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Backup Documents 06/08/2021 Item #16C 2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP i C 2 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. .\[tacit to original document. l he completed routing slip and original documents arc 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 he received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 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 routinpzlines#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 6/8/21 4. BCC Office Board of County Commissioners .....Ncy3) 646 tA 5. Minutes and Records Clerk of Court's Office pc6 121 Q '— AVA 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 Tom Sivert/PUD Contact Information 239-252-5376 Contact/Department Agenda Date Item was June 8,2021 Agenda Item Number 16-C-2 Approved by the BCC Type of Document Work Order in the amount of$457,680,pursuant Number of Original 1 Attached to a Request for Quotation under Agreement No. Documents Attached 14-6213 to Douglas N.Higgins,Inc.,and to authorize the necessary budget amendment for the NCRWTP Surge Control System PO number or account 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 N/A 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 TS signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 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 TS 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 TS signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip N/A 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 06/8/2021 and all changes made during TS [//i is not the meeting have been incorporated in the attached document. The County Attorney's option for Office has reviewed the changes,if applicable. s line. 9. Initials of attorney verifying that the attached document is the version approved by the BCC, A is not ' all changes directed by the BCC have been made,and the document is ready for the ` option for Chairman's signature. s line. r- 16C Z WO1U(O1U)I.It/PUJtCHASI ORl)I:It Cont-net 1114-6213"UNJ)ERGIROUND UTILITY CONTRACTING" Contract Expiation Late;July 4,2(121 This Work Order is for professional set vices for work known fist 1'rojectNamo;NCI1WTP Surge Control System Project No;71066,3,1,2 Tito work is specified in the proposal dated April 7,2021 which is attached hereto and made a part of this Work Order, In accordance with Terns and Conditions of the Agreement referenced above, this Work Order/Purchase Order Is assigned to pouttlns Ni Ili�tdns,Inc, $cope of Work;As detailed in the attached proposal and the following; a Task I Perform nil work as described in the 1U Q and ns listed on the Quote Form,Items 1-9 4' '1'nsk II Owner's Altowmnco,Quote Form Item 10 Schedule of Work; Complete work within 270 days from the date of the Notice to Proceed which Is accompanying this Work Order,The Vendor agrees that any\Volk Order that extends beyond the expiration date of Agreement II14-6213 will survive and remain subject to the terms and conditions of thnt Agreement until the completion or termination of this Work Order, Componsntiont.In accordance with the Agreement referenced above,the County will compensate the Firm in accordance with following method(s); t9 Negotiated Lump Sum(NLS)0 Lump Stun Plus Reimbursable Costs(LS•t RC)(Si Time & Muterial (T&M) O Cost Plus Fixed Pee(CPR), as provided in the attached proposal. 7'nsk I $407,680,00 (NLS) Task 11 $50,000.00 (T&M) TOTAL FELL S457,680,00 —14/ PRUI'ARtil)BY:Thin Siveil, P.L.,Senior Project Manage , tie.,/ 0413202/ r )I 2 12i /�. .