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HomeMy WebLinkAbout2021-085DIndian River County Purchasing Division 1800 27th Street Vero Beach, FL 32960 Phone (772) 226-1416 CONTRACT DOCUMENTS AND SPECIFICATIONS FOR FLEET FACILITY FUEL ISLAND CANOPY REFURBISHMENT BID NO. 2021024 PROJECT NO. IRC -2025 PREPARED FOR THE BOARD OF COUNTY COMMISSIONERS INDIAN RIVER COUNTY, FLORIDA JOSEPH E. FLESCHER, CHAIRMAN PETER D. O'BRYAN , VICE-CHAIRMAN COMMISSIONER SUSAN ADAMS COMMISSIONER JOE EARMAN COMMISSIONER LAURA MOSS JASON E. BROWN, COUNTY ADMINISTRATOR JEFFREY R. SMITH, CLERK OF COURT AND COMPTROLLER DYLAN REINGOLD, COUNTY ATTORNEY RICHARD B. SZPYRKA, P.E., PUBLIC WORKS DIRECTOR Page 1 of 39 ��vER�oG Indian River County Purchasing Division 180027 th Street Vero Beach, FL 32960 *� Phone (772) 226-1416 Invitation to Bid Project Name: Bid #: Bid Bond Required: Public Construction Bond Required: 2021024 5% if bid over $35,000 Yes, if total award is over $100,000 Bid Opening Date: Tuesday, -May 25, 2021 Bid Opening Time: 2:00 P.M. All bids must be received by the Purchasing Division, 1800 27th Street, Vero Beach, Florida 32960 prior to the date and time shown above. Late bids will not be accepted, opened or considered. PLEASE SUBMIT: (1) ONE MARKED ORIGINAL, (1) COPY OF YOUR BID, AND ONE ELECTRONIC COPY AS A SINGLE PDF ON USB, CD OR EMAILED TO PURCHASING@IRCGOV.COM PRIOR TO THE BID OPENING DATE AND TIME. Refer All Questions to: Email: purchasing@ircgov.com Page 2 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT ADVERTISEMENT FOR BID Notice is hereby given that the Indian River County Board of County Commissioners is calling for and requesting bids for the following: Bid # 2021024 FLEET FACILITY FUEL ISLAND CANOPY REFURBISHMENT, IRC -2025 Detailed specifications are available at: www.demandstar.com or by selecting "Current Solicitations" at http://www.ircgov.com/Departments/Budget/Purchasing. Deadline for receipt of bids has been set for 2:00 P.M. on Tuesday, May 2P, 2021. Only bids received on or before the time and date listed will be considered. Bids should be addressed to Purchasing Division, 1800 27th Street, Room 131-301, Vero Beach, Florida 32960. All bids will be opened publicly and read aloud at 2:00 PM. Bids submitted after 2:00 PM on the.day specified above, will not be opened or considered. BID SECURITY in the sum of not less than five percent (5%) of the total bid must accompany each bid over $35,000. The Board of County Commissioners reserves the right to cancel the bid, accept or reject any and all bids in whole or in part and to waive any technicality or irregularity. Publish: For Publication in the Indian River Press Journal Date: Sunday, May 2nd, 2021 Please furnish Tear Sheet, Affidavit of Publication, and Invoice to: Indian River County Purchasing Division 180027 th Street Vero Beach, FL 32960 Page 3 of 39 PURCHASING MANAGER INDIAN RIVER COUNTY IRC-,2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT Instructions to Bidders Definitions Bidder — Individual or entity submitting a bid to Owner. Contractor — The lowest, responsive, and responsible bidder to whom Owner makes award. Owner — Indian River County General Terms and Conditions Cone of Silence. Potential bidders and their agents must not communicate in any way with the Board of Commissioners, County Administrator or any County staff other than Purchasing personnel in reference or relation to this solicitation. This restriction is effective from the time of bid advertisement until the Board of County Commissioners meets to authorize award. Such communication may result in disqualification. Interpretations: No oral interpretations will be made to any Bidder as to the meaning of the Specifications. Every request for such an interpretation shall be made in writing, addressed and forwarded to the Purchasing Division (purchasing@ircgov.com) ten (10) or more days before the date fixed for opening of the bids. The County shall not be responsible for oral interpretations given by any County employee. Every interpretation made to bidder will be in the form of an Addendum to the specifications, which if issued, will be sent promptly as is practical to all persons to whom specifications have been issued. All such Addenda shall become part of the specifications. Further, it shall be the responsibility of each bidder, prior to submitting their bid, to determine if addenda were issued and to make such addenda a part of their bid. Licensure: Bidder must possess licensure as indicated in the Technical Specifications Scope of Work. Indian River County Code section 400.01(1) requires that "No person shall engage in the business of construction, contracting or subcontracting as regulated by Florida Statutes or in a [any] categories listed in Appendix A to Ordinance No. 94-16 without a valid certificate of competency issued by the Indian River County Building Department unless certified under Florida Statutes." Bidders who do not hold the appropriate licensure at the time of bid opening will be deemed non-responsive. Insurance: • Owners and Subcontractors Insurance: The Contractor shall not commence work until they have obtained all the insurance required under this section, and until such insurance has been approved by the owner, nor shall the contractor allow any subcontractor to commence work until the subcontractor has obtained the insurance required for a contractor herein and such insurance has been approved unless the subcontractor's work is covered by the protections afforded by the Contractor's insurance. • Worker's Compensation Insurance: The Contractor shall procure and maintain worker's compensation insurance to the extent required by law for all their employees to be engaged in work under this contract. In case any employees are to be engaged in hazardous work under this contract and are not protected under the worker's compensation statute, the Contractor shall provide adequate coverage for the protection of such employees. • Public Liability Insurance: The Contractor shall procure and maintain broad form commercial general liability insurance (including contractual coverage) and commercial automobile liability insurance in Page 4 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT amounts not less than shown below. The owner shall be an additional named insured on this insurance with respect to all claims arising out of the operations or work to be performed. Commercial General (Public) Liability, other than Automobile $1,000,000.00 Combined single limit for Bodily Injury and Property Damage Commercial General A. Premises / Operations B. Independent Contractors C. Products / Completed Operations D. Personal Injury .11 E. Contractual Liability F. Explosion, Collapse, and Un Automobile A. Owner Leased Automobiles B. Non -Owned Automobiles $1,000,000.00 Combined single limit C. Hired Automobiles Bodily Injury and Damage Liability D. Owned Automobiles Proof of Insurance: The Contractor shall furnish the owner a certificate of insurance in a form acceptable to the owner for the insurance required. Such certificate or an endorsement provided by the contractor must state that the owner will be given thirty (30) days written notice prior to cancellation or material change in coverage. Copies of an endorsement -naming owner as Additional Insured must accompany the Certificate of Insurance. Permits, Impact and Inspection Fees. In accordance with Florida Statutes Section 218.80, the "Public Bid Disclosure Act", County as OWNER is obligated to disclose all license, permit, impact, or inspection fees that are payable to Indian River County in connection with the construction of the Work by the accepted bidder. The anticipated cost of the permit fees due to the Building Division is provided as a fixed line item on the bid form, specifically noted in the scope of work, or attached as an appendix to the invitation to bid. This amount does not include fees for any necessary re-inspection(s), which are the responsibility of the Contractor. Variations to Specifications: For purposes of evaluation, Bidder must indicate any variances from the specifications and / or conditions on the form provided with this Invitation to Bid. Otherwise, it will be assumed that the product or service fully complies with the specifications. Items specifically described, as alternates shall be reviewed as an alternative bid to be considered by the County, in lieu of the primarily specified item(s). However, item(s) varying from the published specifications shall be considered substitutes, and the County reserves the right to consider or not to consider substitute bids. Substitutes shall be subject to disqualification if the County does not approve the substitution. Sealed Bids and Envelope Markings: All bids must be submitted in a sealed opaque envelope. The outside of the envelope must be clearly marked with the Sealed Bid #, Title of the Bid, Date of the Bid opening, and Time of the Bid Opening and name of firm submitting. Bid Submission: All bids must be signed with the legal Firm name and by an Officer or employee having authority to bind the company or firm by his / her signature. Bids must be submitted on forms provided by the County. The bid forms shall not be recreated. Bids notsubmitted on the attached form(s) shall be rejected, as will bids submitted on rewritten or recreated bid forms. Submittal of one marked original bid and one copy, plus one electronic copy as a single pdf is required unless otherwise instructed. Electronic bids emailed to purchasing@ircgov.com should have the subject "Sealed bid 20210xx so that it will not be inadvertently read or opened prior to the bid opening Page 5 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT date and time. The County will not reimburse any bidder for costs associated with preparation or submittal of this bid. Errors: When an error is made in the bid extension of generating total bid prices or in any other process of completing the bid, the original unit prices submitted will govern. Discrepancies between words and figures will be resolved in favor of the words. Carelessness in quoting prices, or in preparation of the bid otherwise, will not relieve the bidder from performance. Bid Rejection: Failure to comply with all the enclosed instructions may result in rejection of the bid. Consideration of Bids: Verbal, emailed or faxed bids will not be considered. Opening Location: It will be the sole responsibility of the Bidder to deliver their bid personally or by mail or other delivery service to "Indian River County Purchasing Division, 1800 27th Street, Vero Beach, FL 32960," on or before the closing hour and date shown for receipt of bids. Bids received in person or by mail after the stated time and date will not be accepted or considered. Bid Security and Public Construction Bond: Bid security must accompany each Bid over $35,000, and must be in the form of an AIA Document A310 Bid Bond, properly executed by the Bidder and by a qualified surety, or a certified check or a cashier's check, drawn on any bank authorized to do business in the State of Florida. Bid Security for bids over $35,000 must be