Backup Documents 02/23/2016 Item #16A 9 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE ar ti)
z �
COUNTY ATTORNEY-PINK ROUTI1
Routed by Procurement Services to the
Following Addressee(s) (In routing order) Office Initials Date
1. Risk Management Risk
2. County Attorney Office County Attorney Office 57,1 5134,1
3. BCC Office Board of County #•
Commissioners DDA Ito
4. Minutes and Records Clerk of Court's Office
n 03forihe l 140fm
5. Return to Procurement Services Procurement Services
Division Contact: Diana De Leon
PRIMARY CONTACT INFORMATION
Name of Primary Diana De Leon for Evelyn Colon Phone Number 252-8375
Procurement Staff March 1,2016
Contact and Date
Agenda Date Item was February 23,2016 Agenda Item Number 16.A.9
Approved by the BCC
Type of Document Work Order and P&P Bonds Number of Original 2
Attached Documents Attached
PO number or account N/A Solicitation/Contract 14-6213-55 Haskins
number if document is Number/Company
to be recorded Name
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? DD
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the N/A
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's DD
signature and initials are required.
7. In most cases(some contracts are an exception),an electronic copy of the document and DD
this routing slip should be provided to the County Attorney's Office before the item is
input into SIRE.
8. The document was approved by the BCC on the date above and all changes made DD
during the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable. f.�
9. Initials of attorney verifying that the attached document is the version approved by the
BCC, all changes directed by the BCC have been made, and the document is ready for the ►o,
Chairman's signature.
.L of ,f,,,,
MEMORANDUM
Date: March 7, 2016
To: Diana De Leon, Contracts Technician
Purchasing & General Services Department
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Work Order for Contract #14-6213-55 "Underground Utility
Contractors""
Contractor: Haskins, Inc.
Attached is an original of the work order referenced above, (Item #16A9) approved by
the Board of County Commissioners on Tuesday, February 23, 2016.
The original work order has been held by the Minutes and Records Department as part
of the Board's Official Record.
If you have any questions, please contact me at 252-8411.
Thank you.
Attachment
a 9
•
,WORK.QRDER/PURCHASE ORDER i 4-6213-S'S
Contract 14-6213 "Underground Utility Contractors"
Contract Expiration Date: 8 JULY ,2016
This Work Order is for construction services to build stormwater management facilities,known as:
i
Project Name: Lely Area Stormwater Improvements Project—Cope Lane/Crews Road Improvements
Project No: 51101
The work is specified in the quote dated January 8, 2016 which is attached hereto and made a part of
this Work Order. In accordance with Terms and Conditions of the Agreement referenced above, this
Work Order/Purchase Order is assigned to:Haskins Inc.
Scope of Work: As detailed in the attached proposal and the following:
* Construct the Cope Lane&Crews Road portions of Lely Area Stormwater Improvements Project
(LASIP) in accordance with the bid schedule and documentation submitted, which are attached
and made part of this Work Order.
Schedule of Work: Complete work within 150 days from the date of the Notice to Proceed which
will be forthcoming. The Consultant agrees that any Work Order that extends beyond the expiration
date of Agreement # 14-6213 will survive and remain subject to the terms and conditions of that
Agreement until the completion or termination of this Work Order.
Compensation: In accordance with the Agreement referenced above,the County will compensate the
Firm in accordance with following method(s): Ei Lump Sum (Quote) OLump Sum Plus
Reimbursable Costs(LS+RC) ['Time& Material (T&M) (established hourly rate—Schedule A) ❑
Cost Plus Fixed Fee (CPFF), (define which method will be used for which tasks) as provided in the
attached proposal.
TOTAL FEE $342,369.80.
,r
-7-0 6 ,e
Prepared by: ..„,..41-'
,;,„,-,1/ Date: .