�' 04/16/2021 ROVED AI i BY:� _ Benjamin Bullert,Principal PM Dote Ch m e l i kTo m Digitally signed by ChnlelikTem APPROVED By: Dote:2021.04.19 10.28 41-04'00' Tom Chmelik,I'UEPMD Dhcctor Date APPROVED BY: llo old Bt'ogdol,Plant Malinger f Dot APPROVED BY: 91 ZOO 1 Save essner,Wa or hector D to Digitally signed by Joseph Joseph Bellone Bellone APPROVED BY: Date:2021.04.1912:11:41-04'00' Joseph Bellone,Operations Support Director Date Digitally signed by Joseph Joseph Bellone Bellone APPROVED BY: Dale:2021.04.1912:12.04-04'00' Dr.George Yilmaz,Public Utilities Administrator Date By the signature below,the Firm(including employees,officers end/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(finnneinl,contractual,organizotionnI,or otherwise)which relates to the proposed work;and bear on whether the Firm has a potential conflict have been filly 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 end/or project duration. ACCEPTED BY: Douglas N.Iligghls INC Dotc: 7 / (tq P 16C 2 ATTEST: BOARD 0 alai TY COMMISSIONERS Crystal K. Kinzel, Clerk of Courts COLLIER ► Y, FLORIDA &Comptroller , By "� By: 01641- Penny Taylor,Chairperson Dated: V one, �fl AtteVas i Chairman's signature only. Approv to fora Id gal ii By: L--- R. each Deputy County Attorney (:AU 16C 2 Date: March 18, 2021 From: Tom Sivert, P.E., Sr. PM ,: 252-5376, Telephone Number Coale' Tom.sivert@colliercountyfl.gov Public Utilities Department Engineering and Project Management Division To: Potential Quoters REQUEST FOR QUOTATIONS FOR MULTIPLE PROJECTS UNDER CONTRACT 14-6213 "Underground Utility Contractors" Selected Vendors: Mitchell & Stark Construction Co., Inc. Haskins, Inc. DN Higgins, Inc. Quality Enterprises As provided in the referenced contract, the County Division is soliciting quotes for the referenced project. Project NCRWTP Surge Control System RFQ Due Date: April 7, 2021 at 3:00PM Q&A Deadline: April 2, 2021 at 5:00 PM Pre-Bid Meeting NA Number of Days to Sub/Final Completion: Substantial: 240 Days Final:270 Scope Provided Yes Plans and Specs: Yes fi Liquidated Damages: $1170.00 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, your quotation must be received in the office of the Public Utilities Engineer & Project Management at the below referenced address no later than the time and date specified. We look forward to your participation in this request for information/quotation process. Douglas N. Higgins, Inc. Firm's Complete Legal Name 239-774-3130/239-774-4266 Tel hone Number/Fax Number 4, ( _-.- ignature Vice President Title LG ?I �iC't./ft�t S 4/7/21 1. Print Name 9(r Date cc: TAS, Senior Project Manager Public Utilities Engineering&Project Management Division•3339 Tamiami Trail East,Suite 303•Naples,Florida 34112 i6C Solicitation No: 14-6213 Soliclation Title: North County Regional Water Treatment Plant(NCRWTP)Surge Control System Bid Due Date: 4/7121 QUOTE SCHEDULE Collier County Public Utilities Department Project No.70136.2.2.1 BIDDER; oo,las N.wsam.i�c. t1 BASE BID:Includes all items described in the Summary of Work and as shown in the attached Drawings and Specifications with no substitutions or limitations. ITEM DESCRIPTION UNIT COST UNIT TOTAL MISCELLANEOUS ITEMS: 1 Mobllization/Demobilization(not more than 5%per Section 01 20 00) $22,000.00 LUMP SUM $22,000.00 2 Record Drawings $5,000.00 LUMP SUM $5,000.00 SUBTOTAL-ITEMS 1-2 $27,000.00 NORTH COUNTY REGIONAL WATER TREATMENT PLANT(NCRWTP) 3 Site Work at NCRWTP 1158,680.00 LUMP SUM $158,680.00 4 Surge System Installation at NCRWTP $140,000.00 LUMP SUM $140,000.00 5 Electrical at NCRWTP $62,000.00 LUMP SUM $62,000.00 6 Startup and training at NCRWTP $10,000.00 LUMP SUM $10,000.00 7 Disinfection at NCRWTP $5,000.00 LUMP SUM $5,000.00 8 Commissioning at NCRWTP $5,000.00 LUMP SUM $5,000.00 SUBTOTAL•ITEMS 3.8 $380,680.00 9 Owners Allowance(Time fi Materials) TIME 8 MATERIALS $50,000.00 IOPAL BID PRICE $457,680.00 NOTES: (1) Failure of the bidder to provide information in ALL of the boxes above may result in the bid proposal being considered non-responsive and rejection of the bid proposal. Zero (0)is considered a valid response,but a blank is not. (2) Owners Allowance-for Owners Use as Directed.This Allowance will be used only at the Owner's direction to