HomeMy WebLinkAbout2025-157SECTION 00942 — Change Order Form
No. Two
DATE OF ISSUANCE: August 19, 2025 EFFECTIVE DATE: August 19, 2025
OWNER: Indian River County
CONTRACTOR Proctor Construction Company, LLC
Project: Fire Station 11 Renovations
You are directed to make the following changes in the Contract Documents:
Reason for Change Order: The project is complete. This change order is intended to make final
adjustments to costs and time to finalize the contract.
Attachments: Description of itemized changes.
CHANGE IN CONTRACT PRICE:
Description
Amount
Original Contract Price with
$511,512.00
Latent Defect Allowance
Net Increase (Decrease) from
$13,775.69
previous Change Orders No.
to
(days)
Contract Price prior to this Change
$525,287.69
Order:
Net increase (decrease) of this
$28,939.22
Change Order:
(days or dates)
Contract Price with all approved
$554,226.91
Change Orders:
ACCEPTED:
Anderson Proctor aTM �r��=•-aOT
By
CONTRACTOR (Signature)
Date: 8/04/ t+TY Cpl
Board of C ty Co s
By:
Jo esch Chairman
Yohn A: Titkanich, Jr., County Ac.9-
ApprForm and Legal Sufficf•.....••
By: .,UNTY FIAT
County Attorney
Gn rc-l5 � c Asad'
CHANGE IN CONTRACT TIMES
Description
Time
Original Contract Time:
(days or dates)
Substantial Completion:
Final Completion:
Net change from previous Change
Orders No. 1 to 1
(days)
Substantial Completion:
30 days
Final Completion:
Contract Time prior to this Change
Order:
(days or dates)
Substantial Completion:
Final Completion:
Net increase (decrease) this Change
Order:
(days or dates)
Substantial Completion:
38 days
Final Completion:
Contract Time with all approved
Change Orders:
(days or dates)
Substantial Completion:
Final Completion:
RECOMMENDED:
By:SAIGINEER
_..._
Project Manager,
Date: �_'2 �
APPROVED:
By:
OWNER (Signature)
Date: 0017/
9CC Approval Date: _8/19/2025
Ryan L. P tler, Cl rk of Court an omptroller
U .'
Attest An .
Dep Clerk
(SEAL)
Change Order Form — 00942
CHANGE ORDER NO. 2
DESCRIPTION OF ITEMIZED CHANGES
PROJECT NAME: FIRE STATION 11 RENOVATIONS
Item No.
Description
Unit
Quanta
Unit Price
Price Increase
Price Decrease
WCDl
ROUGH OPENINGS OF 9 DOORS TO BE CORRECTED
LS
1
11,231.83
11,231.83
WCD2
REMOVE DUROCK, SINKS, COUNTERTOPS, THEN FIRE CAULK
LS
1
8,276.03
8,276.03
WCD3
DIRECTION TO WORK, NO MONEY
LS
1
-
0.00
WCD4
TIME ADJUSTMENT, NO MONEY
LS
1
-
0.00
WCDS
PLUMBING REMOVE & RE -PIPE CEILING PLUMBING TO CODE
LS
1
8,222.50
8,222.50
WCD6
REPAIR INTERIOR & EXTERIOR OF ROOF NOT CORRECT FROM
IPREVIOUS CONTRACTOR
LS
1
4,280.30
4,280.30
WCD7
FURNISH & INSTALL NEW A/C SPLIT SYSTEM
LS
1
8,666.01
8,666.01
WCD8
FURNISH & INSTALL NEW SOLID CORE WOOD DOORS FOR
RESTROOMS
LS
1
6,675.04
6,675.04
WCD9
APPLY INTUMESCENT FIRE BAQRRIER PAINT TO FIREWALL AREAS
REMOVED IN DEMOLITION
LS
1
2,300.00
2,300.00
WCD10
INSTALL 6" BASE IN LIEU OF 4", RE -PAINT DEFECT AREAS
LS
1
8,727.98
8,727.98
WCD11
FURNISH & INSTALL ADDITIONAL WALL TILE OVER 8' HEIGHT,
BEYOND PLANS CALLED FOR
LS
1 1
6,030.27
6,030.27
WCD12
BALANCE THE DIFFERENCE OF CHANGE ORDER 1 LEFT IN LATENT
DEFECT ACCOUNT
LS
1
2,309.40
2,309.40
66,719.36
col
UPDATE RESTROOMS TO CULTURED MARBLE, METAL LADDER,
AND ANOTHER NEW A/C SYSTEM
LS
1
13,775.69
13,775.69
CO2
ADD NEW CIRCUITS, NEW DUCTWORK, LIGHTING, RE -DIRECT
GENERATOR EXHAUST, FLASHING,PATCHING, PAINTING