in the sum of not less than five percent (5%) of the total amount of the bid, made payable to""fndian River County'Board of County Commissioners." -Electronically-signed {bid bonds will be acceptable. In the event the Contract is awarded to the Bidder, Bidder will enter into a Contract with the County and furnish the required 100% Public Construction. Bond and insurance certificates within the timeframe set by the County. If Bidder fails to do so, the Bid Security will be retained by the County as liquidated damages and not as a penalty. If bid does not exceed $100,000, no Public Construction Bond will be required. Bid Security of other Bidders whom OWNER believes do not have a reasonable chance of receiving the award will be returned within seven days after the Bid opening. Irrevocable Offer: Bidder warrants by virtue of submitting a signed bid, that the prices quoted will remain firm and be considered an irrevocable offer for a period of sixty (60) days, during which time one or more of the bids received may be accepted by the County. The Board of County Commissioners shall deem the offer accepted upon approval. Withdrawal of Bids: A bid may be modified or withdrawn by an appropriate document duly executed in the manner that a Bid must be executed and delivered to the place where Bids are to be submitted prior to the date and time of opening of bids. If, within 48 business hours after Bids are opened, any bidder files a duly signed written notice with Owner and promptly thereafter demonstrates to the reasonable satisfaction of Owner that there was a material and substantial mistake in the preparation of its Bid, that bidder may withdraw its bid and bid security will be returned. Thereafter, if the work is rebid, that bidder may be disqualified from further bidding on the work. Co -Operative Purchasing: It is the intent of the Invitation of Bid to secure goods or services to be used by Indian River County. However, by virtue of bidding, the bidder accepts the right of other Florida Governmental agencies to purchase from this bid proposal, when appropriate. The successful bidder and the requesting Governmental agency, apart from Indian River County, shall handle any such purchases separately. Further, County assumes no Page 6 of 39 IRC-,2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT liability for materials or services ordered by any other Governmental agency by virtue of this bid. Bidders that find this condition unsatisfactory should indicate this by showing exception on the Bid Form. Public Record Exemption: Correspondence, materials, and documents received pursuant to this Invitation for Bid become public records subject to the provisions of Chapter 119, Florida Statutes. Should the Bidder assert any exemptions to the requirements of Chapter 119, Florida Statutes, and related statutes, the burden of establishing such exemption, by the way of injunctive or other relief as provided by law, shall be upon the Bidder. Local Preference: County has no local ordinance or preferences, as set forth in Florida Statutes section 255.0991(2) in place, therefore no preference prohibited by that section will be considered in the acceptance, review or award of this bid. Supplemental Information: The County reserves the right to conduct such investigations as it deems necessary to assist in the evaluation of any Bid and to establish the responsibility, qualifications and financial ability of Bidders, proposed subcontractors, suppliers, and other relevant parties to perform and furnish the work. To demonstrate qualifications to perform the work, each Bidder must be prepared to submit, within 5 days of Owner's request, written evidence, such as financial data, previous experience, present commitments, and other such data as may be necessary to prove to the satisfaction of the Owner that the Bidder is qualified by experience to do the work and is prepared to complete the work within the stated time period. Failure to provide any requested information may result in the determination of the Bidder as non -responsible. Awards: The Countyreserves,t'he-right,toCancel-the-bid, accept-orreject any and all bids -in -whole orin part, and waive any irregularity or technicality in bids received. When it is determined there is no competition to the lowest responsive, responsible Bidder, rebidding of the project is not required. Bidders are cautioned to make no assumptions unless their bid has been evaluated as being responsive. The County reserves the right to not make any award(s) under this bid. Bid Protest: Any actual or prospective bidder or proposer who is aggrieved in connection with a competitive selection process may protest to the Purchasing Manager. The protest shall be submitted to the Purchasing Manager in writing within seven (7) calendar days after the bidder or proposer knows or should have known of the facts giving rise to the protest. If the protest is not resolved by mutual agreement, the Purchasing Manager shall promptly issue a decision in writing, after consulting the using Department and the Office of the County Attorney. Applicable Law and Venue: The resulting Agreement and all rights and duties of the parties hereto shall be governed by the laws of the State of Florida, including but not limited to the provisions of the Florida Uniform Commercial Code Chapters 671-679 F.S., for any terms and conditions not specifically stated within. Venue for any lawsuit brought by either party against the other party or otherwise arising out of this Contract shall be in Indian River County, Florida, or, in the event of a federal jurisdiction, in the United States District Court for the Southern District of Florida. Cancellation: It is the intention of the County to purchase material and / or services from sources of supply that will provide prompt and convenient shipment and service. Any failure of the supplier to satisfy the requirements of the County shall be reason for termination of the award. Termination by the County. The County reserves the right to terminate a contract by giving thirty (30) days notice, in writing, of the intention to terminate, if at any time the contractor fails to abide by or fulfill any of the terms and conditions of the contract. The County also reserves the right to terminate this contract for convenience of the County and / or with or without cause. Page 7 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT Non -Collusion: By signing and submitting the Bid Form, the Bidder certifies that, This bid has been arrived at by the Bidder independently and has been submitted without collusion, and without any agreement, understanding, or planned common course, or action with, any vendor of materials, supplies, equipment, or services described in the invitation to bid, designed to limit independent bidding or competition, and • The contents of the bid have not been communicated by the Bidder or its employees or agents to any person not an employee or an agent of the bidder or its surety on any bond furnished with the bid; and will not be communicated to any such person prior to the official opening of the bid. • No attempt has been made or will be made by the Bidder to induce any other person(s) or firm(s) to submit or not to submit a bid for the purpose of restricting competition. Conflict of Interest: Any entity submitting a bid or proposal or entering into a contract with the County shall disclose any relationship that may exist between the contracting entity and a County Commissioner or a County Employee. The relationship with a County Commissioner or a County Employee that must be disclosed is as follows: father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, husband, wife, father-in-law, mother-in-law, daughter-in-law, son-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother,:half sister, grandparent, or grandchild. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in -the -managemeritof`the entity. The disclosure ofrelationships shall "be a sworn statement -made -on a County approved form. Failure to submit the form may be cause for rejection of the bid or proposal. Public Entity Crimes: Pursuant to Florida Statutes Section 287.133(2)(a), all Bidders are hereby notified that a person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity (defined as the State of Florida, any of its departments or agencies, or any political subdivision); may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in Florida Statutes Section 287.017 for CATEGORY TWO [currently $35,000] for a period of 36 months from the date of being placed on the convicted vendor list. A "public entity crime" 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 with the United.States, including, but not limited to, any bid, proposal, reply, or contract for goods or services, any lease for real property, or any contract for the construction or repair of a public building or public work, involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. Suspension and Debarment: County will not make award to parties listed on the government -wide exclusions in the System for Award Management (SAM). The bidder agrees to comply with the requirements of 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C while this offer is valid and throughout the period of any contract that may arise from this offer. The bidder or proposer further agrees to include a provision requiring such compliance in its lower tier covered transactions. The bidder or proposer further agrees to include a provision requiring such compliance in its lower tier covered transactions. By submittal of a bid in response to this solicitation, bidder asserts neither it nor its principals is presently debarred, suspended or proposed for debarment, declared ineligible, or voluntarily excluded from participation in this work by any Federal department or agency. Page 8 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT Scrutinized Companies Lists: The bidder certifies that it and those related entities of respondent as defined by Florida law are not on the Scrutinized Companies that Boycott Israel List, created pursuant to s. 215.4725 of the Florida Statutes, and are not engaged in a boycott of Israel. In addition, if this agreement is for goods or services of one million dollars or more, Contractor certifies that it and those related entities of respondent as defined by Florida law are not on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, created pursuant to Section 215.473 of the Florida Statutes and are not engaged in business operations in Cuba or Syria. The County may terminate this Contract if Company is found to have submitted a false certification as provided under section 287.135(5), Florida Statutes, been placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or been engaged in business operations in Cuba or Syria, as defined by section 287.135, Florida Statutes. County may terminate this Contract if Company, including all wholly owned subsidiaries, majority-owned subsidiaries, and parent companies that exist for the purpose of making profit, is found to have been placed on the Scrutinized Companies that Boycott Israel