Shane Cox PE,Sr Project Manager
Capital Project Planning,Impact Fees&Program Management Division
APPROVED BY: 5ZA✓x 49. `1%.62/4"7 6
GeraldKurtz N P E,Principal Project Manager Date
Capital Project Planning,Impact Fees&Program Mgmt Division
Page I of 3
I
APPROVED BY:
a 14 A APO I I t
Amy Patters ,Division Director Date
Capital Project Planning,Impact Fees&Program Mgmt Division
APPROVED BY: A x Z/tet, l 16
David S. Wilkison Date
Department Head
Growth Management Department
Pllif •APPROVED BY: f rii/co
Everyn Colon,Pr�ment Strategist Date
Purchasing Division
By the signature below,the Firm(including employees,officers and/or agents)certifies,and hereby discloses,
that,to the best of their knowledge and belief,all relevant facts concerning past,present, or currently planned
interest or activity(financial,contractual,organizational,or otherwise)which relates to the proposed work;and
bear on whether the Firm has a potential conflict have been fully disclosed.
Additionally,the Firm agrees to notify the Procurement Director,in writing within 48 hours of learning of any
actual or potential conflict of interest that arises during the Work Order and/or project duration.
ACCEPTED BY: Haskins,Inc
ifke
Ry acPhee
Estimator
Haskins Inc.
Page 2 of 3
6 A 9
IN WITNESS WHEREOF,the parties hereto,have each,respectively,by an authorized person or
agent,have executed this Work Order on the date and year first written below.
ATTEST:; BOARD OF COUNTY COMMISSIONERS
Dwight'E..Brock,Clerk of Courts COLLIER COUNTY,FLORIDA
y: 2 By:
J
Dated: [ - !p Donna F la,Chairman
Atter646 Chairman's Name of Finn Haskins Inc.
signature only.
. !..!
By:
First With ture Ryan MacPhee/Secretary
/677 /X S;M/TtrtiA) 'PType/print signature and title'
tType/pness : ' T
LL ,�( •
Second tness
til Cdr)a 'div
tType/print witness i: 09'
prov as topyd Le ity:
AosiCounty Attorney
Sf
Print Name
item# (06
Agenda c9Jai J co
Date
Date
Recd `3 fl Ip Page 3 of 3
Deputy lerk V
4
Co ver County
Administrative Services Department
Procurement Services Divvsion
REQUEST FOR QUOTATIONS FOR MULTIPLE PROJECTS UNDER CONTRACT
#14-6213
"Annual Contract for Underground Utilities&General Contractors"
Date: January 8, 2016 •
From: Shane Cox PE, Sr Project Manager
239-252-5792, Telephone Number
•
shanecox(t�coiliergov.net
To: Potential Proposers
Subject: RFQ 14-6213-55 LASIP/Cope Ln/Crews Rd Stormwater improvements •
As provided in the referenced contract, the Collier County Growth Management Department is
soliciting quotes for the referenced project.
RFQ Due Date: 2:00 PM 1/22/2016
Q&A Deadline: 5:00 PM 1/19/2016
Pre-Quote Meeting no
Number of Days to Final Completion: 120 Days Substantial+30 Days Final=150 Days Total
Scope Provided Yes
Plans and Specs: Yes
Liquidated Damages: $758.00 per day(fr FDOT Manual)
Payment&Performance Bonds Yes,if project value exceeds$200,000.00
Your quotation response for this project is due no later than the date and time specified above.We
will not accept any quotation responses later than the noted time and date. if your firm is unable to
respond electronically, your quotation must be received in the office of the Purchasing Department at
the above referenced address no tater than the time and date specified.We look forward to your
participation in this request for information/quotation process.
Haskins Inc,
Firm's Complete Legal Name
239-947-1846/239-947-3857
Telephone Number/Fa ber
Si
Estimator,Secretary
Title
Ryan MacPhee 1-22-16
Print Name Date
C:Shane Cox/Sr Project Manager
1
RFQ 14-6213-54
.0"))
U >
1 6 A 9
Lent Area Stormwater Improvement Project
Crews Road and Cope Lane
Rid Form
General Costs(Includes Sections 1&2)
Item No. Item Description Units Quantity Unit Cost Cost
1 101-1 Mobltzation LS 1 $30,000.00 $30,000.00
2 101-1-1 Stakeout and record drawing LS 1 $10,000.00 $10,000.00
3 101-1-2 Testing and certifications LS 1 $5,000.00 $5,000.00
4 101-14 Design and Permitting by Contractor(ROW,Clearing,etc) LS 1 $3,000.00 $3,000.00
Allowance' Fendng Allowance,Use of allowance must be approved by the LS 1 $4,000.00 $4,000.00
