100 E. BOYNTON BEACH BOULEVARD. BOYNTON BEACH, FLORIDA, 33435. 561 - 742 -6061. PYLEJ @BBFL.US Article 12. MISCELLANEOUS. 12.1 No assignment by a party hereto of any rights under or interests in the Contract Documents 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. 12.2 CITY and CONTRACTOR each binds itself, their partners, successors, assigns and legal representatives to the other party hereto, their partners, successors, assigns and legal representatives in respect of all covenants, agreements and obligations contained in the Contract Documents. Boynton Beach Utilities — Master LS309 Improvements C -5 Revised 03/22/2016 IN WITNESS WHEREOF, the parties have hereunto set their hands and seals on the day and year set forth below their respective signatures. IN WITNESS WHEREOF, the parties hereto have executed this Contract in multiple copies, each of which shall be considered an original on the following dates: DATED this day of , 2016. CITY OF BOYNTON BEACH City Manager Contractor Attest/Authenticated: Title (Corporate Seal) City Clerk Approved as to Form: Attest/Authenticated: Office of the City Attorney Secretary Boynton Beach Utilities — Master LS309 Improvements C -6 Revised 03/22/2016 APPENDIX "C" ATTACHMENTS Boynton Beach Utilities — Master LS309 Improvements PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS: that (Insert name of Contractor) as Principal, (Address or legal title of Contractor) hereinafter called Contractor, and (Name and address of Surety) as Surety, hereinafter called Surety, are held and firmly bound unto CITY OF BOYNTON BEACH, P.O. BOX 310, BOYNTON BEACH, FLORIDA 33425 -0310 as Obligee, hereinafter called Owner, in the amount of Dollars ($ ), for payment whereof Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, Contractor has by written agreement dated , 20 , entered into a contract with Owner for in accordance with drawings and specifications prepared by which contract is by reference made a part of hereof, and is hereinafter referred to as the Contract. Boynton Beach Utilities — Master LS309 Improvements PFB -1 THIS FORM SHALL BE EXECUTED BY CONTRACTOR AND SUBMITTED AT AWARD NOW THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if Contractor shall promptly and faithfully perform such Contract, then this obligation shall be null and void; otherwise it shall remain in full force and effect. The Surety hereby waives notice of any alteration or extension of time made by the Owner. Whenever Contractor shall be, and declared by Owner to be in default under the Contract, the Owner having performed Owner's obligations thereunder, the Surety may promptly remedy the default, or shall promptly: 1. Complete the Contract in accordance with its terms and conditions, or 2. Obtain a bid or bids for completing the Contract in accordance with its terms and conditions, and upon determination by Surety of the most responsible bidder, or, if the Owner elects, upon determination by the Owner and the Surety jointly of the most responsible bidder, arrange for a contract between such bidder and Owner, and make available as work progresses (even though there should be a default or a succession of defaults under the contract or contracts of completion arranged under this paragraph) sufficient funds to pay the cost of completion less the balance of the contract price; but not exceeding, including other costs and damages for which the Surety may be liable hereunder, the amount set forth in the first paragraph hereof. The term "balance of the contract price ", as used in this paragraph, shall mean the total amount payable by Owner to Contractor under the contract and any amendments thereto, less the amount properly paid by Owner to Contractor. Any suit under this bond must be instituted before the expiration of one (1) year from the date on which final payment under the Contract falls due. No right of action shall accrue on this bond to or for the use of any person or corporation other than the Owner named herein or the heirs, executors, administrators or successors of the Owner. This bond is issued in compliance with Section 255.05, Florida Statutes as may be amended. A claimant, except a laborer, who is not in privity with the Contractor and who has not received payment for its labor, materials, or supplies shall, within 45 days after beginning to furnish labor, materials, or supplies for the prosecution of the 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 its labor, materials, or supplies shall, within 90 days after performance of the labor or after complete delivery of the materials or supplies, deliver to the Contractor and to the Surety written notice of the performance of the labor or delivery of the materials or supplies and the nonpayment. No action for the 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 bond after one (1) year from the performance of the labor or completion of delivery of the materials or supplies. Boynton Beach Utilities — Master LS309 Improvements PFB- 2 THIS FORM SHALL BE EXECUTED BY CONTRACTOR AND SUBMITTED