accomplish work due to unforeseen conditions and/or as directed by the Owner.Inclusion of the Allowance as part of the Contract Price is not a guarantee that the Contractor will be paid any portion or the full amount of the Allowance. Expenditures of Owners Allowance will be made through Change Order with proper documentation of Time and Materials supporting the change ( 0 1 6 C 2 • EXHIBIT A . PUBLIC PAYMENT BOND Bond No, 35BCSAQ4400 • Contract No, 14-6213 KNOW ALL MEN BY THESE PRESENTS: That Douglas N. Higgins, Inc. , as Principal, and Hartford Accident and Indemnity Company , as Surety, located at One Hartford Plaza,Hartford, ._GT 06115 (Business Address) are held and firmly bound to Board of County Commissioners Collier County,Florida as Oblige In the sum of Four Hundred Fifty Seven Thousand,Six Hundred Eight 457,680,00 ) 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 14t1day of April , 2021, with Oblige for NCRWTP Surge Control System,Project No•711)66 14 9 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 Surete_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. IN WITNESS WHEREOF, the above parties have executed this instrument this 14thday of April , 20 21 , the name of under-signed representative, pursuant to authority of its governing body. Signed, seale and delivered in the_pr en e of: PRINCIPAL; Douglas N.Higgins,Inc. ) ./ kfc."1,..„...,--". Wltnes`ses as to Principal Name: RRelly'IA. Wilkie Its: Vice—President • STATE OF Michigan COUNTY OF Wash.t_enaw The foregoing instrument was acknowledged before me this 14th of April 2021 by Kelly A. Wilkie , as Vice—President of Douglas N. Higgins, 1rac. Michigamorporation, on behalf of the corporation. He/she is personally known to me OR has produced personally known as identification and did (did not) take an oath. I My Commission Expires: \ ) (Signture qr otary) Name: David J. Wilkie (Legibly Printed) . (AFFIX OFFICIAL SEAL) Notary Public, State of Michigan Commission No•: N/A DAVID J.WILKIE J Page-12- Notary Public,Michigan County of Washtenaw My Comm. Expires 05/20/2024 16 C 2 ATTEST: SURETY: • Hartford Accident&Indemnity Company (Printed Name) One Hartford Plaza Hartford,CT 06115 (Business Address) (Authorized Signature) Witness as to Surety (Printed Name) OR As Attorney in Fact 1 — 6- (Attach Power of Attorney) Witnesses -�---�a_... �,(� • ���U Gam..-�-,-�.. 24 Frank Lloyd Wright,Drive,Snite J4100 Ann Arbor MT 4R105 • (Business Address) Kristie A.Pudvan,Attorney-in-Fact (Printed Name) FL Non-Resident Agent License No.W523460 734-662-1154 (Telephone Number) STATE OF Michigan COUNTY OF Oakland acting in Washtenaw The foregoing instrument was acknowledged before me this 14th day of April 20 21 , by Kristie A.Pudvan , as Attorney-in-Fact of Hartford Accident&Indemnity Company , Surety, on behalf of Surety. He/She is personally known to me OR has produced personally known as identi!cation and who did (did not) taka 1`o>3th. My Commission Expires: 5 a.1-3 t r i �j 1,� • ' t (Signature o,Notary) Name: Lisa M.Wilmot (Legibly Printed) (AFFIX OFFICIAL SEAL) Notary Public, State of Michigan Commission No.: N/A LISA M WILMOT Notary Public-Michigan 4 Oakland County My Commission Expires Iy1a 22, 021 Acting in the County of11a„►• Page-13- t 6 E EXHIBIT A-2 PUBLIC PERFORMANCE BOND Bond No. 35BCSAQ4400 Contract No. 14-6213 KNOW ALL MEN BY THESE PRESENTS: That no„gias N Higg ns.Tnlr , as Principal, and Hartford Accident and indemnity Company , as Surety, located at One Hartford Plaza.Hartford.CT 06115 (Business Address) are held and firmly bound to Board of County Commissioners Collier County.Florida , as Oblige in the sum of Four Hundred Fifty Seven Thousand,Six Hundred Eighty ($ 457f,R0 nn ) 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 14th day of April , 20 21, with Oblige for NCRWTP Surge Control System,Project No.:71066.34.2 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- 16C 2 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 14th day of April , 20 21 , 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 Douglas N.Higgins,lnc. in the pre e of : PRINCIPAL: g 7 ---, /-'1-7 By: � r 1� t .; Witnesses as to Principal Name: Kelly A.