5 County prior to the execution of the work.
'Quantity/location of fencing to be as directed by County TOTAL $52,000.00
Section 1-Crews Road
Estimated Contractor
Item No, item Description Units Quantity Verified Unit Cost Cost
Quantity
6 102-1 Maintenance of traffic LS 1 1 $3,000.00 $3,000.00 '
7 104-10-3 Staked sift fence,type ill(install and maintain) IF 3,620 1 $2.50 $9,050.00
8 104-15 Soll tracking prevention device EA 1 3620 $2,656.00 $2,656.00
9 104-18 Inlet Protection System FA 1 1 $145.00 $145,00
10 110-1-1 Clearing and grubbing(1.80 ACj LS 1 1.00 $20,000.00 $20,000.00
11 110-1-1 Remove existing 15"corrugated metal pipe(30 LF) LS 1 1 $1,000.00 $1,000.00
12 120-1 Excavation CY 2,261 2261 $10.00 $22,610.00
13 120-6 Embankment CY 144 144 $2900 $4,176.00
14 120-6-1 Final site grading SY 4,759 4759 $2.90 $13,801.10
15 160-4 12"Stabilized subgrade(shoulder) SY 1,155 1155 $3.60 $4,158.00
16 160-4 12"Stabilized sub _grade(roadway) SY 2,737 2737 _ $4.15 $11,358.55
17 285-704 6'Ltrnerock(shoulder) SY 1,155 1155 $11.80 $13,629.00
18 286-704 6'Limerock(roadway) SY 2,737 2737 $12.00 $32,844.00 _
19 425-1-581 Modified type"H`inlet EA 1 1 $14,500.00 $14,500.00
20 430-174-242 53"x34"Elliptical reinforced concrete pipe LF 40 40 $290.00 $11,600.00
21 430-176-124 24"Reinforced concrete pipe IF 88 88 $75.00 $6,600.00 _
22 430-175-124A Connect to existing type'H"inlet EA 1 1 $2,800.00 $2,800.00
23 430-982-129 24"Mitered end section , EA 2 2 $1,800.00 $3,600.00
24 5303-4 Rip-rapLS 1 1 $6,275.00 $6,275.00
26 570-1-1 Seed and mulch SY 4,759 4759 $0.65 $3,093.35 ;i'
26 OC-R-24 Open-cut and restore existing driveway for 24"RCP install _ EA 1 1 $2,500.00 $2,500.00
TOTAL $189,396.00
Section 2-Cope Lane
Item No. Item Description Units Quantity Unit Cost Cost
27 102-1 Maintenance of traffic LS 1 1 $5,500.00 $5,500.00ti
28 110-1-1 Clearing and grubbing(0.22 AC) LS 1 1 $17,000.00 $17,000.00 J
29 104-10-3 Staked silt fence,type Ill(Install and maintain) LF 804 804 $2.50 $2,010.00
30 104-18 inlet Protection System EA 2 2 $145.00 $290.00 -
31 110-1-1 Remove existng-chain Mk fence(330 LF) LS 1 1 $1,500.00. $1,500.00
32 120-1 Excavation CY 131 ` 131 $38.00 - $4,978.00
33 1204 Embankment CY 36 36 $80.00 $2,880.00
34 120-66 Final site grading SY 1,067 1,067 $5.75 $6,135.25
36 160-4 12"Stabilized subgrade(shoulder) SY 229 229 $26.00 $5,954.00
36 285-704 6'Limerock(shoulder) SY - 229 - 229 $27.00 $6,183.00
37 425-1421 Type'C'Inlet EA 2 2 $4,100.00 $8,200.00
38 430-175-124 24"Reinforced concrete pipe LF 48 48 $100.00 $4,800.00
39 630.34 Rip-rap LS 1 1 $3,400.00 $3,400.00
40 550-10-222 Replace fence-black vinyl coated chain link(6'high) LF 345 345 $50.00 $17,250.00
41 570-1-1 Seed and mulch SY 1,067 1,067 $0.65 $693.55
42 OC-R-24 Open cut and restore Cope Lane for 24"RCP install EA 1 1 $3,200.00 $3,200.00
43 RE-1 Rehab existing road(1,140 SY) LS 1 1 $11,000.00 $11,000.00
TOTAL $100,973.80
GRAND TOTAL(Lump Sum) $342,369.80
Q
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i
1 6 9
FRONT PAGE OF PUBLIC PAYMENT & PERFORMANCE BOND
In compliance with F.S. Chapter 255.05(1)(a)
Bond No.: 929610821
Contractor Name: Haskins, Inc.
