Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Backup Documents 07/09/2019 Item #16C10
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16 C 10 THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW**ROUTING SLIP Complete routing lines#I through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing_lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. 2. 3. County Attorney Office County Attorney Office SRT 7/29/19 4. BCC Office Board of County Commissioners 5. Minutes and Records Clerk of Court's Office PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Tim Sivert/PUD Contact Information 239-252-5376 Contact/Department Agenda Date Item was July 9, 2019 Agenda Item Number 16C10 Approved by the BCC I2G3Type of Work Order under Request for Quotation Number of Original 1 Document Attached No. 15-6469-5 to Wells& Water System, Documents Attached Inc.,under Project Number 70085,to condition and treat twelve production wells in the Golden Gate Wellfield. PO number or account N/A number if document is to be recorded 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 STAMP OK SRT 2. Does the document need to be sent to another agency for additional signatures? If yes, SRT 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 SRT 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 SRT 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 SRT 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 SRT signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip SRT should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 07/9/2019 and all changes made during SRT the meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes, if applicable. 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 \0 Chairman's signature. 16C10 Ann P. Jennejohn From: Ann P.Jennejohn Sent: Monday,July 29, 2019 12:12 PM To: S ivertTo m Subject: Item#16C10 (7-9-19 BCC Meeting) Attachments: Backup Documents 07_09_2019 Item#16C10.pdf Good Morning Tom, Avt executed copy of Agenda Item #16C1o, from the Board's July q, 201q Meeting is attached for your records. Thank you. Ann Jennejohn Irilir' BMR Senior Deputy Clerk Clerk to the Value Adjustment Board Office:239-252-8406 Fax:239-252-8408(if applicable) Ann.Jenneiohn@CollierClerk.com Office of the Clerk of the Circuit Court &Comptroller of Collier County 3299 Tamiami Trail,Suite#401 Naples, FL 34112-5324 www.CollierClerk.com 1 16C10 WORK ORDER/PURCHASE ORDER ('contract #15-6469"Well Drilling,Testing and Maintenance" Contract Expiration fate: November 13,2019 This Work Order is for professional services for work known as: Project Name: Acidification of Twelve Wells(.G Wellfield Phase 3/ Project No: 70085.19.2/ The work is specified in the proposal dated May 22,2019 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: WELLS& WATER SYSTEMS INC. Scope of Work: As detailed in the attached proposal and the following: * 'Task I Perform all work as described in the RF)and as listed on the quote list. Bid Item A.I- A.14 * Task II Allowance Bid Item A.15 Schedule of Work: Complete work within 14(1 days from the date of the Notice to Proceed which is accompanying this Work Order. The Vendor agrees that any Work Order that extends beyond the expiration date of Agreement 1115-6469/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); ® Negoti/ated Lump Sum (NLS) 0 Lump Sum Plus Reimbursable Costs (LS i-RC)® Time & Mateial (T&M) 0 Cost Plus Fixed Fee (CPFF), as provided in the attached proposal. Task I $377,608.00 (NI,S) "Task II $20,000.00 (T&M)✓ TOTAL FEE S397,608.00 1 PREPARED BY: osigo°' A�` ? I 1 Toi • Sivert, Senio \Project.Manager Date V� 16C1 () nl I ROvl;u 13Y: Ben Bullert, Principal Project Manager Date AI>I>ItoVl1) I;Y: 611/462-6kq1) 9 'I' m Chmelik, EPMI) Director Date APPROVED BY: ! 5/ c4) Pam I,ihby, Water I)i gution Manager Date APPROVED BY: 51.3i11? Set Johnssc , In-Ground Services Directo I ate { APPROVE) BY: ,.•��• ��"�/�•Joe I ellon', erations Support Director 4-11 te APPROVED BY: 5111/7 Dr. eorge Yilmaz, blic Utilities Administrator Date Ik 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: WELLS& WATER SYSTEMS INC `I ik - I,) yr hlfiei" J </ / 7 'r Robert J. Kohlmeier, President Date 16 C1{ IN WI'T'NESS WI II ftI?OF, the parties hereto, have each, respectively, by au a►►thorir.ed person or agent, have executed this Work Order on the date and year First written below. A'I"fI?S"I': BOARD OF('O1IN'l'Y COMMISSIONERS Crystal K Kintel> Interim Clerk C01.1,11?R COUNTY I,ORII)A By:,:- - . - . ' .' 