List or is engaged in a boycott of Israel as set forth in section 215.4725, Florida Statutes. Accordingly, firms responding to this solicitation shall return with their response an executed copy of the attached "Certification Regarding Prohibition Against Contracting With Scrutinized Companies." Failure to return this executed form with submitted bid/proposal/statement of qualifications will result in the response being deemed non-responsive and eliminated from consideration. Alan=Discrimination: County-willnot-lknovvringiy,do~business-withvendors-orTontractorswho discriminate onthe basis of race, color or national origin, sex, sexual orientation, gender identity, age and/or disability. Through the course of providing services to the County, Contractors shall affirmatively comply with all applicable provisions of Title VI of the Civil Rights Act of 1964, the Civil Rights Restoration Act of 1987 and the Florida Civil Rights Act of 1992, as well as all other applicable regulations, guidelines and standards. Any person who believes their rights have been violated should report such discrimination to the County's Title VI/Nondiscrimination Coordinator through the office of the County Attorney. E -Verify: Bidder must be registered with and use, at their sole expense, the Department of Homeland Security's E - Verify system (www.e-verify.gov) to confirm the employment eligibility of all newly hired employees, as required by Section 448.095, F.S. Owner, contractor, and subcontractors may not enter into a contract unless each party to the contract registers with and uses the E -Verify system. Contractor is responsible for obtaining proof of E -Verify registration for all subcontractors. This requirement applies to any provider of services or goods. If bidder is not listed as a participating employer at the time of bid opening, the bid will be declared non-responsive. Assignment/Delegation: No right, obligation or interest in an awarded Agreement may be assigned or delegated by the Bidder without prior written consent of the County, without prejudice to County's other rights and remedies. Energy Policy and Conservation Act —The Contractor agrees to comply with mandatory standards and policies relating to energy efficiency which are contained in the state energy conservation plan issued in compliance with the Energy Policy and Conservation Act. Compliance with Laws and Regulations: Bidder agrees that they will comply with all Federal, State, and Local Laws and Regulations applicable to the production, sale, and delivery of the goods or the furnishing of any labor or services called for by the resulting Agreement, and any provisions required thereby to be included herein shall be Page 9 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT deemed to be incorporated herein by reference. Noncompliance may be considered grounds for termination of contracts. Affirmative Steps: CONTRACTOR must take the following affirmative steps to ensure minority business, women's business enterprises and labor surplus area firms are used when possible: 1. Placing qualified small and minority businesses and women's business enterprises on solicitation lists. 2. Ensuring that small and minority businesses, and women's business enterprises are solicited whenever they are potential sources. 3. Dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by small and minority businesses, and women's business enterprises. 4. Establishing delivery schedules, where the requirement permits, which encourage participation by small and minority businesses, and women's business enterprises. 5. Using the services and assistance of the Small Business Administration and the Minority Business Development Agency of the Department of Commerce. DHS Seal: If this project is federally -funded, the Department of Homeland Security (DHS) seal(s), logos, crests, or reproductions of flags or likenesses of DHS agency officials shall not be used by the Bidder without specific FEMA pre -approval. Indemnification: CONTRACTOR shall indemnify and hold harmless the County, and its commissioners, officers and employees; from liabilities, damages, losses and costs, including, but not limited to, reasonable attorney's fees, to the extentxaused by the,negligence,-recklessness, or -intentional wrongful misconduct of the,contractor and persons employed or utilized by the contractor in the performance of the construction contract. Records/Audit: The Bidder shall maintain books, records and documents pertinent to performance under this Invitation and any resulting Agreement in accordance with generally accepted accounting principles consistently applied. The County and the Florida Office of the Inspector General shall have inspection and audit rights to such records for audit purposes during the term of the contract and for three years following the termination of obligations hereunder. Records which relate to any litigation, appeals or settlements of claims arising from performance under this work or purchase shall be made available until a final disposition has been made of such litigation, appeals, or claims. Public Access: The Bidder shall allow public access to all documents and materials in accordance with the provisions of Chapter 119, Florida Statutes. Delivery Requirements: Delivery of goods is "FOB Destination" unless delivery terms are specified otherwise in the specifications. If County agrees in writing to reimburse Seller for transportation costs, County shall have the right to designate the method of shipment. In either case, the title and all risk of loss of the goods shall remain with the Seller until the goods are received and accepted by the County. Rejected materials will be returned to Seller at the Seller's risk and expense. Descriptive Information: Descriptive literature including Specifications must accompany your bid. Manufacturer's name and model numbers are used herein solely for the purpose of establishing a standard of design, quality, and use of the merchandise required. Products of other manufacturers will be acceptable if they meet or exceed established standards with the exception of those items specified "NO SUBSTITUTION". Manufacturer's Certification: County reserves the right to request from the Bidder a separate manufacturer's certification of all statements made in the bid. Page 10 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT Made In U.S.A.: Indian River County prefers materials and goods to be made in the U.S.A. Price and Discount Requirements: Quote net prices after deducting trade discounts. All discounts must be incorporated in the prices contained in the bid, and not shown separately. Invoices submitted must agree with the prices formally bid. Taxes: County is exempt from any taxes imposed by State and / or Federal Government. Exemption Certificates, if required, are to be furnished by the successful bidder and will be filled out by the County. Delivery and Completion Dates: Indicate delivery and completion dates. This may be a determining factor in the award of the bid. The County may, at its option, grant additional time for any delay or failure to perform hereunder if the delay will not adversely affect the best interests of the County and is due to causes beyond the control of the Bidder. Such grant must be in writing and made part of the resulting Agreement. Direct Purchase: County reserves the option to purchase certain tangible materials necessary for the performance of the Contract, and thereby save the amount of the sales tax thereon by virtue of the Owner's status as a Tax Exempt Institution. For the purpose of these procedures, the Contractor will assign to the County any rights the Contractor may have under quotes, contracts or commitments received from the particular vendor or supplier for the materials described in the requisition. The invoiced amount of County Purchased Materials and applicable sales tax, had°the purchases not been tax exempt, once finalized through the Owner's Purchase Order and after -confirmation-of,completed,deliveT"nd "acceptance;mill-be-•deductedfrom-the C-ontractor's Contract price°via Change Order. Acceptance: Receipt of an item shall not be an indication that the items are acceptable. Final acceptance and authorization of payment shall be given after a thorough inspection indicates that the item is delivered in accordance with the Bid Specifications. Suppliers are advised that in the event the delivered item does not meet specifications, payment will be withheld until such time the supplier takes necessary corrective action. Default Provision: In case of default by the Bidder, County may procure the articles or services from other sources and hold the Bidder responsible for excess costs incurred thereby, and may take such action, as it deems appropriate, including legal action for Damages or Specific Performance. Note: Any and all special conditions attached hereto, which may vary from these General Conditions, shall have precedence. End of General Terms and Conditions Page 11 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT Technical Specifications Scope FURNISH MATERIAL, LABOR, AND EQUIPMENT TO REFURBISH THE FLEET FACILITY FUEL ISLAND CANOPY TO NEW CONDITION AS FOLLOWS: 1. Replace 140LF of prefinished white aluminum fascia panels and check/re-secure 276LF of existing fascia panels. 2. Clean & reseal 532 LF of canopy gutters. 3. Remove, repair, and re -install twelve (12) canopy drains. 4. Replace 12 column trim kits. 5. Replace twenty-six (26) rusted 3" x 16" x 43' white ceiling panels. 6. Prep, prime, and paint twelve (12) canopy columns with Sherwin Williams Kern Kromik primer and finish in Sherwin Williams Sher-Cyrl top coat white. 7. Prep, prime, and paint 732 LF of island curbs with Sherwin Williams Pro -Park safety yellow. 8. Prep, prime, and paint thirty-six (36) bollards with Sherwin Williams Pro -Park safety yellow. 9. Prep and prime upper structural steel with one coat of Sherwin Williams Pro-Cyrl primer in red oxide. 10. Prep, prime, and paint 10,810 SF of canopy deck with Sherwin Williams Kern Kromik primer and finish in Sherwin Williams Sher-Cyrl top coat white. 11. Prep, prime, paint 416 LF of canopy fascia with Sherwin Williams Kern Kromik primer and finish in Sherwin Williams Sher-Cyrl top coat white. 12. Install four (4) scuppers to relieve water at center gutters. 