LS
1
22,219.86
22,219.86
35,995.55
TOTAL
$ 102,714.91
F,&YOag6FacitlmOegWojech�F Slabon 11 Reidt-MmnNgetla Xame,➢ra�eu Cbamuf,Cp2 • Pa}.pp 8 • trackYp• aril npvt1FS11 CO2_DESC C N GES
SECTION 00622 - Contractor's Application for Payment
FS#11 Renovations
Application for Payment No. 6
For Work Accomplished through the period of 7/1/2025 through 7/31/2025 . FINAL COMPLETION
To: Indian River County (OWNER)
From: Proctor Construction, LLC.( CONTRACTOR)
Bid No.: 2022061
1) Attach detailed schedule and copies of all paid invoices.
1.
Original Contract Price:
$451,512.00
2.
Net change by Change Orders and Written Amendments (+ or -):
$35,995.55
3.
Total Work Change Directives
$66,719.36
4.
Current Contract Price (1+2+3):
$554,226.91
5.
Total completed and stored to date:
$554,226.91
6.
Retainage (per Agreement):
5% retainage:
$N/A
7.
Total completed and stored to date less retainage (4 minus 5):
$554,226.91
8.
Less previous Application for Payments:
$492,486.20
9.
DUE THIS APPLICATION (6 MINUS 7):
$61,740.71
CONTRACTOR'S CERTIFICATION:
UNDER PENALTY OF PERJURY, the undersigned CONTRACTOR certifies that (1) the labor
and materials listed on this request for payment have been used in the construction of this Work; (2)
payment received from the last pay request has been used to make payments to all subcontractors,
laborers, materialmen and suppliers except as listed on Attachment A, below; (3) title of all Work,
materials and equipment incorporated in said Work or otherwise listed in or covered by this
Application for Payment will pass to OWNER at time of payment free and clear of all Liens, security
interests and encumbrances (except such as are covered by a Bond acceptable to OWNER
indemnifying OWNER against any such Lien, security interest or encumbrance); (4) all Work
covered by this Application for Payment is in accordance with the Contract Documents and not
defective; and (5) If this Periodic Estimate is for a Final Payment to project or improvement, I further
certify that all persons doing work upon or furnishing materials or supplies for this project or
improvement under this foregoing contract have been paid in full, and that all taxes imposed by
Chapter 212 Florida Statutes, (Sales and Use Tax Act, as Amended) have been paid and
discharged, and that I have no claims against the OWNER.
Attached to or submitted with this form are:
1. Signed release of lien forms (partial or final as applicable) from all subcontractors, laborers,
materialmen and suppliers except as listed on Attachment A, together with an explanation as
to why any release of lien form is not included;
IRC BUILDING & FACILITIES SERVICES
APPROVED
OI9Xally slgnea Ey: ROEM
DIVISION HEAD Rob Skok�,°m;°��
Date'. 2025 00.11
ACCOUNT # 11412022-066510-22040
00622-1
GAProject Files\IRCFD Station #11 RemodelV. Project Accounting\1. Owner Pay App\6. July 2025
Page 2 of 5
2. Updated Construction Schedule per Specification Section 01310.
r
Dated 'l >7G`;� By:
(CONTRACTOR — must be signed by
an Officer of the Corporation)
Anderson Proctor, V. President
Print Name and Title
STATE OF Florida
COUNTY OF Indian River
Sworn to (or affirmand subscribed bef re me by means of hysical pr encep_r ❑ online
notarization, this day of ,20 , by�f�U1L
(name of person making statement).