-'Wilkie Its: Vice-President STATE OF Michigan COUNTY OF Washtenaw The foregoing instrument was acknowledged before me this 14th day of April 20121 , by Kelly A. Wilkie , as Vice-President of Doug]as N. Higgins, Inc. , a Michigan corporation, on behalf of the corporation. He/She is personally known to me OR has produced p rsonally known as identification and did (did not) take an oath. My Commission Expires: 05/20/2024 ` vk (Signatur( f Notary) • Name: David J. Wilkie (Legibly Printed) (AFFIX OFFICIAL SEAL) Notary Public, State of Michigan Commission No.: N/A DAVID J.WILKIE Notary Public,Michigan County of Washtenaw My Comm.Expires 05/20/2024 l' ' 1 Page-15- 16C 2 ATTEST: SURETY: Hartford Accident and Indemnity Company (Printed Name) One Hartford Plaza Hartford CT (16115 (Business Address) (Authorized Signature) Witness as to Surety (Printed Name) , ----A-A4---t—s.) .., A_ P...,..., \c.,e,,,. As Attorney in Fact (Attach Power of Attorney) Witnesses 24 Frank Lloyd Wright Dr..Suite J4100 Ann Arbor,MI 48105 (Business Address) Kristie A.Pudvan,Attorney-in-Fact FL Non-Resident License No.W523460 (Printed Name) 734-662-1154 , (Telephone Number) STATE OF Michigan COUNTY OF Oakland acting in Wachtenaw The foregoing instrument was acknowledged before me this 14th day of April , 20 21 , by Kristie A.Pudvan , as Attorney-in-Fact of HartfordAccident and Indemnity Company , Surety, on behalf of Surety. He/She is personally known to me OR has produced Personally Known - as identification and who did (did not) take an oath. A My Commission Expires: 1-, ,?,7 -) ('� _ ti -' tAA :IL ; '(Signat re of Notary) Name: Lisa M.Wilmot - (Legibly Printed) (AFFIX OFFICIAL SEAL) Notary Public, State of Michigan Commission No.: N/A - III, �. *� -' A ,� LISA M WILMOT ) Notary Public - Michigan Oakland County j My Commission Expires May 22, 2021 Acting In the County of Li}ra(ti--c=rti (`,� II '�i Page-16- 1 6 C 2 Direct Inquiries/Claims to: /y O_ y THEBOND,T-12 HARTFORD POWER �� N 1TO it ;\ tl�! HartfOne Hartrd ord,Conn e 1cu106155 r ..sty 1 t.,ttii€ a:'ill^['»Sti fl t.'I.t'3-1 call:888-265-348B or fax:860.757.5835 KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: HYLANT GROUP INC/ANN ARBOR � encyCode: 35-350851 ------- X Hartford Fire Insurance Company,a corporation duly organized under the laws of the State of Connecticut X Hartford Casualty Insurance Company,a corporation duly organized under the laws of the State of Indiana X Hartford Accident and Indemnity Company,a corporation duly organized under the laws of the State of Connecticut Hartford Underwriters Insurance Company,a corporation duly organized under the laws of the State of Connecticut Twin City Fire Insurance Company,a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of Illinois,a corporation duly organized under the laws of the State of Illinois Hartford Insurance Company of the Midwest,a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of the Southeast,a corporation duly organized under the laws of the State of Florida ----- having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the"Companies")do hereby make, constitute and appoint, up to the amount of Unlimited : Susan E. Hurd, Vicki S. Duncan, Terri Mahakian, Monica M. Mills, Kristie A. Pudvan, Joel E. Speckman, Lisa M. Wilmot of ANN ARBOR, Michigan their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(les) only as delineated above by ®, 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. In Witness Whereof,and as authorized by a Resolution of the Board of Directors of the Companies on May 6,2015 the Companies have caused these presents to be signed by Its Senior Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant Secretary. Further,pursuant to Resolution of the Board of Directors of the Companies,the Companies hereby unambiguously affirm that they are and will be bound by any mechanically applied signatures applied to this Power of Attorney. y hy7Y 44. ,eOkRi ..