13. Replace an approximate 1000 additional deck clips to reinforce existing deck panels. (old clips are rusting off) 14. Inspect, repair, replace light fixtures, bulbs as needed. Contractor will be responsible for any permit fees — Building Division schedule of fees included with package. Each bidder must be an actively registered Contractor in the State of Florida and be registered with the Indian River County Building Division. Regular working hours are defined as Monday through Friday, excluding Indian River County Holidays, from 7 a.m. to 5 p.m. All costs of inspection and testing performed during overtime work by the CONTRACTOR, which is allowed solely for the convenience of the CONTRACTOR, shall be borne by the CONTRACTOR. End of Technical Specifications Page 12 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT Bid Form t Project Name: FLEET FACILITY FUEL ISLAND CANOPY . REFURBISHMENT, IRC -2025 Bid #: 2021024 Bid Opening Date and Time: May 251h, 2021 2:00 P.M. Bid Opening Location: Purchasing Division 180027 th Street Vero Beach, FL 32960 The following addenda are hereby acknowledged: Addendum Number NA Date NA [THE REMAINDER OF THIS PAGE WAS LEFT BLANK INTENTIONALLY] Page 13 of 39 IRC -2025 IT,B FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT In accordance with all terms, conditions, specifications, and requirements, the Bidder offers the following: ITEMIZED BID SCHEDULE PROJECT NAME: FLEET FACILITY FUEL ISLAND CANOPY REFURBISHMENT PROJECT NO. IRC -2025 BID NO. 2021024 BIDDER'S NAME: JSR Enterprises East Coast, LLC. d/b/a JSR Fueling Technologies, LLC. Item No_ Description Unit Unit Frice Quantiq Amount 1 REPLACE PREFINISHED FASCIA PANELS LF $ 68.02 140 $ 9523.92 2 CANOPY GUTTERS - CLEAN & SEAL LF $ 9.02 532 $ 4800.00 3 CANOPY DRAINS -REMOVE, REPAIR, RE -INSTALL EA 1$174.85 12 ls2098.20 4 COLUMN TRIM KITS - REPLACE EA $ 174.96 12 $ 2099.50 5 WHITE EMBOSSED CEILING PANELS - REPLACE EA $ 650.31 26 $ 16908.00 6 CANOPY COLUMNS - PREP, PRIME, & PAINT EA $ 487.50 12 $ 5850.00 7 ISLAND CURBS - PREP, PRIME, & PAINT LF $ 4.32 732 3159.00 8 ISLAND BOLLARDS - PREP, PRIME, & PAINT EA $ 67.03 36 $ 2413.13 5 STRUCTURAL STEEL -PREP &PRIME LS 1 2091.68 $ 1 $12091.68 10 CANOPY DECK - PREP, PRIME, & PAINT SF $ 2.24 10,810 1$24183.60 .11 CANOPY FASCIA - PAINT LF $ 32.69 416 $ 13598.40 12 INSTALL SCUPPERS EA $127.27 4 $ 497.09 13 DECK CLIPS -REPLACE LS $ 2937.48 1 $2937.48 14 LIGHT FIXTURES - INPSECT, REPAIR, REPLACE, FIXTURES, BULBS LS 7800.00 $ 1 7800.00 $ BASE BID $ 107,960.00 FORCE ACCOUNT $20,000.00 TOTAL BID AMOUNT (INCLUDING FORCE ACCOUNT) # 127,960.00 LS= Lump Sum SY=Square Yard CY=Cubic Yard TN=Ton CF=Cubic Foot LF=Linear Foot EA=Each TOTAL PROJECT BID AMOUNT IN WORDSEone hundred twenty-seven thousand nine hundred sixty dollars Project completion time after receipt of "Notice to Proceed" or PO: 90 DAYS TO SUBSTANTIAL COMPLETION — 120 DAYS TO FINAL COMPLETION Page 14 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT The undersigned hereby certifies that they have read and understand the contents of this solicitation and agree to furnish at the prices shown any or all of the items above, subject to all instructions, conditions, specifications, and attachments hereto. Failure to have read all the provisions of this solicitation shall not be cause to alter any resulting contract or request additional compensation. Company Name: JSR Enterprises East Coast, LLC. d/b/a JSR Fueling Technologies, LLC. Company Address: 3111 Skyway Circle Suite 111 City, State Melbourne, FL Zip Code 32934 Telephone: 321-610-70441321-403-4646 E-mail: info&srfueltech.com Business Tax Receipt Number: 885403561 Authorized Signature: Name: Joshua Ghiz (Type / Pri ted) Page 15 of 39 Fax: NA FEIN Number: 46-3035170 Date: 05.24.2021 Title: Contractor IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT Qualifications Questionnaire 1. How many years has your organization been providing these services? 11 2. List State of Florida Registration Number(s): L10000002452 3. List government agencies and private firm(s) with whom you have completed similar work: Agency/Firm Name: City of West Melbourne Address: 1415 Henry Avenue West Melbourne, FL 32904 Contact Name: Mark Picciriito Title: Public Works Director E -Mail: MPiccirillo westmelbourne.org Phone: 321-837-7777 Services Provided: BUILD AND INSTALL A NOMINAL 34'x 24' CANOPY Dates of Service: 02.2018 Agency/Firm Name: Brevard County Fleet Address: 4694 N Wickham Rd Melbourne, FL 32935 Contact Name: Carl Cotner Title: Central Fleet Manager E -Mail: Carl.Cotner brevardfl-gov Phone: 321-255-4355 anopy rem ova . rovr a materials labior and equipmento remove existing canopy ac to canopy columns. Services Providedinch„tp� far;aTn„r Ri�onn-c rimptprguttar, Cpntprguttpr, light firturac roofnanpk and strur_tural steel. Includes electrical disconnect. Dates of Service: 0812019 Agency/Firm Name: Address: Contact Name: Title: E -Mail: Phone: Services Provided: Dates of Service: Agency/Firm Name: Address: Contact Name: Title: E -Mail: Phone: Services Provided: _ Dates of Service: Page 16 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT 4. Subcontractors: Type of Work Subcontractor Name License Number S. Date Registered with e-Verify.gov: 04.01.2021 6. List all ligation cases during the past three (3) years in which the Contractor has been a named party. Use additional sheets, as necessary. YearYfi�led Case number Venue Description NA Attach Occupational License/Business Tax Receipt proof of current liability insurance and W-9. Page 17 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT DRUG-FREE WORKPLACE CERTIFICATION (Please include this form with your bid) The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that JSR Enterprises East Coast, LLC. d1bla JSR Fueling Technologies, LLC. does: (Name of Business) 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. S. 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 Section 287.087. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. JSR Fueling Technologies, LLC. Company Name B' er's Sign Date: 05.24.2021 Page 18 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT Affidavit of Compliance (Please include this form with your bid. Failure to include will be interpreted as indication you take no exceptions.) Indian River County Bid # 2021024 for FLEET FACILITY FUEL ISLAND CANOPY REFURBISHMENT We DO NOT take exception to the Bid / Specifications. 0 We TAKE exception to the Bid / Specifications as follows: Furnish material, labor, and equipment to refurbish the fleet facilit Fuel island canopy to new conditions as listed on the scope & technical specifications on page 12 of 39 in the bid package. Company Name: JSR Enterprises East Coast, LLC. d/b/a JSR Fueling Technologies, LLC. Company Address: 3111 Skyway Cir Suite 111 Melbourne, FL 32934 Telephone Number: 321-610-7044 / 321403-4646 Fax: NA E-mail: Authorized Signature: _f Joshua Ghiz Name: (Typed f Printed) Page 19 of 39 Title: Contractor IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT SWORN STATEMENT UNDER SECTION 105.08, INDIAN RIVER COUNTY CODE, ON DISCLOSURE OF RELATIONSHIPS THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement MUST be submitted with Bid, Proposal or Contract No. 2021024 for FLEET FACILITY FUEL ISLAND CANOPY REFURBISHMENT 2. This sworn statement is submitted by: JSR Enterprises East Coast, LLC. d/b/a JSR Fueling Technologies, LLC. (Name of entity submitting Statement) whose business address is: 3111 Skyway Circle, Suite 111, Melbourne, FL 32934 and its Federal Employer Identification Number (FEIN) is 46-30351 3. My name is Joshua Ghiz (Please print name of individual signing) and my relationship to the entity named above is Owner/ Contractor 4. 1 understand that an "affiliate" as defined in Section 105.08, Indian River County Code, means: The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of the entity. I understand that the relationship with a County Commissioner or County employee that must be disclosed as follows: Father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, husband, wife, father-in-law, mother-in-law, daughter-in-law, son-in-law, brother-in-law, sister- in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent, or grandchild. 6. Based on information and belief, the statement, which I have marked below, is true in relation to the entity submitting this sworn statement. [Please indicate which statement applies.] ✓ Neither the entity submitting this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members,;or agents who are active in management of the Page 20 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT entity, have any relationships as defined in section 105.08, Indian River County Code, with any County Commissioner or County employee. The entity submitting this sworn statement, or one or more of the officers, directors, executives, partners, shareholders, employees, members, or agents, who are active in management of the entity have the following relationships with a County Commissioner or County employee: Name of Affiliate Name of County Commissioner Relationship or entity or employee C-. O` (S" nature) (Date) STATE OF F (v - r/` COUNTY OFC ova --2 Sworn to (or affirmed) and subscribed before me by means of 19''physical presence or ❑ online notarization, this Q.5 day of 2021 , by c -Ay (name of person making statement). May (�ignature of Nota Public - Sta e of Florida) (Print, Type, or Stamp Commissioned Name of Notary Public) ❑ who is personally known to me or E?;; ho has produced )_ "-Pr C'(u I�t�V's 4 ; c -"3f e as identification. Page 21 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT CERTIFICATION REGARDING PROHIBITION AGAINST CONTRACTING WITH SCRUTINIZED COMPANIES (This form MUST be submitted with your bid) I hereby certify that neither the undersigned entity, nor any of its wholly owned subsidiaries, majority-owned subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose of making profit have been placed on the Scrutinized Companies that Boycott Israel List created pursuant to s. 215.4725 of the Florida Statutes, or are engaged in a boycott of Israel. In addition, if this solicitation is for a contract for goods or services of one million dollars or more, I hereby certify that neither the undersigned entity, nor any of its wholly owned subsidiaries, majority-owned subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose of making profit are on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, created pursuant to s. 215.473 of the Florida Statutes, or are engaged in business operations in Cuba or Syria as defined in said statute. I understand and agree that the County may immediately terminate any contract resulting from this solicitation upon written notice if the undersigned entity (or any of those related entities of respondent as defined above by Florida law) are found to have submitted a false certification or any of the following occur with respect to the company or a related entity: (i) it has been placed on the Scrutinized Companies that Boycott Israel List, or is engaged in a boycott of Israel, or (ii) for any contract for goods or services of one million dollars or more, it has been placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or it is found to have been engaged in business operations in Cuba or Syria. JSR Enterprises East Coast, LLC, d1b/a Name of Respondent: JSR Fuelin echnol ie__s� C. By: (Authoriz ignature) Title_'"Contractor Date: 05.24.2021 Page 22 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT CERTIFICATION REGARDING LOBBYING Certification for Contracts, Grants, Loans, and Cooperative Agreements (This form MUST be submitted with each bid or offer exceeding $100,000) The undersigned Contractor certifies, to the best of his or her knowledge, that: 1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. 2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. 3. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was. made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The Contractor, JSR Fueling Technologies, LLC. certifies or affirms the truthfulness and accuracy of each statement of its cer' ' ation re, if any. In addition, the Contractor understands and agrees that the provisions o 01 et s, apply to this certification and disclosure, if any. Sign of.Aff6--ntractorr �oT d Official Joshua Ghiz - Contractor Name and Title of Contractor's Authorized Official 05.24.2021 Date Page 23 of 39 IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT Warranty Information Form (All Blanks must be filled in and Submitted with your Bid) Indian River County Bid # 2021024 for FLEET FACILITY FUEL ISLAND CANOPY REFURBISHMENT Make and Model of Proposed Equipment: NA � Is there a warranty on the proposed equipment? Yes No Does the warranty apply to all components or only part? (Please specify) Parts and workmanship Warranty period for parts: 1 Year Warranty period for service: 1 Year Nearest source to Indian River County for parts and service: Brevard - Melbourne, Who will provide service and where in the event of failure within warranty period? Company Name: JSR Fueling Technologies, LLC Phone: 321-403-4646 3111 Skyway - Suite 111 - Melbourne, FL 32934 Address: Contact person: Joshua Ghiz Will any voluntary service follow installation or delivery? Yes ❑ No if so, by whom? When? Who is the highest authority (manufacturer, distributor, dealer, etc...) fully behind this warranty? JSR A copy of the complete warranty statement is submitted herewith: Yes ❑ Nog Page 24 of 39 a VM -9 Request for Taxpayer Identification Number and Certification ► Go to www.irs.gov/ForinW9 for instructions and the latest information. 1 rJlallit• Id's $III,IWi+ on y-ir nc,omv idz ie,wm Name is r;,(.l,r±ired wi t:ns lino: too not leave,! Joshua Harvey Ghiz SR ? l:� : r ,. �r r.^ -, ka.Grd t -h; •,t lr f arty: ,.,t !mm f,q , JSR EN -I ERPRISES EAST COAST LLC d/b/a/ ISR FUELING TECHNOLOGIES, LLC 9 , • tu,, rt,uux;r at, b,<,a t�.dela, tai ia; r:+c _aa :,I the., person whose name ts enured on Ime L Check only one of the ' _✓ � 1:idi•:It tj,il <;Ic: flydpri-tor (,, .—i r;n•porat;r_,n 'J S Corporatio �.'- Partners!', Ej 1'rdst!estalr; ;jin Jig-'-m:wlixar I Li, 1 ,.,rite; l iardit; ;;w,1p (nV. E !aa; the tat ctras;ificat:nn rC;=c) ::r;rperation. i�=3 f:orpar:ation. � =:Parinerstllf�.J ---- Note: CrwCk the aperonriate hot u, -hr Ilne abovu f:y in- tax classification of the s:ngIe-meo:ber owner. Do not check LL.; .f the t.i_C rs citiss+lted as a s-nyle-mcn,i.er LI -C. that Is :ilsregarded fro•' Inc owner :,;mess the owner nt the LL.C, is norhw L.t. C that Is not disregarded from 1e n%,,ver for U.S. to;ieral tax purposes. Otherwise. a single -member i-I_C that i, r!�:;wtt,rrdoJ from the (owner should chuck tha at.,propriite box for the tax classr ;cation of is owner. �...' t )I IP:,I tJ,:,; it iJifilGlVrlbl r ., rld,u,....; t., illi r _.trro.Gt. ,.nd at,.. ;tr ,.. .(.: iti.:.,r... ,n,t ',:r.ton,. 350') TADLOCK AVE V t:,:.v .. ,. ;Ii,o 71E' co(d(: CRANI VAIKARIAFt 329SO 7 i i:.+ ., �..,nn❑ r:l n In;rL,) I+: .. (_,,nb(aunl( Taxpayer Identification Number (TIN)_ Give Form to the requester. Do not send to the IRS. 4 Exempuons fcoor.�- arply only id amour e^titres, net aid:vir:oral;:. s. ;. 2nstluctions or: paa+ 3). Exempt payee code if ; - Exemp,ion ron; r=Att;l, !sporting code tit any( I ReC;ui;3ter s narile .1 1.6 address t'.p': mw I r ,our 1 IN in it a, appropriate her. Thr; TIN provsdad must match tyre name give -„n on line, t to avoid v?i111INd n(I. Frit Ind:v du;.tl this r, gertr•r:idly your ­-%C171's:3.^:Irity nirn'ber (SSN). HowevAr, for a :ak;nt air(,• . t.oli; propnctor_ or r.flsr(,rgirded ent+ty, see the nstructtons for Part I later. f -or other rt:tlr:es: It it, y,.;ur einpioyt-i identification number (EIN). It you do riot have a number, see How to get a ON, lat-r, Note: 14 .the account is in more that, one name. see the instructions for line 1. Also see lNhat Name and Number Ti', Give the Requester for qufdelines cm whose number to enter. Certification _ ,jr-idet penait.;as of oerfurv. I certify that: or number 4161-13101315 1 1!710 I IIH number --how,, on this form Is my correct iaxpayei Identification number to• I am waiting for a number to be issued to me): and _. innot subject to backup wrthl �oldlnq oecause. sal 1 am exempt from backup withholding, or (b) i have not been notified by the Internal Revenue S•:-rvica (IR�;t that I am subject to backup withholding as a result of a failure to report all interest or divicenos. or (c) the IRS has notified me that I am no ioncjet sit lent to backup withholding. and '. 1 a^; a td.S. rit;,.rrt or other I.f.S. person (defined below): and 4. 'h( [A I GA codes eritered on this forts, id any, ridicating that I ant exempt from.; FATCA reporting is correct. Certification instructions. You must c;ress out tela 2 above .f you have been notilied by the IRS that you are currently subject to backup withholding because ,ou have tailed to fepor, all interest and dividends ort yoilm. For real estateTrATiSactions, item 2 does not apply. For mortgage Interest paid. :;Gaus;`1 on at abandonment of secured oroperty eaticellayah of deot.pettfF6utions to an individual ret dement arrangement (IRA), andgeneraliy, payments other than interest and dividends. you are nqi- euu red , sign -.r,9 r✓%tiLcatlon, but you must provide your correct TIN. See the Ins�rt`i;,tions for Part If, later. t9n 1 Smimture of r `lam ^ i Here = '� rti I U.S. person r ,., � m"`��..._--.. ,...��_�, Date► General Instructions Srct:on references areZ,61he Internal Rev(' Code unless otherwise Future developments. For the latest information ,about developments ?last o to F ^nn W-9 anG ,ts instructions. such as Iyglslatic:m enacted if r f -ey wet. published, go to wVVw irs.gov/f-orrr'A9. Purpose of Form /fin v divwual :�( entity (!-orrn W-9 requester) *h(I is mqurred to file an Monlali nt reaurn with the IHS mutt obtain your currect taxpayer tt;fic:tion number (?IN) which may be gent soc.al security number !SSN), Indiv dual taxpayer identification number It IN). adoption :,;xp-rp.;r dentttication number'ATIN). or employer identi`cation number riN). to report on an intonratlon return the amount paid to you. or other :;mount rc4p,xtable on an information ret.un, Examples cf information include, but are not limited to. the foilow+ :q. • Form, :099 INT (interest earned or paid) • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • f=orm 1099 -MIST (various types of income, prizes, awards. or gross proceeds) • 'Form 1099-R (stor.k or mutual fund sates and relain other transactions i -y brokersl • l orm 1099-5 (pro,; t,eds frorn real estate transachonsi • t ofnl 1099-K (merchant card :rnd third,' party network tran,,actiw s) • Form 1098 (home mortgage Interest). 1098-ir (stude(,t loan interesti, 1098-T ;tuition) • Form 1099-C ('canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only :f you are a U.S. person (Including a resident alien), to provide your correct TW. It you do riot return Form W-9 to the requester with a TIN. you might be subject to backup withholding. See What is backup withholding. later. Cat. No, IU231X Form W-9 fRev. 10-2018) Name: GHIZ, JOSHUA HARVEY SR License Number: 1256948 Rank: Certified Pollutant Storage Contractor License Expiration Date: 08/31/2022 Primary Status: Current Original License Date: 10/08/2015 Secondary Status: Active Licence Information License Relationship Relation Expiration Number Status Related Party Type Effective Rank Date Date Current JSR ENTERPRISES EAST COAST, L.L.C. DBA:ISR FUELING TECHNOLIGIES, LLC. Primary 10/08/2015 Construction Qualifying Business Agent for Information Business Agreement THIS AGREEMENT is by and between INDIAN RIVER COUNTY, a Political Subdivision of the State of Florida organized and existing under the Laws of the State of Florida, (hereinafter called OWNER) and JSR Enterprises East Coast, LLC d/b/a JSR Fueling Technologies, LLC (hereinafter called CONTRACTOR). OWNER and CONTRACTOR, in consideration of the mutual covenants hereinafter set forth, agree as follows: ARTICLE 1- WORK CONTRACTOR shall complete all Work as specified or indicated in the Contract Documents. The Work is generally described as follows: FURNISH MATERIAL, LABOR, AND EQUIPMENT TO REFURBISH THE FLEET FACILITY FUEL ISLAND CANOPY TO NEW CONDITION AS FOLLOWS: 1. Replace 140LF of prefinished white aluminum fascia panels and check/re-secure 276LF of existing fascia panels. 2. Clean & reseal 532 LF of canopy gutters. 3. Remove, repair, and re -install twelve (12) canopy drains. 4. Replace 12 column trim kits. 5. Replace twenty-six (26) rusted 3" x 16" x 43' white ceiling panels. 6. Prep, prime, and paint twelve (12) canopy columns with Sherwin Williams Kern Kromik primer and finish in Sherwin Williams Sher-Cyrl top coat white. 7. Prep, prime, and paint 732 LF of island curbs with Sherwin Williams Pro -Park safety yellow. 8. Prep, prime, and paint thirty-six (36) bollards with Sherwin Williams Pro -Park safety yellow. 9. Prep and prime upper structural steel with one coat of Sherwin Williams Pro-Cyrl primer in red oxide. 10. Prep, prime, and paint 10,810 SF of canopy deck with Sherwin Williams Kern Kromik primer and finish in Sherwin Williams Sher-Cyrl top coat white. 11. Prep, prime, paint 416 LF of canopy fascia with Sherwin Williams Kern Kromik primer and finish in Sherwin Williams Sher-Cyrl top coat white. 12. Install four (4) scuppers to relieve water at center gutters. 13. Replace an approximate 1000 additional deck clips to reinforce existing deck panels. (old clips are rusting off) 14. Inspect, repair, replace light fixtures, bulbs as needed. ARTICLE 2 - THE PROJECT The Project for which the Work under the Contract Documents may be the whole or only a part is generally described as follows: Project Name: FLEET FUEL ISLAND CANOPY REFURBISHMENT Bid Number: 2021024 Project Address: 5235 41st St # A, Vero Beach, FL 32967 ARTICLE 3 - CONTRACT TIMES 3.01 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 specifications are of the essence of the Agreement. 3.02 Days to Achieve Substantial Completion, Final Completion and Final Payment A. The Work will be substantially completed on or before the 901h calendar day after the date when the Contract Times commence to run as provided in the Notice to Proceed and completed and ready for final payment in accordance with the Notice to Proceed on or before the 120" calendar day after the date when the Contract Times commence to run. 3.03 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 3.02 above, plus any extensions thereof allowed in writing as a change order to this Agreement. Liquidated damages will commence for this portion of work. The parties also recognize the delays, expense, and difficulties involved in proving in a legal 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 $1,405.00 for each calendar day that expires after the time specified in paragraph 3.02 for completion and readiness for final payment until the Work is completed and ready for final payment. ARTICLE 4 - CONTRACT PRICE 4.01 OWNER shall pay CONTRACTOR for completion of the Work an amount in current funds equal to the sum of the amounts determined pursuant to paragraph 4.01.A and summarized in paragraph 4.01.B, below: A. For all Work, at the prices stated in CONTRACTOR's Bid, attached hereto as Exhibit 1. B. THE CONTRACT SUM subject to additions and deductions provided in the Contract Documents: Numerical Amount: $ 128,004.22 Written Amount: One hundred twenty-eight thousand four dollars and twenty-two cents ARTICLE 5 - PAYMENT PROCEDURES 5.01 Progress Payments. A. The OWNER shall make progress payments to the CONTRACTOR on the basis of the approved partial payment request as recommended by ENGINEER in accordance with the provisions of the Local Government Prompt Payment Act, Florida Statutes section 218.70 et. seq. The OWNER shall retain five percent (5%) of the payment amount due to CONTRACTOR until final completion and acceptance of all work to be performed by CONTRACTOR under the Contract Documents. 