(Signature of Notary Public - Mate of Florida)
(Print, Type, or Stamp Commissioned Name of Notary Public)
CT'who is personally known to me or ❑ who has produced
as identification. CARIANN GOwIM
Notary Public
S State of Florida
Please remit payment to: y 0 Comm# HH279116
Expires 6/21/2026
Contractor's Name: Proctor Construction Company
Address: 2050 US HWY 1 Ste 200
Vero Beach, FL 32960
******,�«***�**«**«***�*,�*�*«*..�*,�*,�r,.***�*�«*«««*�*.*�*�*«.****,ter.*.r�*,�*,ter*****,►*,ter«,ter,.«***
(The remainder of this page was left blank intentionally]
IRC -2104 -PROCTOR -PAI 5 MAY 2025 (DRAFT)
00622-2
G:1Projecl FilesVRC Traffic Operations Fecililyl7. Project Accountingll. Owner Pay App\15. May 2025 PA 151owner pay appleountyllRC-2104_PROCTOR_PA15 MAY 2025
(DRAFT).doc Rev. 05/01
Page 3 of 5
SURETY'S CONSENT OF PAYMENT TO CONTRACTOR:
The Surety, TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
,a
corporation, in accordance with Public Construction Bond Number 108137977 , hereby
consents to payment by the OWNER to the CONTRACTOR, for the amounts specified in
this CONTRACTOR's APPLICATION FOR PAYMENT.
TO BE EXECUTED BY CORPORATE SURETY -
Attest:
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
Secretary Corporate Surety
2420 LAKEMOUNT AVENUE. 2nd FLOOR
ORLANDO, FL 32814
Business AIdress
BY:
Print e: JOHN W. CHARLTON
Title: AITORNEY-IN-FACT
V
(Affix Corporate SEAL)
STATE OF FLORIDA
Sworn to (or affirmed) and subscribed before me by means of R physical presence or ❑ online
notarization, this 6TH day of AUGUST 20 25 , b : JOHN W. CHARLTON (name of person
making statement). L& ��
(Signature of>lotary P blic -State of Florida)
(Print, Type, or Stamp Commissioned Name of Notary Public)
T who is personally known to me or 11 who has produced r rpU�� DINIACAVALIERE
as identification e< Commissbn a HH 525596
oc roe Expires June 19, 2028
[The remainder of this page was left blank intentionally]
FS11 PA6 20250730 FinaIR1
00622-3
GAProject File6VRCFD Station #11 RemodeN. Project AccountingN, Owner Pay App%. July 20251owner pay applcounty1FS1 /_PA6_20250730 FinalRt.doc Rev. 05/01
Travelers Casualty and Surety Company of America
Travelers Casualty and Surety Company
TRAVELERS RAVELERS St. Paul Fire and Marine Insurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St.
Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the
"Companies"), and that the Companies do hereby make. constitute and appoint John W Charlton, and D W Matson III of Coral Gables, Florida their true
and lawful Attorney (s) -in -Fact tosign, execute, seal and acknowledge any andall bonds, recognizances,conditional undertakings and other writings
obligatory in the nature thereof on behalf of the Companies in the,r business of guaranteeing the fidelity of persons, guaranteeing the performance of
contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
IN WITNESS WHEREOF. the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 21st day of April,
2021.
'aesuaery".. ."�1v4,r��
�y,�" . ...............moo i ��
{ d%+�Tj 2
HARTFORD. t g .