Contractor Address: 10956 Enterprise Avenue
Bonita Springs, FL 34135
Contractor Phone No: 239-947-1846
Surety Company Name: Western Surety Company
Surety Company Address: 333 Wabash Ave
Chicago, IL 60604
Surety Company Phone No: 312-822-5000
Agent Name: Waldorff Insurance & Bonding, Inc.
Agent Address: 1110 NW 6th Street
Gainesville, FL 32601
Agent Phone No: 352-374-7779
Obligee Name: Collier County
Obligee Address: 3327 Tamiami Trail E
Naples, FL 34112
Obligee Phone No:
Bond Amount: $342,369.80
Contract No: (if applicable) 51101
Description of Work: Lely Area Stormwater Improvements Project-Cope Lane/Crews Road
Improvements
Project Address:
Collier Co, FL
FRONT PAGE
All other bond page(s)are deemed subsequent to this page regardless of any page ntltrnier(s)that may be pre-printed thereon.
1. 6 A 9
EXHIBIT A
PUBLIC PAYMENT BOND
Bond No. 929610821
Contract No. 14-6213
KNOW ALL MEN BY THESE PRESENTS: That Haskins,Inc.,10956 Enterprise Avenue,Bonita Springs,FL 34135 as Principal,and
Western Surety Company , as Surety, located at 333 Wabash Ave.,Chicago,IL 60604
(Business Address) are held and firmly bound to Board of County Commissioners for Collier County,Florida
as Oblige in the sum of Three Hundred Forty Two Thousand,Three Hundred Sixty Nine Dollars and 80/100 ($ 342,369.80 ) for the payment whereof
we bind ourselves, our heirs,executors, personal representatives, successors and assigns,jointly and severally.
WHEREAS, Principal has entered into a contract dated as of the 8th day of July 2014, with Oblige for
Lely Area Stormwater Improvements Project-Cope Lane/Crews Road Improvements Project No,51101
in accordance with
drawings and specifications,which contract is incorporated by reference and made a part hereof, and is referred to as the
Contract.
THE CONDITION OF THIS BOND is that if Principal:
Promptly makes payment to all claimants as defined in Section 255.05(1), Florida Statutes, supplying Principal with labor,
materials or supplies, used directly or indirectly by Principal in the prosecution of the work provided for in the contract,
then this bond is void; otherwise it remains in full force.
Any changes in or under the Contract and compliance or noncompliance with any formalities connected with the Contract
or the changes do not affect sureties obligation under this Bond.
The provisions of this bond are subject to the time limitations of Section 255.0592. In no event will the Surety be liable in
the aggregate to claimants for more than the penal sum of this Payment Bond, regardless of the number of suits that may
be filed by claimants.
24th February
IN WITNESS WHEREOF, the above parties have executed this instrument this ^, day of , 2016 , the
name of under-signed representative, pursuant to authority of its governing body.
Signed, sealed and delivered
in the presence of: PRINCIPAL:
f.'t,,1 Haskins,Inc.
61,4t By:
W nesses as Pnnci•al Name: G k �"• 100
Its: V �{ — -
STATE OF
�J
COUNTY OF
The Foregoing instrument was ac owled ed before me this / 4 of �✓'� 20 1,‘, b > L((�N it-Lae-A&
4 ..
, as (ULfia of J(-toa 4 / corporation, on
behalf of the corporation. He/she is personall known to me OR has produced 4.443,
as identification and did (did not)take an oath.