14280...d0 'e-- • Ily: (---1") 111/ v-• -.or_ Ad. {egg gi' i4''."! r.4if,S William/'.. McDaniel, Jr., Chairman f ons (4415)., R.ct ' ib iN1lV'' Name of Firm Wells& Water Systems. Inc. t __L V64 ( ( liy• First/ itne s Signature '01'.1' 1-__..) )',i'J di,Akiici ,_�',r1 .,', t /_r"'lel,/11 ,/ /(l/ TType/print signature and titlet T'I'ype/print witness namet Second Witness ,,F., ,1 :' : L ;,L . ( I T•I'ype/print witness nameT Ap -- . as to Form and t egality: V -/Z--------- lir 'ounty Attorney GAVT_f 7�L. Print Name Item# 111C-10 Agenda deletlc( Date Date i ...241..idk Reed ` DaIJ 0 I 6 C10 Date: Monday May 13th, 2019 From: Patrick Boyle, Operations Analyst Comity 239-252-8941, Telephone Number iiatrick.noyle colliercounlyll.gm Administrative Services Department Procurement Services Division To: Potential Quoters REQUEST FOR QUOTATIONS FOR MULTIPLE PROJECTS UNDER CONTRACT I!) Al Huta' Contract for Weil Testinq, Drillin9 Selected Vendors: Yountiquisi Layne Christensen / Wells and Water Naples Well Drilling/ All Webbs As provided in the referenced contract, the County Division is soliciting quotes for the referenced project. Project • RFQ 15-6469-5 ACIDIFICATION OF TWELVE PRODUCTION WELLS IN GG WELLFIELU RFQ Due Date: Wednesday, May 22nd, 2019 at 3:00 PM Q&A Deadline: Monday, May 20th, 2019 at 5:00 PM Number of Days to Final Completion: 140 days total Contractor will be able to work on 2(two)wells at a time and possibly 3(three)if raw water demand allows. Scope Provided Yes Plans and Specs: Yes Liquidated Damages: $200.00 per day Payment & Performance Bonds If over $200,000.00 Your quotation response for this project is due electronically to the Email address listed above no later than the date and time specified above. We will not accept any quotation responses later than the noted time and date. If your firm is unable to respond electronically, please contact Procurement Services Division at the address below. Wells &Water Systems, Inc Firm's Complete Legal Name (239) 872-5955 Telephone Number/Fax Number (ober/ WO filmier Signature President rjk@floridadriller.com Title Robert J Kohlmeier 5/22/2019 Print Name Date cc: Tom Sivert, Senior Project Manager •3295 Tamiami Trait East Naples FL 34112•Patrick.bg_yle@colliercotintyflov•239-252-8941 • = v-i C..) IC OM , , I 2 -;'s• f..,,, l,d, 2 fil 2 2 2 .1 ,,1 8 8 e:', .1, 5". •w$ ty La i.„; 1 I ..,7 irl ....1. .q ',/ (/ C•4 4 1 ' 17,7 '4;1 't .1 Vir N: . 1 "It .11 1 i --.--^ , '1 •• 2 7 4 .5 1 1 1 k E t L t I t 1--; .S" I. % 5 .,,k, I 1 1tt U) 4.4 U) U) U) U) to ch ch ch U) (fl 1/.1 o ' lli 1 111 J1 g :, t.:, r...... :, .,-, Ogie L 15 ...._ . • - 4 W, t g t' E i — .6 i .. (1) k vt' 1 111 L a 0 13 15 i 1 F E m , t a), o I a 8 th - , t\ ti 1 f .. or), 0 co ...... .o 4 4 1 1 li N iiT N, 1? at 51 "0 rtt.- g ."' 1'1 22 N N .- 12' i E ,-) o as a' a 0 1 r' 5 'P 'g -7, l L.L. -0 c ' i F.' e- vci E vo 4/ at r0 •— L_ ri Ac A .. 0 - F w .1" 0 _se (L) C •—. .e "0 I-- -- ._ . . 1 1 la 4 IP F t 1 zq 2: It I `" (1 . ,, a , (0 0 ci) = a 6 et 1 1A61 1 • 0 g' 6 6 w EE) p „ „„. ...... 3 4, = 1... Lii : 2 '.4-: ... All' tit ff. 44 i ›., 0 .0 in a v T - " S ii i T, I h 4 9 a ii, hy 5 'CO 0 0 ul 1 i F13 g ,0 V N t.i 43 § 9 t - i .L.- rcti 9 •,r13 ,-, ttEX1 ca c o c`i <-- McoFR .1 ..-',15 i i "`• M %,../ r-- 0 is E to Z V, ti 13 h, V 1 Egli =1 'g g t 0 ..1 t E g i vE .4 ETwaP. -t, r s 4 ' 'A ,t2 I iiga'. 14 6 cn c.) 1 1 .. C.1 v. 1,1• 10 Ca t, co a• 9. •-• " 4") :4- '41 to o 76 .,_03 :si •Ir. .x .1- •-4 -t 4 4 4 4 :e rri •*Te :e .i ..1. - ' r- Ce (_) Z 6 co 0_ __.......... 41)) 16C1U r -ATA Document A3� 0 M — 2010 Bid Bond CONTRACTOR: SURETY: (Name, legal stains and address) (Name, legal statue and principal plum Wells&Water Systems, Inc. rdhnslnt'ss) 15761 Country Court Merchants National Bonding Inc,P.OThis document has important legal Fort Myers, Florida 33912 Des X io8 consequences.Consultation with Des Moines,Iowa 50306 OWNER: an attorney is encouraged with (Name, legal villas and address) respect to its completion or Collier County modification. 