CONN. ',4i 'a''
State of Connecticut
# i
City of Hartford ss. Robert CRaney, Senior Vice President
On this the 21st day of April, 2021, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of each
of the Companies, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on
behalf of said Companies by himself as a duly authorized officer,
IN WITNESS WHEREOF, I hereunto set my hand and official seal
My Commission expires the 30th day of June, 2026
k H�
P� Anna P. Nowik, Notary Public
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of each of the Companies,
which resolutions are now in full force and effect, reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any
Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attomeysin-Fact and
Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign
with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of
a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and
revoke the power given him or her, and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation
is in writing and a copy thereof is filed in the office of the Secretary, and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional
undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any
Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any
Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if
required) by one or more Attomeys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one
or more Company officers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any
Vice President, any Assistant Vice President, any Secretary. any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any
Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attomeys-in-Fact for
purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or
certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified
by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to
which it is attached.
I, Kevin E. Hughes, the undersigned, Assistant Secretary of each of the Companies, do hereby certify that the above and foregoing is a true and correct
copy of the Power of Attorney executed by said Companies, which remains in full force and effect.
Dated this 6TH day of AUGUST 2025
�� slNr�j� y, O •r 4hn �
4yµ..._...-.. �,' �s •J1�'
j 111ARTFORD,'{'�
77 CONN.
Kevin E. Hughes, Assistant Secretary
To verify the authenticity of this Power ofAttomey, please call us at 1-800-421-3880.
Please refer to the above-named Attomey(s)-in-Fact and the details of the bond to which this Power of Attomey is attached.
Page 4 of 5
CERTIFICATION OF INDIAN RIVER COUNTY PROJECT MANAGER:
I certify that I have reviewed the above and foregoing Periodic Estimate for Partial
Payment; that to the best of my knowledge and belief it appears to be a reasonably
accurate statement of the work performed and/or material supplied by the Contractor. I am
not certifying as to whether or not the Contractor has paid all subcontractors, laborers,
materialmen and suppliers because I am not in a position to accurately determine that issue.
Dlgd.hy signed by: Rob Skok
Rob Skok DN CN = Rob Skok email = rskok@indiann,er
Dated gov C=AD
Date 9025 OR 11 13 ds 1A -04'00'
SIGNATURE
CERTIFICATION OF INDIAN RIVER COUNTY INSPECTOR:
I have checked the estimate against the Contractor's Schedule of Amounts for Contract
Payments and the notes and reports of my inspections of the project. To the best of my
knowledge, this statement of work performed and/or materials supplied appears to be
reasonably accurate, that the Contractor appears to be observing the requirements of the
Contract with respect to construction, and that the Contractor should be paid the amount
requested above, unless otherwise noted by me. I am not certifying as to whether or not the
Contractor has paid all subcontractors, laborers, materialmen and suppliers because I am
not in a position to accurately determine that issue. Digitally signed by Rick
Dated
Rick ' v' a `h i SMaths
Date 12025.08.08 15:23:49
SIG 4ATHRE -64,00,
****************************************************************************************************
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Page 5 of 5
FS11_PA6_20250730 FinalR1
00622-4
G:\Project Files\IRCFD Station #11 Remodel\7. Project Accounting\1. Owner Pay App\6. July 2025\owner pay app\county\FS11_PA6_20250730 FinalRl.doc Rev. 05/01
ATTACHMENT A
1. List of all subcontractors, laborers, materialmen and suppliers who have not been
paid from the payment received from the last Pay Request and the reason why
they were not paid (attach additional pages as necessary):