MABEL LAGO
a IPpY ApB.x (Signature of otary)
Notary Public-State of Florida ,,
:• My Comm.Expires Feb 13,2019
Name:
=, ��.s; Commission#FF 169752
'"%;8riss Bonded through National Notary Assn. (Legibly Printed). Ora-it
(AFFIX OFFICIAL SEAL) Notary Public, State of
Commission No.: k •-1‘.).**
Page -12-
Bond No.929610821 16 A9
ATTEST:
SURETY:
Western Surety Company
(Printed Name)
333 Wabash Ave
Chicago,IL 60604
(Business Address)
CA14/e4- See Below
(Authorized Signature)
Witness as to Surety
(Printed Name)
/ < 4re4/0
OR ���%e •�//� .�
As Attorney in Fact Paul A.Locascio,Attorney-In-Fact&Fla.Resident Agent
(Attach Power of Attorney)
Witnesses
1110 NW 6th Street
Gainesville,FL 32601
(Business Address)
Paul A.Locascio
(Printed Name)
352-374-7779
(Telephone Number)
STATE OF Florida
COUNTY OF Alachua
The foregoing instrument was acknowledged before me this 24th day of February
2016 ,by Paul A.Locascio as Attorney-In-Fact
of Western Surety Company , Surety. on behalf of Surety. He/She is personally known to me
OR has produced Personally known as identificafon and who did(did not)take an oath.
My Commission Expires: 444 14t4_
(Signature o Notary) '�
Name: Rebekah Wolf
(Legibly Printed)
(AFFIX OFFICIAL SEAL)
Notary Public, State of Florida
Commission No.: FF 243374
REBEKAH WOLF
-NOTARY ECOMMISSION SI FF 243374
S PUBLIC EXPIRES August 15,2019
STATE OF
`FL BONDED THROUGH
Ru INSURANCE COMPANY
•
Page-13-
Bond No. 929610821 Western Surety Company 16 A 9
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT
Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation,is a duly organized and existing corporation
having its principal office in the City of Sioux Falls,and State of South Dakota,and that it does by virtue of the signature and seal herein affixed hereby
make,constitute and appoint
L. Dale Waldorff, Benjamin H French, Pamela L. Jarman, Paul A Locascio, K. Wayne
Walker,Rebekah G Wolf, Clyde D Hare,Individually
Of Fort Walton Beach,FL,its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on its
behalf bonds,undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts-
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney,pursuant to the authority hereby given,are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof,duly adopted,as indicated,by
the shareholders of the corporation.
In Witness Whereof,WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be
hereto affixed on this 29th day of December,2015.
�Suaerp WESTERN SURETY COMPANY
awl E
'aul T.Bruflat,Vice President
State of South Dakota
ss
County of Minnehaha
On this 29th day of December,2015,before me personally came Paul T.Bruflat,to me known,who,being by me duly sworn,did depose and say: that
he resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which
executed the above instrument;that he knows the seal of said corporation;that the seal affixed to the said instrument is such corporate seal;that it was so
affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and
acknowledges same to be the act and deed of said corporation.
My commission expires
J. o
Z soun+rwn�
June 23,2021
s HcnRram c 7
)9X11/1—J
J.Mohr,Notary Public
CERTIFICATE
I,L.Nelson,Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force,and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this 24th day of February . 2016
-;T , WESTERN SURETY COMPANY
'� pPQgq �;_
mot
IlkSr
L.Nelson,Assistant Secretary
Form F4280-7-2012
}K.
EXHIBIT A-2
PUBLIC PERFORMANCE BOND
Bond No. 929610821
Contract No. 14-6213
KNOW ALL MEN BY THESE PRESENTS: That Haskins,Inc., 10956 Enterprise Avenue,Bonita Springs,FL 34135
, as Principal, and Western Surety Company
, as Surety, located at 333 Wabash Ave.,Chicago,IL 60604
(Business Address) are held and firmly bound to
Board of County Commissioners for Collier County,Florida as Oblige in the sum of Three Hundred Forty Two Thousand,Three Hundred Sixty Nine Dollars and 80/100
($ 342,369.80 ) for the payment whereof we bond ourselves, our heirs,
executors, personal representatives, successors and assigns,jointly and severally.
WHEREAS, Principal has entered into a contract dated as of the 8th day of July , 2014 ,
with Oblige for Lely Area Stormwater Improvements Project-Cope Lane/Crews Road Improvements Project No.51101
in accordance with drawings and specifications, which contractor is incorporated by reference and made a pat
hereof, and is referred to as the Contract.