3301 Tamiarnl Trail East Any singular reloretico to Naples, Florida 34112 Contractor,Surely,Owner or BOND AMOUNT: Five Percent(5%) of Amount Bid other party shall be considered plural where applicable. PROJECT: (Name, location or address.and Project number. daisy) Acidification of Twelve Production Wells in GG Wellfield I RFQ 15-6469-5 The Contractor and Surety arc bound to the Owner in the amount set forth above,for the payment of which the Contractor and Surety bind themselves,their heirs,executors,administrators,successors and assigns,jointly and severally,as provided herein.The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the hid documents,or within such time period as may be agreed to by the Owner and Contractor,and the Contractor either(I)enters into a contract with the Owner in accordance with the terms of such bid,and gives such bond or bonds as may he specified in the bidding or Contract Documents,with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner,kir the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof;or(2)pays to the Owner the difference,not to exceed the amount of this Bond,between the amount specified in said hid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid,then this obligation shall be null and void,otherwise to remain in full force and effect.The Surely hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid.Waiver of notice by the Surety shall not apply to any extension exceeding sixty(60)days in the aggregate beyond the time for acceptance of bids specified in the bid documents,and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty(60)days. if this Bond is issued in connection with a subcontractor's bid to a Contractor,the term Contractor in this Bond shall be deemed to he Subcontractor and the term Owner shall be deemed to he Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall he deemed incorporated herein. When so furnished,the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. Signed and ogled this , 22nd clay or May, 2019 f,,,. :. , ,) r r V./ Wells&Water Systems, Inc. �' ' (I nm:pul)rap I ) Anhlntll T (,S'rr1) ( r - ',, ('fill') { it Merchants National Bonding Ito , lot> - - (Title) orl ,dy L. Hingson,Attrirney-in-Fact andf da Resident Agent(2.19)275-8226 tett MA Document A310,"-2010.Copyright 0 t963,1970 and 2010 by The American Institute of Architects.All rights reserved.WARNING:ibis—Alit. Document is protected by U.S.Copyright taw and International Treaties.Unauthorized reproduction or distribution of this AIA'Document,or any portion of It.may result in severe civil and criminal portables.and will bo prosecuted to the maximum extent possible unNor the law.This / document was created on 01/27/2012 07:23:12 under the terms of AIA Documents-on-Demand'"order no. 2008397493,and is not for resale.This document is licensed by The American institute of Architects for onetime use only,and may not be reproduced prior to its completion.cc Ito 16 C10 M.E RC.EL i s._.__ BONDING COMPANY. POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC., both being corporations of the State of Iowa(herein collectively called the"Companies")do hereby make,constitute and appoint,individually, Alan P Chandler;Ian J Donald;Jeffrey A Chandler;Kathleen M Irelan;Robert Trobec;Susan I Small;Wendy L Hingson their true arid lawful Attorneys)-in-Fact, to sign Its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings. contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law, This Power-of-Attorney is granted and Is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company(Mutual)on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding,Inc.,on October 16,2015. "The President, Secretary,Treasurer,or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys-In-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto,bonds and undertakings,recognizances,contracts of Indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company,and such signature and seal when so used shall have the same force and effect as though manually fixed.' In connection with obligations In favor of the Florida Department of Transportation only,it Is agreed that the power and out hority hereby given to the Attorney-In-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations In favor of the Kentucky Department of Highways only,it is agreed that the power and authority hereby given to the Attorney-In-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner- Department of Highways of the Commonwealth of Kentucky at least thirty(30)days prior to the modification or revocation. In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 6th day of April , 2017 . .r•..n.,,,� •.