AT AWARD Signed and sealed this day of , 2016. Principal (Seal) Witness Title Surety Witness Attorney -in -Fact END OF PERFORMANCE BOND Boynton Beach Utilities — Master LS309 Improvements PFB- 3 THIS FORM SHALL BE EXECUTED BY CONTRACTOR AND SUBMITTED AT AWARD N1Y O o r . u p w THIS BOND IS ISSUED SIMULTANEOUSLY WITH PERFORMANCE BOND IN FAVOR OF THE OWNER CONDITIONED ON THE FULL AND FAITHFUL PERFORMANCE OF THE CONTRACT KNOW ALL MEN BY THESE PRESENTS: that (Address or legal title of contractor) hereinafter called (Insert name of Contractor) as Principal, Principal, and (Name and address of Surety) as Surety, hereinafter called Surety, are held and firmly bound unto CITY OF BOYNTON BEACH, P.O. BOX 310, BOYNTON BEACH, FLORIDA 33425 -0310 as Obligee, hereinafter called Owner, for the use and benefit of claimants as here below defined, in the amount of Dollars ($ ), for payment whereof Principal and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, Principal has by written agreement dated , 20165, entered into a contract with Owner for in accordance with drawings and specifications prepared by which contract is by reference made a part of hereof, and is hereinafter referred to as the Contract. NOW THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if Principal shall promptly make payment to all claimants as hereinafter defined, for all labor and material used or reasonably required for use in the performance of the Contract, then this obligation shall be null and void; otherwise it shall remain in full force and effect, subject, however, to the following conditions: Boynton Beach Utilities — Master LS309 Improvements PYB- 1 THIS FORM SHALL BE EXECUTED BY CONTRACTOR AND SUBMITTED AT AWARD I . A claimant is defined as one having a direct contract with the Principal or with a subcontractor of the Principal for labor, material or both, used or reasonably required for use in the performance of the Contract, labor and material being construed to include that part of water, gas, power, light, heat, oil, gasoline, telephone service or rental of equipment directly applicable to the Contract. 2. The above named Principal and Surety hereby jointly and severally agree with the Owner that every claimant as herein defined, who has not been paid in full before the expiration of a period of ninety (90) days after the date on which the last of such claimant's work or labor` was done or performed, or materials were furnished by such claimant, may sue on this bond for the use of such claimant, prosecute the suit to final judgment for such sum or sums as may be justly due claimant, and have execution thereon. The Owner shall not be liable for the payment of any costs or expenses of any such suit. 3. No suit or action shall be commenced hereunder by any claimant: a. Unless claimant, other than one having a direct contract with the Principal, shall have given written notice to any two of the following: the Principal, the Owner, or the Surety above named, within ninety (90) days after such claimant did or performed the last of the work or labor, or furnished the last of the materials for which such claimant is made, stating with substantial accuracy the amount claimed and the name of the party to whom the materials were furnished, or for when the work or labor was done or performed. Such notice shall be served by mailing the same by registered mail or certified mail, postage prepaid, in an envelope addressed to the Principal, Owner or Surety, at any place where an office is regularly maintained for the transaction of business, or served in any manner in which legal process may be served in the State in which the aforesaid project is located, save that such service need not be made by a public officer. b. After the expiration of one (1) year following the date on which Principal ceased work on such Contract, it being understood, however, that if any limitation embodied in this bond is prohibited by any law controlling the construction hereof such limitation shall be deemed to be amended so as to be equal to the minimum period of limitation permitted by such law. c. Other than in a State Court of competent jurisdiction in and for the County or other political subdivision of the State in which the Project, or any part thereof, is situated, or in the United States District Court for the district in which the Project, or any part thereof, is situated, and not elsewhere. 