2. List of all subcontractors, laborers, materialmen and suppliers for which a signed
release of lien form (partial or final as applicable) is not included with this Pay
Request, together with an explanation as to why the release of lien form is not
included (attach additional pages as necessary):
FS11_PA6_20250730 FinaIR1
00622-5
GAProject Files\IRCFD Station #11 Remodel\7. Project Accounting\l. Owner Pay App\6. July 2025\owner pay app\county\FSl l_PA6_20250730 FinalRl.doc Rev. 05/01
FWI RENOVATIONS
PAY AVP S
I I FIRE STATION 11 REMODEL I I- 6xnt. I OOiAi .,Am I - -, I ]mu .ADI, am I I - am
Digitally signed
John by John Binkley
Date:
Binkley2025.08.11
08:13:45 -04'00'
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I I FIRE STATION 11 REMODEL I I- 6xnt. I OOiAi .,Am I - -, I ]mu .ADI, am I I - am
Digitally signed
John by John Binkley
Date:
Binkley2025.08.11
08:13:45 -04'00'
Project:
Exhibit A-2
CONDITIONAL WAIVER AND RELEASE UPON
PAYMENT
(Conditional Lien Waiver)
Fire Station #11 Remodel
The undersigned has been contracted by Indian River County to perform work
which includes labor, services, materials and/or equipment to the jobsite of the project known as
Fire Station #11 Remodel
This progress payment lien waiver is conditional upon receipt of payment by Proctor Construction Company, LLC
of the sum of $ 61,740.71 , which represents payment for the application for payment dated
Pay App 6 Through JULY 31, 2025 , to the extent of this payment, the undersigned does hereby waive and release
any and all liens or claim of liens, or right to lien or to withholding of labor, services, materials, fixtures, apparatus,
or machinery furnished and included in the foregoing application for payment, by the undersigned, with respect to
and on behalf of said above-described premises, and the improvements thereon. The undersigned additionally
certifies that to the extent of the payments made to date all obligations for materials, equipment furnished, and
payment for all work, labor, and services performed, have been satisfied.
By signing below, the undersigned states that he/she has full authority to sign on behalf of the below -named
contractor.
Dated this 4th day of August 12025
Printed Name Anderson Proctor
Signature
Title Vice President
Company
Proctor Construction Company, LLC
e--'
State of Florida County of C11 G �rl
Subscribed and sworn to before me this L-01— day of , 20
Notary Public
My Commission expires p (F.
Please return to: Proctor Construction Company, LLC
Thank you.
(Seal)CARIANN GOWIN
*V1
Notary Public
State of Florida
Comm# HH279116
Expires 6/21/2026
Exhibit A-1
PROGRESS UNCONDITIONAL WAIVER AND RELEASE UPON
PAYMENT
(Progress Unconditional Lien Waiver)
Project: Fire Station #11 Remodel
Proctor Construction Company, LLC lu perform work
The undersigned has been contracted by _ -__
which includes labor, services, materials and/or equipment to the jobsite of the project known as
Fire Station #11 Remodel
In consideration of the payment of S 26,827.22 _ , the undersigned acknowledges payment of progress
invoices Pay App 5 Through JUNE 30, 2025 , further, the undersigned does hereby waive and release any and all
lien or claim of lien, or right to liens or to withholding, of labor, services, materials, fixtures, apparatus, or
machinery furnished for listed progress invoices by the undersigned with respect to and on behalf of said above-
described premises, and the improvements thereon.
The undersigned additionally certifies that to the extent of the payments made to date, the undersigned has paid in
full or has otherwise satisfied all obligations for materials, equipment furnished, and payment for all work, labor,
and services performed, and for all known indebtedness and claims that may arise against the undersigned, or any
of the undersigned's subcontractors, and the Owncr/Owner/Owners' Representatives for damages arising in any
manner in connection with the performance of the contract referenced above for which the owner of the property
might in any way be held responsible.
By signing below, the undersigned states that he/she has full authority to sign on behalf of the below -named
contractor.
Dated this 28th day of —_ _ July 20_25
Printed Name Anderson Proctor
Signature
Title Vice President
Company Proctor Construction Company, LLC
Slate of Florida County of
Subscribed and sworn to before me this _ day of ,A 20—�
Notary Public (Seal) CARIANN GOWIN
– -- –^y q °c, Notary Public
My Commission expires 4t:+ :�� �.�J� �y p 2 o State of Florida
y Comm# HH279116
sib t J"J' Expires 6/21/2026
Please return to: Proctor Construction Company, LLC
Thank you.