5.02 Pay Requests. A. Each request for a progress payment shall contain the CONTRACTOR'S certification. All progress payments will be on the basis of progress of the work measured by the schedule of values established, or in the case of unit price work based on the number of units completed. 5.03 Paragraphs 5.01 and 5.02 do not apply to construction services work purchased by the County as OWNER which are paid for, in whole or in part, with federal funds and are subject to federal grantor laws and regulations or requirements that are contrary to any provision of the Local Government Prompt Payment Act. In such event, payment and retainage provisions shall be governed by the applicable grant requirements and guidelines. 5.04 Acceptance of Final Payment as Release. A. The acceptance by the CONTRACTOR of final payment shall be and shall operate as a release to the OWNER from all claims and all liability to the CONTRACTOR other than claims in stated amounts as may be specifically excepted by the CONTRACTOR for all things done or furnished in connection with the work under this Agreement and for every act and neglect of the OWNER and others relating to or arising out of the work. Any payment, however, final or otherwise, shall not release the CONTRACTOR or its sureties from any obligations under this Agreement, the Invitation to Bid or the Public Construction Bond. 5.02 Acceptance of Final Payment as Release The acceptance by the CONTRACTOR of final payment shall be and shall operate as a release to the OWNER from all claims and all liability to the CONTRACTOR other than claims in stated amounts as may be specifically excepted by the CONTRACTOR for all things done or furnished in connection with the work under this Agreement and for every act and neglect of the OWNER and others relating to or arising out of the work. Any payment, however, final or otherwise, shall not release the CONTRACTOR or its sureties from any obligations under this Agreement, the Invitation to Bid or the Public Construction Bond. ARTICLE 6 - INDEMNIFICATION 6.01 CONTRACTOR shall indemnify and hold harmless the OWNER, and its officers and employees, from liabilities, damages, losses and costs, including, but not limited to, reasonable attorney's fees, to the extent caused by the negligence, recklessness, or intentional wrongful misconduct of the CONTRACTOR and persons employed or utilized by the CONTRACTOR in the performance of the Work. ARTICLE 7 - CONTRACTOR'S REPRESENTATIONS 7.01 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 Invitation to Bid 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 obtained and carefully studied (or assumes responsibility for having done 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 applying the specific means, methods, techniques, sequences, and procedures of construction, if any, expressly required by the Contract Documents to be employed by CONTRACTOR, and safety precautions and programs incident thereto. E. 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. F. 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. G. 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. H. CONTRACTOR has given OWNER written notice of all conflicts, errors, ambiguities, or discrepancies that CONTRACTOR has discovered in the Contract Documents, and the written resolution thereof by OWNER is acceptable to CONTRACTOR. I. The Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. J. Contractor is registered with and will use the Department of Homeland Security's E -Verify system (www.e-verify.gov) to confirm the employment eligibility of all newly hired employees for the duration of this agreement, as required by Section 448.095, F.S.. Contractor is also responsible for obtaining proof of E -Verify registration and utilization for all subcontractors. ARTICLE 8 - CONTRACT DOCUMENTS 8.01 Contents A. The Contract Documents consist of the following: (1) This Agreement; (2) Notice to Proceed; (3) Public Construction Bond; (4) Certificate(s) of Liability Insurance; (5) Invitation to Bid 20210XX; (6) Addenda (numbers _ to _ , inclusive); (7) CONTRACTOR'S Bid Form; (8) Bid Bond; (9) Qualifications Questionnaire; (10) Drug Free Workplace Form; (11)Affidavit of Compliance; (12) Sworn Statement Under Section 105.08, Indian River County Code, on Disclosure of Relationships; (13) Certification Regarding Prohibition Against Contracting with Scrutinized Companies; (14) Certification Regarding Lobbying; (15) The following which may be delivered or issued on or after the Effective Date of the Agreement and are not attached hereto: a) Written Amendments; b) Work Change Directives; c) Change Order(s). ARTICLE 9 - MISCELLANEOUS 9.01 Terms A. Terms used in this Agreement will have the meanings indicated in the Invitation to Bid. 9.02 Assignment of Contract A. No assignment by a party hereto of any rights under or interests in the 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. 9.03 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. 9.04 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. 9.05 Venue A. This Agreement shall be governed by the laws of the State of Florida. Venue for any lawsuit brought by either party against the other party or otherwise arising out of this Agreement shall be in Indian River County, Florida, or, in the event of a federal jurisdiction, in the United States District Court for the Southern District of Florida. 9.06 Public Records Compliance A. Indian River County is a public agency subject to Chapter 119, Florida Statutes. The Contractor shall comply with Florida's Public Records Law. Specifically, the Contractor shall: (1) Keep and maintain public records required by the County to perform the service. (2) Upon request from the County's Custodian of Public Records, provide the County 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 or as otherwise provided by law. (3) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the contractor does not transfer the records to the County. (4) Upon completion of the contract, transfer, at no cost, to the County all public records in possession of the Contractor or keep and maintain public records required by the County to perform the service. If the Contractor transfers all public records to the County upon completion of the contract, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the County, upon request from the Custodian of Public Records, in a format that is compatible with the information technology systems of the County. B. 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 AT: (772) 226-1424 publicrecords@ircgov.com Indian River County Office of the County Attorney 1801 27th Street Vero Beach, FL 32960 C. Failure of the Contractor to comply with these requirements shall be a material breach of this Agreement. Article 10: TERMINATION OF CONTRACT A. The occurrence of any of the following shall constitute a default by CONTRACTOR and shall provide the OWNER with a right to terminate this Contract in accordance with this Article, in addition to pursuing any other remedies which the OWNER may have under this Contract or under law: (1) if in the OWNER's opinion CONTRACTOR is improperly performing work or violating any provision(s) of the Contract Documents; (2) if CONTRACTOR neglects or refuses to correct defective work or replace defective parts or equipment, as directed by the Engineer pursuant to an inspection; (3) if in the OWNER's opinion CONTRACTOR's work is being unnecessarily delayed and will not be finished within the prescribed time; (4) if CONTRACTOR assigns this Contract or any money accruing thereon or approved thereon; or (5) if CONTRACTOR abandons the work, is adjudged bankrupt, or if he makes a general assignment for the benefit of his creditors, or if a trustee or receiver is appointed for CONTRACTOR or for any of his property. B. OWNER shall, before terminating the Contract for any of the foregoing reasons, notify CONTRACTOR in writing of the grounds for termination and provide CONTRACTOR with ten (10) calendar days to cure the default to the reasonable satisfaction of the OWNER. C. If the CONTRACTOR fails to correct or cure within the time provided in the preceding Sub -Article B, OWNER may terminate this Contract by notifying CONTRACTOR in writing. Upon receiving such notification, CONTRACTOR shall immediately cease all work hereunder and shall forfeit any further right to possess or occupy the site or any materials thereon; provided, however, that the OWNER may authorize CONTRACTOR to restore any work sites. D. The CONTRACTOR shall be liable for: (1) any new cost incurred by the OWNER in soliciting bids or proposals for and letting a new contract; and (2) the difference between the cost of completing the new contract and the cost of completing this Contract; (3) any court costs and attorney's fees associated with any lawsuit undertaken by OWNER to enforce its rights herein. E. TERMINATION FOR CONVENIENCE: OWNER may at any time and for any reason terminate CONTRACTOR's services and work for OWNER's convenience. Upon receipt of notice of such termination CONTRACTOR shall, unless the notice directs otherwise, immediately discontinue the work and immediately cease ordering of any materials, labor, equipment, facilities, or supplies in connection with the performance of this Contract. Upon such termination Contractor shall be entitled to payment only as follows: (1) the actual cost of the work completed in conformity with this Contract and the specifications; plus, (2) such other costs actually incurred by CONTRACTOR as are permitted by the prime contract and approved by the OWNER. Contractor shall not be entitled to any other claim for compensation or damages against the County in the event of such termination. F. TERMINIATION IN REGARDS TO F.S. 287.135: TERMINATION IN REGARDS TO F.S. 287.135: CONTRACTOR certifies that it and those related entities of CONTRACTOR as defined by Florida law are not on the Scrutinized Companies that Boycott Israel List, created pursuant to s. 215.4725 of the Florida Statutes, and are not engaged in a boycott of Israel. In addition, if this agreement is for goods or services of one million dollars or more, CONTRACTOR certifies that it and those related entities of CONTRACTOR as defined by Florida law are not on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, created pursuant to Section 215.473 of the Florida Statutes and are not engaged in business operations in Cuba or Syria. OWNER may terminate this Contract if CONTRACTOR is found to have submitted a false certification as provided under section 287.135(5), Florida Statutes, been placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or been engaged in business operations in Cuba or Syria, as defined by section 287.135, Florida Statutes. OWNER may terminate this Contract if CONTRACTOR, including all wholly owned subsidiaries, majority- owned subsidiaries, and parent companies that exist for the purpose of making profit, is found to have been placed on the Scrutinized Companies that Boycott Israel List or is engaged in a boycott of Israel as set forth in section 215.4725, Florida Statutes. 