4. The amount of this bond shall be reduced by and to the extent of a payment or payments made in good faith hereunder, inclusive of the payment by Surety of mechanics liens which may be filed of record against such improvements, whether or not claim for the amount of such lien be presented under and against this bond. 5. This bond is issued in compliance with Section 255.05, Florida Statutes, as may be amended. A claimant, except a laborer, who is not in privity with the Contractor and who has not received payment for its labor, materials, or supplies shall, within 45 days after beginning to furnish labor, materials, or supplies for the prosecution of the 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 its labor, materials, or supplies shall, within 90 days after performance of the labor or after complete delivery of Boynton Beach Utilities— Master LS309 Improvements PYB- 2 THIS FORM SHALL BE EXECUTED BY CONTRACTOR AND SUBMITTED AT AWARD the materials or supplies, deliver to the Contractor and to the Surety written notice of the performance of the labor or delivery of the materials or supplies and the nonpayment. No action for the 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 bond after one (1) year from the performance of the labor or completion of delivery of the materials or supplies. Signed and sealed this day of , 2016. Principal (Seal) Witness Surety Witness Attorney -in -Fact END OF PAYMENT BOND Boynton Beach Utilities— Master LS309 Improvements PYB- 3 THIS FORM SHALL BE EXECUTED BY CONTRACTOR AND SUBMITTED AT AWARD Sy p STATE OF FLORIDA CITY OF BOYNTON BEACH WARRANTY OF TITLE COUNTY OF , being first duly sworn, deposes and says , as follows: He is of (Title) a Florida Corporation a Florida General Partnership a Florida Limited Partnership a Sole Proprietor ( ) Check One which is named in Construction Contract dated the day of 20 , between such corporation as the CONTRACTOR and the City of Boynton Beach, Florida as the OWNER, for the construction of and Affiant is authorized to make this Affidavit as, or on behalf of, the Contractor as named above. Title to all work, materials and equipment covered by the attached Final Application for Payment dated , passes to the Owner at the time of payment free and clear of all liens, and all laborers, material men and subcontractors have been paid for performing or furnishing the work, labor or materials upon such Contract work covered by the aforesaid Final Application for Payment. This statement under oath is given in compliance with Section 713.06 Florida Statutes. Sworn to and subscribed before me this day of , 2016. Notary Public, State of Florida at Large My Commission expires: (SEAL) (Name of Corporation or Firm) Affiant END OF WARRANTY OF TITLE Boynton Beach Utilities — Master LS309 Improvements WT - 1 THIS FORM SHALL BE EXECUTED BY CONTRACTOR AND SUBMITTED WITH FINAL APPLICATION FOR PAYMENT City of Boynton Beach Risk Management Department INSURANCE ADVISORY FORM Under the terms and conditions of all contracts, leases, and agreements, the City requires appropriate coverages listing the City of Boynton Beach as Additional Insured. This is done by providing a Certificate of Insurance listing the City as "Certificate Holder' and "The City of Boynton Beach is Additional Insured as respect to coverages noted." Insurance companies providing insurance coverages must have a current rating by A.M. Best Co. of "B +" or higher. (NOTE: An insurance contract or binder may be accepted as proof of insurance if Certificate is provided upon selection of vendor.) The following is a list of types of insurance required of contractors, lessees, etc., and the limits required by the City: (NOTE: This list is not all inclusive, and the City reserves the right to require additional types of insurance, or to raise or lower the stated limits, based upon identified risk.) TYPE (Occurrence Based Only) General Liability Commercial General Liability Owners & Contractor's Protective (OCP) Liquor Liability Professional Liability Employees & Officers Pollution Liability Asbestos Abatement Lead Abatement Broad Form Vendors Premises Operations Underground Explosion & Collapse Products Completed Operations Contractual Independent Contractors Broad Form Property Damage Fire Legal Liability MINIMUM LIMITS REQUIRED General Aggregate $ 1,000,000.00 Products - Comp /Op Agg. $ 1,000,000.00 Personal & Adv. Injury $ 1,000,000.00 Each Occurrence $ 1,000,000.00 Fire Damage (any one fire)$ 50,000.00 Med. Expense (any one person) $ 5,000.00 Automobile Liability Any Auto All Owned Autos Scheduled Autos Hired Autos Non -Owned Autos PIP Basic Intermodal Combined Single Limit $ 300,000.00 Bodily Injury (per person) to be determined Bodily Injury (per accident)to be determined Property Damage to be determined Trailer Interchange $ 50,000.00 Garage Liability Auto Only, Each Accident $ 1,000,000.00 Any Auto Other Than Auto Only $ 100,000.00 Garage Keepers Liability Each Accident $ 1,000,000.00 Aggregate $ 1,000,000.00 --------------------------------------------------------------------------------------------------------------------------------------- Excess Liability Each Occurrence to be determined Umbrella Form Aggregate to be determined -------------------------------------------------------------------------------------------------------------------------------------- Worker's Compensation Statutory Limits Employer's Liability Each Accident $ 100,000.00 Disease, Policy Limit $ 500,000.00 Disease Each Employee $ 100,000.00 Property Homeowners Revocable Permit Builder's Risk Other - As Risk Identified $ 300,000.00 Limits based on Project Cost to be determined INSURANCE ADVISORY FORM