PARTIAL WAIVER AND RELEASE OF LIEN UPON PROGRESS PAYMENT
The undersigned lienor, in consideration of the sum listed below, hereby waives and releases its lien and right to claim
a lien for labor, services, or materials furnished through date shown below
Name of Claimant: COMPLETE RESTAURANT EQUIP DBA SERV. REFRIGERATION
Name of Customer: INDIAN RIVER COUNTY
Job: T -FIRE -FIRE STATION #11 REMODEL
Owner: Proctor Construction Company, LLC
Through Date: 06/20/2025
Conditional Waiver and Release
This document waives and releases lien, stop payment notice, and payment bond rights the claimant has for labor and
service provided, and equipment and material delivered, to the customer on this job through the Through Date of this
document. Rights based upon labor or service provided, or equipment or material delivered, pursuant to a written
change order that has been fully executed by the parties prior to the date that this document is signed by the
claimant, are waived and released by this document, unless listed as an Exception below. This document is effective
only on the claimant's receipt of payment from the financial institution on which the following check is drawn:
Maker of Check: Proctor Construction Company, LLC
Amount of Check: 54,324,92 (fifty-four thousand, three hundred and twenty-four dollars and ninety-two
cents)
Check Number: 0000061024
Check Payable to: COMPLETE RESTAURANT EQUIP DBA SERV. REFRIGERATION
This waiver and release does not cover any retention or labor, services, or materials furnished after the date specified.
Signature
Claimant's Signature:
Claimant's Title: Q'1,,gn��GE/� V
Date of Signature: ' JESSICAPARISH
_•: MY COMMISSION # HH 479182
EXPIRES: May 8.2028
N ota ry: L>
PARTIAL WAIVER AND RELEASE OF LIEN UPON PROGRESS PAYMENT
The undersigned lienor, in consideration of the sum listed below, hereby waives and releases its lien and right to claim
a lien for labor, services, or materials furnished through date shown below
Name of Claimant:
Name of Customer:
Job:
Owner:
Through Date:
EVEREST MECHANICAL SERVICES
INDIAN RIVER COUNTY
T -FIRE - FIRE STATION #11 REMODEL
Proctor Construction Company, LLC
06/20/202S
Conditional Waiver and Release
This document waives and releases lien, stop payment notice, and payment bond rights the claimant has for labor and
service provided, and equipment and material delivered, to the customer on this job through the Through Date of this
document. Rights based upon labor or service provided, or equipment or material delivered, pursuant to a written
change order that has been fully executed by the parties prior to the date that this document is signed by the
claimant, are waived and released by this document, unless listed as an Exception below. This document is effective
only on the claimant's receipt of payment from the financial institution on which the following check is drawn:
Maker of Check:
Proctor Construction Company, LLC
Amount of Check:
13,654.26 (thirteen thousand, six hundred and fifty-four dollars and twenty-six cents)
Check Number:
0000061025
Check Payable to:
EVEREST MECHANICAL SERVICES
This waiver and release does not cover any retention or labor, services, or materials furnished after the date specified.
Signature
Claimant's Signature:
Claimant's Title: Prt5l
Date of Signature: 2u'LS
Notary:
ma
o1pR�' n�Bt.
JULIA A. BIENEMANN
Commission # HH 378777
9FOF F1.� Expires March 26, 2027
WAIVER AND RELEASE OF LIEN
UPON PROGRESS PAYMENT
268353-54N80338
The undersigned lienor, in consideration of the stun of $10.00 hereby waives and releases its lien and right
to claim a lien for labor, services or materials, through 06-20-2025 to EVEREST MECHANICAL
SERVICES on the job of INDIAN RIVER COUNTY (owner), to the following described property:
2555 93RD ST, VERO BEACH; FIRE STATION #11 REMODEL; BOND #108137977, TRAVELERS
CASUALTY AND SURETY COMPANY OF AMERICA $451,512.00; BOND RECORDED IN INDIAN
RIVER COUNTY FL O.R. BOOK 3758 PAGE 264;
This waiver and release does not cover any retention or labor. services or materials after the date
specified.