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 June 15, 2021 (the date the Agreement is approved by the Indian River County Board of County Commissioners, which is the Effective Date of the Agreement). OWNER: By: APPROVED AS By -106n' j.!!ft- , Dylan Reingold, Cou Jeffrey R. Smith, Clerk of Court and Comptroller License No. �CC- 1,to 970 �64 / Attest: _ (Where applicable) Deputy Clerk (SEAL) Agent for service of process: CONTRACTOR: �g notices- �`1 �'��hnot/eg.ts llG Designated Representative: Name: James W. Ennis, P.E., PMP Title: Assistant Public Works Director Address: 180127th Street, Vero Beach, FL 32960 Phone: (772) 226-1221 Email: jennis@ircgov.com Designated Representative: Name: Title: Address: Phone: Email: (If CONTRACTOR is a corporation or a partnership, attach evidence of authority to sign.) IRC-2025—ITB—FLEET FACILITY GAS ISLAND CANOPY REFURBISHMENT PUBLIC CONSTRUCTION BOND INSTRUCTION FOR PUBLIC CONSTRUCTION BOND The front or cover page to the required public construction/payment and performance bond shall contain the information required by Fla. Stat. 255.05(1)(a), and be substantially in the format shown on the first page following this instruction. The Public Construction Bond shall be in the form suggested by Fla. Stat. 255.05(3) as shown on the second page following this instruction. A Power of Attorney from a surety insurer authorized to do business in Florida, authorizing the signature of the Attorney in Fact who executes the Public Construction Bond shall accompany that Bond. Page 35 of 39 3lLUL1UU404Un RECORDED IN THE PUBLIC RECORDS OF JEFFREY R SMITH, CLERK OF COURT INDIAN RIVER COUNTY FL BK: 3440 PG: 1564 Page 1 of 4 7/6/2021 2:43 PM Public Work Executed In 2 Counterparts F.S. Chapter 255.05 (1)(a) Cover Page THIS BOND IS GIVEN TO COMPLY WITH SECTION 255.05 OR SECTION 713.23 FLORIDA STATUTES, AND ANY ACTION INSTITUTED BY A CLAIMANT UNDER THIS BOND FOR PAYMENT MUST BE IN ACCORDANCE WITH THE NOTICE AND TIME LIMITATION PROVISIONS IN SECTION 255.05(2) OR SECTION 713.23 FLORIDA STATUTES. BOND NO: 608-102162-1 CONTRACTOR NAME: JSR Enterprises East Coast, LLC DBA JSR Fueling Technologies, LLC CONTRACTOR ADDRESS: 3111 Skyway Circle, Unit 111 Melbourne, FL 32934 CONTRACTOR PHONE NO: 321-610-7044 SURETY COMPANY: United States Fire Insurance Company 305 Madison Avenue Morristown, NJ 07962 973-490-6600 OWNER NAME: Indian River County OWNER ADDRESS: 1800 27th Street Vero Beach, FL 32960 OWNER PHONE NO.: 772-226-1416 OBLIGEE NAME: (If contracting entity is different from the owner, the contracting public entity) OBLIGEE ADDRESS: OBLIGEE PHONE NO.: BOND AMOUNT: $128,004.22 CONTRACT NO,: (If applicable) Bid Number: 2021024 DESCRIPTION OF WORK: Fleet Fuel Island Canopy Refurbishment PROJECT LOCATION: 5235 41 st St. A, Vero Beach, FL 32967 LEGAL DESCRIPTION: (If applicable) FRONT PAGE All other bond page(s) are deemed subsequent to this page regardless of any page number(s) that may be printed. thereon. THE ATTACHED STATUTORY COVER PAGE FORMS AND BECOMES A PART OF THIS BOND. Bid Number: 2021024 Bond NO. 608-102162-1 Executed in 2 Counterpart(s) PUBLIC CONSTRUCTION BOND BY THIS BOND, We, JSR Enterprises East Coast, LLC DBA JSR Fueling Technologies, LLC (insert name, principal business address and telephone number of contractor) _T 3111 Skyway Circle, Unit 111 , Melbourne, FL 32934 , 321-610-7044 as Principal and United States Fire Insurance Company 305 Madison Avenue , Morristown, NJ 07962, 973-490-6600 (insert name principal business address and telephone number.of surety) as Surety, are bound to Indian River County 1800 27th Street , Vero Beach, FL 32.960 , 772-226-1416 (insert name, principal address and telephone number of owner of the property or contracting public entity and its contract, number), herein called the Owner, in the sum of $ 128,004.22 , for payment of which we bind ourselves, our heirs, personal representatives, successors, and assigns, jointly and severally. THE CONDITION OF THIS BOND is that if Principal: 1 Performs the contracted dated June 15, 2021 ., between Principal and Owner for Construction of Fleet Fuel Island Canoov Refurbishment----------------------------- ---------------------- 5 41st St. A, Vero Beach, FL 32967 (insert legal description, street.address of the property beingimproved, and, general description of the improvement) 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 payments 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. 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 June 28, 2021 PRINCIPAL: JSR Enterprises East Coast, LLC UA,SRT ting Printeted Name 01-1 Printed Title 'Technologies, LLC STATE OF l` COUNTY OF Varel SURETY, United States Fire Insurance Company Gloria A. Richards) Printed Name.- ; Attorney -in -Fact & Florida Licensed Resident Agent ` Printed Title Inquiries: 467-786-7770 The foregoing Inst ument was acknowledged before me this day of by 4hiz , as (title) of 4V____ (name of corporation), a (.State) corporation, on behalf of the corporation. Me/She [please check as applicable] 1 ✓/ is personally known to me, or has produced / / his/her (state) driver'slicense, or /_ / his/her (type of identification) as identification DONNAM.PURDY MY COMMISSION # GG 236526 EXPIRES: August 9, 2022 .Fodt 4• Bonded Tiuu Notary Public Underwriters STATE OF FLORIDA COUNTY OF Orange 1�?L1'1 C1 rn Pf LIJI��� (Si nature) (Printed..Name) NOTARY PUBLIG, STATE OF ( ornmission E-xpiration Date) The foregoing instrument was acknowledged before me this 28th day of June 2021 U Gloria A. Richards (name), as Attorney -in -Fact (title) of United States Fire Insurance Company name of car oration .-� DE ( p ), (State) corporation, on behalf of the corporation. She is personally known to nye:. Notary Public Sbft of Flodde ^ Teresa L Durham pa My Commission GG 284543 a �9" Expires 02/22/20523 akl" (Signature) Teresa L. Durham (Printed Name) NOTARY PUBLIC, STATE OF FLORIDA 2/22/2023 (Commission Expiration Date) A� Roy CERTIFICATE OF LIABILITY INSURANCE 4/1312021 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 ADDITIONAE INSURED, the policy(les) 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(!). PRODUCER Prime Insurance Solutions, Inc. 3040 N. Wickham RD. CO ACT E: PHONE . (321) 259-7920 FA'1 N :321 259-7921 o�Ls : INSURER(S) AFFORDING COVERAGE MAIC# Suite 8 Melbourne FL, 32935 INSURER A: WESTCHESTER SURPLUS LINES INS. 10172 INSURED INSURER 8: INSURER C: J.S.R. ENTERPRISES EAST COAST LLC INSURERD: JSR FUELING TECHNOLIGIES, LLC INSURER E: 3505 TADLOCK AVE GRANT VALKARIA, FL 32950 INSURERF: 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. INSRTYPE LTRWVb OF INSURANCE ADD SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMIE Ea o=mncal $ 50,000 CLAIMS -MADE a OCCUR MED EXP Any one person) $ 5,000 XX G7176025A 002 11/09/20 11/09/21 $ 1,000,000 A PERSONAL BADV INJURY GEN% AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMPIOPAGG $ 2,000,000 ✓ POLICY JELOC OTHER: c D L LIM $ COMBAUTOMOBILE LIABILITY BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE $ er n AUTOS ONLY AUTOS ONLY $ UMBRELLALI iOCCUR EACH OCCURRENCE $ _ AGGREGATE _ $ . EXCESS UAS CLAIMS -MADE DED I I RETENTION b $ DTH - PAR11. WORKERS COMPENSATION E.L. EACH ACCIDENT $ AND EMPLOYERS' LIABILITY Y 1 N ANypROPWETOWPARTNERlEXECUTNE E.L DISEASE - EA EMPLOYE $ OF FICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) NIA EL DISEASE - POLICY LIMIT $ B yes, describe under DESCRIPTION OF OPERATIONS below EACHAIM-$1,000,00 CONTRACTORS G7176025A 002 11/09/20 11/09/21 AGGREGATE-$2,IN70,000 A POLLUTION DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe aNachad If mora space Is required) A PROFESSIONAL LIABILITY G7176025A 002 11/09/20 11/09/21 EACH CLAIM $1,000,000 AGGREGATE $2,000,000 CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED {rGRi1rIVA1G nVwLc� ---- "' INDIAN RIVER COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1801 27TH STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. VERO BEACH, FL 32960 AUTHORIZED REPRESENTATIVE W-IyDD-LU 1.7 11liVR4J a.vRrvrw 11v1.. r.w nyuw .coc..`.+. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations As required by written contract, prior to a loss to N/A which this insurance applies exclusions apply: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", This insurance does not apply to "bodily injury" or "property damage" or "personal and advertising "property damage" occurring after injury" caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations on behalf of the additional insured(s) at the location of the covered operations has been for the additional insured(s) at the location(s) completed; or designated above. 2. That portion of "your work" out of which the However: injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted other than another contractor or by law; and subcontractor engaged in performing 2. If coverage provided to the additional insured operations for a principal .as a part of the is .required by a contract or agreement, the same project. insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 2010 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following Is added to Section Ill — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. I Page 2 of 2 O Insurance Services Office, Inc., 2012 CG 2010 0413 ® �'►�!�� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) TYPE OF INSURANCE 4/9/2021 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). Nexus Partners Insurance 5745 North Scottsdale Road, Suite B120 Scottsdale, AZ 85250 CONTPRODUCER NAME: Tiffany Meyer HCo"N Ext): 800-409-8958 AIC No E-MAIL ADDRESS: certs vensure.com INSURER(S) AFFORDING COVERAGE NAIC # EACH OCCURRENCE $ INSURER A: StarStone National Insurance Company 25496 MED EXP (Any one person) $ INSURED National Employer Services, LLC L/C/F AVANTI HUMAN CAPITAL LLC INSURER B: INSURERC: INSURER D: 2600 W. Geronimo Place Suite 100 INSURER E: Chandler AZ 85224 INSURER F : COVERAGES CERTIFICATE NUMBER: 6119R154 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMIDDIYYYY LIMITS COMMERCIALGENERALLIABILITY CLAIMS -MADE DOCCUR R. Kramer Cole EACH OCCURRENCE $ DAMAGE ToRENTED PREM SES Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- P POLICY EI PRO- ❑ LOC OTHER: GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY L AUTOS ONLY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBEREXCLUE F (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A T80210001-838 1/1/2021 1/1/2022 �/ STATUTE EORH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage provided for all leased employees but not subcontractors of: AVANTI HUMAN CAPITAL LLC Eff Date: 1/1/2021 CERTIFICATE HOLDER CANCELLATION ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 61128154 1 VHR I Master Certificate I Paula Ochoa 1 4/9/2021 8:11:55 AM (MDT) I Page 1 of 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Indian River County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1801 27th Street ACCORDANCE WITH THE POLICY PROVISIONS. Vero Beach FL 32960 AUTHORIZED REPRESENTATIVE 41,4LJodie !