THE CONDITION OF THIS BOND is that if Principal:
1. Performs the Contract at the times and in the manner prescribed in the Contract, and
2. Pays Oblige any and all losses, damages, costs and attorneys' fees that Oblige sustains because of
any default by Principal under the Contract, including, but not limited to, all delay damages, whether
liquidated or actual, incurred by Oblige; and
3. 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 and compliance or noncompliance with any formalities connected with the Contract or
the changes do not affect Sureties obligation under this bond.
The Surety, for value received, hereby stipulates and agrees that no changes, extensions of time, alterations or
additions to the terms of the Contract or other work to be performed hereunder, or the specifications referred to
therein shall in anywise affect its obligations under this bond, and it does hereby waive notice of any such
changes, extensions of time, alternations or additions to the terms of the Contract or to work or to the
specifications.
Page-14-
Bond No.929610821 0 t
This instrument shall be construed in all respects as a common law bond. It is expressly understood that the
time provisions and statute of limitations under Section 255.05, Florida Statutes, shall not apply to this bond.
In no event will the Surety be liable in the aggregate to Oblige for more than the penal sum of this Performance
bond regardless of the number of suits that may be filed by Oblige.
IN WITNESS WHEREOF the above parties have executed this instrument this 24th day of February
, 20 16 , the name of each party being affixed and these presents duly signed by its undersigned
representative. pursuant to authority of its governing body.
Signed, sealed and delivered
in the presence of : PRINCIPAL:
>niAtt
i ! Haskins,Inc.fi
il
lie 1 el f-�,Ct7 . By: s! /� �;
Witnesses as to;n '/_ t
ncipal Name: � t nt "
Its: S.e ' .'. •,tv',
n _
STATE OF Orl k
COUNTY OF
The foregoing ' strument w s a�n owledged before me -'s -L day of T,,P�o
201 , by q4 . k a , as ,' ' % oil 44,744.
,� ire _.377,(___.
G-
/ U
a "T(ort 4•rroratton, on behalf of the corporation.
He/She is personally known to me OR has produced AJ ' as identification and
.aid (did not) taTer—a—rd5Th.
My Commission Expires:
(Signat re ofaNotary)
Name: N1 Ct_hd 0
(Legibly Printed)
(AFFIX OFFICIAL SEAL)
• - Notary Public, State of �t O(L
MABEL LAGO
.'o '� Notary Public-State of Florida
_; gay«.•- My Comm.Expires Feb 13,2019 1 Commission No.:
'- '-':',,*_..._1111--.,_4,7•? Commission#FF 169752
,°; Bonded through National Notary Assn.s'
Page-15-
Bond No.929610821
ATTEST: SURETY:
16x9
Western Surety Company
(Printed Name)
333 Wabash Ave
Chicago,IL 60604
(Business Address)
4,11 (14441, See Below
(Authorized Signature)
Witness as to Surety
(Printed Name)
Ge7,..e21P. -t__.) dt0-11---;-1--) OR
reu./....4 A - /A0,A?,L.PC
As Attorney in Fact Paul A.Locascio,Attorney-In-Fact&Fla.Resident Agent
(Attach Power of Attorney) .
Witnesses
1110 NW 6th Street
Gainesville,FL 32601 •
(Business Address)
Paul A.Locascio
(Printed Name)
352-374-7779
(Telephone Number)
STATE OF Florida
COUNTY OF Alachua
The foregoing instrument was acknowledged before me this 24th day of February 20 16 . by
Paul A.Locascio as Attorney-In-Fact of Western Surety Company
, Surety, on behalf of Surety. He/She is personally known to me OR has producedPersonalIv known
as identification and who did (did not)tak an oath.
My Commission Expires: Ltcq'
(Signature of Notary)
Name: Rebekah Wolf
(Legibly Printed)
(AFFIX OFFICIAL SEAL)
Notary Public, State of Florida
ANvdwol33NvanSMna Commission No.: FF 243374
H9fOaH1 OIONOB VOIdOb 1
6FOZ'ST lsn$ny S3aidX3 do aryls`
Mend .
VLE£PZ 11#NOISSIWWOD AMON ri
d1OM Hd)138321 `��"
Page-16-