••' 0.N. :4 NG Cp••. ,, ,.....,l • e.• • gy• p\. .. MERCHANTS MERCHANTS BONDING COMPANY(MUTUAL) lc) •y �' .cs, 9N��y�; MERCHANT NATIONAL BONDING,INC. *72:' -o- 0:0: •►vs:,,' -o- r^; • 2003 ,:;,041' :y,` 1933 : By President STATE OF IOWA •••.••'nu.•••••• •••.. COUNTY OF DALLAS ss. On this this 6th day of April 2017 ,before me appeared Larry Taylor, to me personally known,who being by me duly sworn did say that he Is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING. INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies;and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. •9irk1A( AUCIA K.GRAM o v Commission Number 767430 z My Commission Expires bye' April 1,2020 Notary Public (Expiration of notary's commission does not invalidate this Instrument) I,William Warner,Jr.,Secretary of MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,do hereby certify that the above and foregoing Is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies,which Is still In full force and effect and has not been amended or revoked. In Witness Whereof,I have hereunto set my hand and affixed the seal of the Companies on this 22nd day of May 201.9 •••..,,A10 ,/' ••_tog COM•.• CS; ;d 1933 :• .: Secretary .v 2003 y • POA 0018(3/17) • .•'"'t...... • •, 0 Client#: 63870 WELWAI DATAMrD/f44 A CORDTM CERTIFICATE OF LIABILITY INSURANCE 5/31/2019 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 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). PRODUCER NAME CT Guadalupe Gonzalez Gulfshore Insurance- SWFL PHONEo,Ext): No): 239 435-7135 FAX 239 213-2803 (AIC,N (AIC, 4100 Goodlette Road N a��Ress: GGonzalez@Gulfshoreinsurance.com Naples,FL 34103 INSURER(S)AFFORDING COVERAGE NAIC# 239 261-3646 INSURER A Cincinnati Insurance Company 10677 INSURED INSURER B:Lancer Indemnity Company 38148 Wells&Water Systems Inc. INSURER C: 15761 Country Court Fort Myers,FL 33912 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A GENERAL LIABILITY X X ENP0531160 06/02/2019 06/02/2020 EACH OCCURRENCE $1,000,000 PREMI X COMMERCIAL GENERAL LIABILITY SS(lroNccTuErence) $500,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $10 000 X PD Ded:500 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X !ECT LOC $ A AUTOMOBILE LIABILITY X X ENP0531160 06/02/2019 06/02/2020 CEaOMaccident)BINED SINGLE LIMIT $1,000,000 ( X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS X HIRED AUTOS X NON-OWNED PROPERTY accident) DAMAGE $ _ AUTOS X Drive Oth Car $ A x UMBRELLA LIAB X OCCUR ENP0531160 06/02/2019 06/02/2020 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION$0 $ B WORKERS COMPENSATION X 10419 06/02/2019 06/02/2020 X WORYTLITAWS F- ANO EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Wells&Water Systems License#2352 For any and all work performed in Collier County; Collier County Board of County Commissioners is included as Additional Insured for on a primary and noncontributory basis with regards to General Liability only as required by written contract per form GA233 0207,including Waiver of Subrogation,ongoing and completed operations.Additional Insured in regards to (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Collier CountyBoard of CountySHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 3295 Tamiami Tri E Naples,FL 34112 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1429474/M1427316 GMG17 CA DESCRIPTIONS (Continued from Page 1) 16 C 10 Auto Liability only as required by written contract per form CA7171 0508.Waiver of Subrogation in regards to Workers Compensation only as required by contract per form WC000313 0484.Umbrella Follows Form. 1 SAGITTA 25.3(2010/05) 2 of 2 #S1429474/M1427316