DATED on JULY 25, 2025
CARRIER ENTERPRISE
ATTN: JAYCE ALFONZO
8050 VISTA RESERVE BLVD STE 2200
ORLANDO FL 32829-8085
By: ' i s 4t
PAO .A CHOCALA
CREDIT MANAGER
Sworn to (or affirmed) and subscribed before me by means of [Oysical presence or [ ] online notarization,
this 25 day of JULY, 2025 by PAOLA CHOCALA (name of person making statement).
1tAMISHA TYRONE
Notary Public • State of Florida
y" Commission 0 HH 295722
a M1 My Comm. Expires Oct 2, 2026
Bonded through National Notary Assn.
Public. StAtiof Florida Print, type or stamp name of notary public
[ ersonally Known OR [ ] Produced Identification
Type of Identification Produced
This is a statutory form prescribed by Section 713.20, Florida Statutes 1996 Effective October 1, 1996, a
person may not require a lienor to furnish a waiver or release of lien that is different from the statutoryform.
PARTIAL WAIVER AND RELEASE OF LIEN UPON PROGRESS PAYMENT
The undersigned lienor, in consideration of the sum listed below, hereby waives and releases its lien and right to claim
a lien for labor, services, or materials furnished through date shown below
Name of Claimant: KLEEN SWEEP, INC.
Name of Customer: INDIAN RIVER COUNTY
Job: T -FIRE - FIRE STATION #11 REMODEL
Ato
Owner: Proctor Construction Company, LLC
Through Date: 06/20/2025
Conditional Waiver and Release
This document waives and releases lien, stop payment notice, and payment bond rights the claimant has for labor and
service provided, and equipment and material delivered, to the customer on this job through the Through Date of this
document. Rights based upon labor or service provided, or equipment or material delivered, pursuant to a written
change order that has been fully executed by the parties prior to the date that this document is signed by the
claimant, are waived and released by this document, unless listed as an Exception below. This document is effective
only on the claimant's receipt of payment from the financial institution on which the following check is drawn:
Maker of Check: Proctor Construction Company, LLC
Amount of Check: 845.00 (eight hundred and forty-five dollars and zero cents)
Check Number: 0000061026
Check Payable to: KLEEN SWEEP, INC.
This waiver and release does not cover any retention or labor, services, or materials furnished after the date specified.
Signature
Claimant's Signature:
Claimant's Title:
Date of Signature:
Notary:
VP
"•• �¢� MILLICENT HEBERT
• Commission M HH 502484
Expires March 21.2028
Fcr r�
PARTIAL WAIVER AND RELEASE OF LIEN UPON PROGRESS PAYMENT
The undersigned lienor, in consideration of the sum listed below, hereby waives and releases its lien and right to claim
a lien for labor, services, or materials furnished through date shown below
Name of Claimant:
Name of Customer:
Job:
Owner:
Through Date:
TNA ELECTRIC LLC
INDIAN RIVER COUNTY
T -FIRE - FIRE STATION #11 REMODEL
Proctor Construction Company, LLC
06/20/2025
Conditional Waiver and Release
This document waives and releases lien, stop payment notice, and payment bond rights the claimant has for labor and
service provided, and equipment and material delivered, to the customer on this job through the Through Date of this
document. Rights based upon labor or service provided, or equipment or material delivered, pursuant to a written
change order that has been fully executed by the parties prior to the date that this document s signed by the
claimant, are waived and released by this document, unless listed as an Exception below. This document is effective
only on the claimant's receipt of payment from the financial institution on which the following check is drawn:
Maker of Check: Proctor Construction Company, LLC
Amount of Check: 3,282.75 (three thousand, two hundred and eighty-two dollars and seventy-five
cents)
Check Number: 0000061027
Check Payable to: TNA ELECTRIC LLC
This waiver and release does not cover any retention or labor, services, or materials furnished after the date specified.
Signature
Claimant's Signature
Claimant's Title: 00_-' ( r-��
Date of Signature:
Notary:
ITZAYANA JACOME
Notary Pubbc. Stale of Flonda
My Comm E,Prrs Dec 12 202E
No HN :140497