/ R. Kramer Cole ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 61128154 1 VHR I Master Certificate I Paula Ochoa 1 4/9/2021 8:11:55 AM (MDT) I Page 1 of 1 _ a,ff"Y s C s ` ( n t r !III S I� vSUP I� I' i[ if > Y• :. i SIC i IF. !t? ri",)' q r I Y (!s it I t Vr t Tlr711' r,la r t +C� t+ I( F�IF i t 111'UP! l Iii (I jirtt I I }(2 1.Jl=t r IVi �i.l IVt dl illCilEK TMSf I I,- l CI Ilii xi1 t)I= Ihl it}f I--+.! + [ r ;M t R ALTER .flr. + - +✓1=}� r Pr_s„S}1 Qt (jl f. -,t11` :x, ;, G ),7:1;f_IJ Irdi iJafl t ():'!)Tt I I';�IF`j I .v rtt ',r �I FItIHri fsF WI v111 c t �r . Ysi L IIn It(r_ (l( R-II)PWALE) *1JLI IL buns and ;tiL lr ipa,,,,, rntivr,,tn - , 'i `:.11i Iv WN Ra NW t I32 P53453,'i I I • 1 r,t i Ji[ Vl it)fa � I IYirifti is t �'M Ii ll lrl-?.ry fll+ISI .0111+(t>✓ilj (;Y\rlsCi.l�: ..till IIt,atatx�\. If, 'I'r a Jl ANY t0i TrI'tF fl-7IL;?)C"I ltnt i�.{51 `v lllrlC -•t,l li�- 7..;1 '1P 10 f( 1 11 If ,� - r,. I1 + ?i is ' 11.11"rr ?-i rvIr\ I liiL tGl.. C I[ L. - - ... C:i f: Kf,lr<a, fiPo .I. t. ,L31f_Ii k• ....._ .__..__.._... 13_:I T5f":ry rY �} ,;Of.r V r : ..... ..... .. .. ..._ r < i i 1s,.l4lctl I f _ rr { I -,toil I GO 1=025M MUD C .,.__.... ........_..._,. Irtr � I�r I trt SHOULD ANY OF -__ ..a cr\„F`rc rail,<a.<11 X71 Tr..r. 5-.,h:,:a tr. L, t,c +Y l,a.Lc.l,i n•.t ,. ._,._.__...._.._.._..... I _ I tr �� 1't LLL h.rl r{+:1 Int EXPRAr. r._ NOUN i3 t; (. FIJI l : t-.,, } + r e;ia. , 1 (t if ? (�.,_t Ftl'..�t,)f.t_, f , II 41 G}1t 1 -f" -t � 1 I ; '''>` .-1-'..• Y.'.i I t,t;^ r;r.cR?I n rtif `ntl logo r t t rst aPJ { .1 ,Y 3i T i of t. .0<•.11C< Of hi WF JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 3/16/2020 PERSON: JOSHUA GHIZ FEIN: 463035170 BUSINESS NAME AND ADDRESS: JSR ENTERPRISES EAST COAST LLC JSR FUELING TECHNOLIGIES, LLC. 700 S JOHN RODES BLVD A-5 MELBOURNE, FL 32904 SCOPE OF BUSINESS OR TRADE: EXPIRATION DATE: 3/16/2022 . EMAIL: JSRENTERPRISESLLC@GMAIL.COM Machinery or Equipment Plumbing NOC and Drivers Concrete Construction NOC Excavation and Drivers NOC Erection or Repair NOC & Drivers IMPORTANT: Pursuant to subsection 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under IMPORTANT: section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(12), F.S., Certificates of election to be exempt issued under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to subsection 440.05(13), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01139112 QUESTIONS? (850) 413-1609 W or- ru ti LU m r i Lfl r L -i ru Ln -13 —... .y renmres mOmOetl. L,JJ Details on Back. T D7 -o ° D cnODo w�. 0D O t� w to O 7l �. n O z x` m N W O A 0mOm �W in r -,m * * > �n c S 3M m O r ZOZ� o m a ad qq3_ -� o o °i 1.' o Q�*Zi a x O W m m l D'°',, n :r)Z m Fnm 71 N _ !iP n 4 N w =O vi-nD0 �' m 0r Km O O N rcaZ7Z rCD 0� N m m m N' N N w A� a: B m • 22 0CC OW O D W //��� ii O m'WODD -n m !__ a' (p A A N N S N Z cD 2 _v D Z Q m CL m D:DDcozZ 0 ZmZ-10 O Mm°m-i � C mcmZm (D Z 5joMO mmzmc D m n C zmm--q0 (Q 0 r• Zr co D0D mT�-<m rF U) = 3 �> O m BCL OZO-Ti Dsr.ocx O cl) n m0Z<z _a mn0m:p O < D 0 K t 0 mm cn o{mei -Zi 0-0>> 0Zr z in0 O 0 c m(n mz�� Sv DDD �t moo N z * O Z m O D W -o ° D cnODo w�. 0D O t� w to O 7l �. n O z x` m N W m m N V V POWER OF ATTORNEY UNITED STATES FIRE INSURANCE COMPANY PRINCIPAL OFFICE - MORRISTOWN, NEW JERSEY 00965413421 KNOW ALI, MEN BY TI HESE PRESENTS: That United States Fire Insurance Company, a corporation duly organized and existing under the laws of the state of Delaware, has made, constituted and appointed, and does hereby make, constitute and appoint: Jeffrey W. Reich, Susan L. Reich, Kin: E. Niv, Cheryl A. Foley, Robert P. O'Linn, Gloria A. Richards, Teresa L. Durhant, Saralt K O'Linn, Emily J. Golecki, Jenna R. Delgado, Coralise M. Medal, Hieneka C. Harrington, Brianna T. Miller, Lisa A. Roseland each, its true and lawful Attorney(s)-In-Fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver: Any and all bonds and undertakings of surety and other documents that the ordinary course of surety business may require, and to bind United States Fire Insurance Company thereby as fully and to the same extent as if such bonds or undertakings had been duly executed and acknowledged by the regularly elected officers of United States Fire Insurance Company at its principal office, in amounts or penalties not exceeding: Seven Million, Five Hundred Thousand Dollars ($7,500,000). This Power of Attorney limits the act of those named therein to the bonds and undertakings specifically named therein, and they have no authority to bind United Slates Fire Insurance Company except in the manner and to the extent therein stated. This Power of Attorney revokes all previous Powers of Attorney issued on behalf of the Attorneys -In -Fact named above and expires on January 31, 2022. This Power of Attorney is granted pursuant to Article IV of the By -Laws of United States Fire Insurance Company as now in full force and effect, and consistent with Article III thereof, which Articles provide, in pertinent part: Article IV, Execution of Instruments - Except as the Board of Directors may authorize by resolution, the Chairman of the Board, President, any Vice -President, any Assistant Vice President, the Secretary, or any Assistant Secretary shall have power on behalf of the Corporation: (a) to execute, affix the corporate seal manually or by facsimile to, acknowledge, verify and deliver any contracts, obligations, instruments and documents whatsoever in connection with its business including, without limiting the foregoing, any bonds, guarantees, undertakings, recognizances, powers of attorney or revocations of any powers of attorney, stipulations, policies of insurance, deeds, leases, mortgages, releases, satisfactions and agency agreements; (b) to appoint, in writing, one or more persons for any or all of the purposes mentioned in the preceding paragraph (a), including affixing the seal of the Corporation. Article 111, Officers, Section 3.1 1, Facsimile Signatures. The signature of any officer authorized by the Corporation to sign any bonds, guarantees, undertakings, recognizances, stipulations, powers of attorney or revocations of any powers of attorney and policies of insurance issued by the Corporation may be printed, facsimile, lithographed or otherwise produced. In addition, if and as authorized by the Board of Directors, dividend warrants or checks, or other numerous instruments similar to one another in form, may be signed by the facsimile signature or signatures, lithographed or otherwise produced, of such officer or officers of the Corporation as from time to time may be authorized to sign such instruments on behalf of the Corporation. The Corporation may continue to use for the purposes herein stated the facsimile signature of any person or persons who shall have been such officer or officers of the Corporation, notwithstanding the fact that he may have ceased to be such at the time when such instruments shall be issued. IN WITNESS WHEREOF, United States Fire Insurance Company has caused these presents to be signed and attested by its appropriate officer and its corporate seal hereunto affixed this 22i' day of August 2019. UNITED SPATES FIRE INSURANCE COMPANY State of Pennsylvania Anthony R. Slimowicz, President } County of Philadelphia } On this 22°d day of August 2019, before me, a Notary public of the State of Pennsylvania, carne the above named officer of United States Fire Insurance Company, to me personally known to be the individual and officer described herein, and acknowledged that he executed the foregoing instrument and affixed the seal of United States Fire Insurance Company thereto by the authority of his office. Commonwealth of Pennsylvania — Notary Seal Tamara Watkins, Notary Public Philadelphia County My commission expires August 22, 2023 Commission number 1348843 Javlttx La.- JraJJA - Tamara Watkins (Notary Public) 1, the undersigned officer of United States Fire Insurance Company, a Delaware corporation, do hereby certify that the original Power of Attorney of which the foregoing is a full, true and correct copy is still in force and effect and has not been revoked. 1N WITNESS WI-IEREOF, I have hereunto set my hand and affixed the corporate seal of United States Fire Insurance Company on the28th:clayof=jyne 2021 UNITED STATES FIRE INSURANCE COMPANY , . • „fir Al Wright, Senior Vice President p IRC-2025 ITB 20210502 IRC -2025 ITB 20210502 Page 39 of 39 I Plan Review FEE Comments 1st and 2nd Application When content fails to meet sufficiency 39 / Plan Rejection ! $100 each Requirement Check List (per state Modification statute). 3rd and subsequentThree (4) times the original � When content fails to meet sufficiency 40 Application !Pian Plan review fee (113 permit feel Requirement Check list (per state I Rejection / Modification statute). II 41 Revision = small format $50.00 1 one 8.5 x 11 sheet 42 Revision - large format $100.00 plan sheets - large format - or more than one 8.5x11 43 Pre -Application Design $100.00 Review C Contractor Licensing ( FEE Competency Card $50,00 r45 A licat!on Fee Competency Cab $50,00 Renewal Fee Administrative Service fEE Comments Fees Microfilm / Microfiche 46 Document Requests See Archive Request form Document Research 47 Digital Document See Archive Request form requests 48 Paper documents from 0.25' 10.50" r e fee Pa9 8.5x11', 8.5x14', 11x17" database or copier 49 Change of contractor $50.00 50 Change of sub• $20.00 contractor _ GENERAL INFORMATION i Valuation valuation is based on the greater of contract value or latest ICC valuation table or as otherwise acceptable to the Building official for methodology specialty work not addressed by the ICC valuation table. The job valuation must include labor, overhead and profit. Valuation of total Improvement (excluding land) shall be used. Any person who commences any work requiring a permit before obtaining the permit shall be subject to a penalty of one hundred percent Penalties (statutory). (100%) (Double) of the standard permit lee. The payment of such penalty shall not relieve any person(s) from complying with the requirement of the Building Code, the IRC Code of Ordinances, any applicable laws, or this resolution Multiple Buildings I Multiple Buildings on one property: Work in common areas of buildings is individually permitted per building not per properly. Refunds Permit and Permit Application fees are non-refundable. Page 39 of 39