% 11T:. xF',itl�.:ri . . ",.-----.-r•.tip W 3oItY.r F `1 (p„, �e�,I...le..ri•i a 0..4P .... afret:4. co`l i *mar ^p i s 1 •� I .-. - 7 't • �•F1�' • },,' Fe.•t1 ,...7 ,•r ^%eot4B71 • /•ol+rw► : .197o , ,A. lN. 97a r` .„••s%9_ ,„_,.....722.-- tick, yi John Gray,Assistant Secretary M.Ross Fisher,Senior Vice President STATE OF CONNECTICUT ss. Hartford COUNTY OF HARTFORD On this 5th day of January,2018,before me personally came M. Ross Fisher,to me known,who being by me duly sworn,did depose and say: that he resides in the County of Hartford, State of Connecticut; that he is the Senior Vice President of the Companies, the corporations described in and which executed the above instrument; that he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals; that they were so affixed by authority of the Boards of Directors of said corporations and that he signed his name thereto by like authority. I vaTAlly e�c--Ci •V,.+� 11aq-r\-fVLC� • PUBLIC „ 0Kathleen T.Maynard Notary Public CERTIFICATE My Commission Expires July 31,2021 I,the undersigned,Assistant Vice President 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 Is still in full force effective as of A ,ai ( ( �i -o, Signed and sealed at the City of Hartford. - ' � .. ���,,yy ) q`1 1� ♦p4 ► Pr"°r t. uev�A3! F " 1 •�•� o�' 'f967 ' R1 t Y : 1 t .. • 4oI� : 19 1. 19' *• ` r'T ' ' ,''': . • .l •• :, Ate`../::-"v- , Kevin Heckman,Assistant Vice President rOA 21)1X _ 16C 2 ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) ‘"!e-^"� 4/14/2021 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 pollcy(ies)must have ADDITIONAL INSURED provisions or he 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 CONTACT Hylant Group Inc-Ann Arbor PHONE FAX 24 Frank Lloyd Wright Dr J4100 _(A/c No,Exn 1(Al :734-741-0044 Ne1734-741-1850 Ann Arbor MI 48105 A ADDDRDR E ESS: INSUREM)AFFORDING COVERAGE NAIC# INSURER A:Transportation Insurance Co 20494 INSURED HIGGI-5 INSURER B:Valley Forge Insurance Co 20508 Douglas N. Higgins, Inc. 3390 Travis Pointe, Suite A INSURER C:Continental Insurance Company 35289 Ann Arbor MI 48108 INSURER D:Allied World Assurance Co Inc(US) 19489 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:872148008 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDOIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y U1061922047 4/1/9091 4/1/7029 EACH OCCURRENCE S1,000,000 DAMAGE TO RENTED --^ ---.......... CI AIMS-MADE (I OCCUR PREMISES(Ea occurrence) $500,000 _______ X Ind XCU MED EXP(Any one person) _S 15,000 X Ind contractual PERSONAL&ADV INJURY $1000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $2,000,000 POLICY X PE� LOC ------_.,.__...... PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ _.....-__._.._.�._.�..__..-.— B AUTOMOBILE LIABILITY BUA1061922033 4/1/2021 4/1/2022 COMBINED SINGLE LIMIT $1,000,000 (Ea acciden0 -- X ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Par Accident) S AU IUS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Pet eccidenLI $ C X LIMBRELLALIAB X OCCUR U1061922050 4/1/2021 4/1/2022 EACH OCCURRENCE $8,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $8,000,000 DED I X I RETENTION S D S B WORKERS COMPENSATION WC7012265571 4/1/2021 4/1/2022 X STATUTE 0TH AND EMPLOYERS'LIABILITY YIN eR ANYPROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N NIA (Mandatory in NH) E.L.DISEASE•EA EMPLOYEE $1,000,000 If yes,describe under -- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Professional/ 0312-7992 4/1/2021 4/1/2022 2,000,000 Each Claim Pollution 4,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Job-NCRWTP Surge Control System,Project No.71066-34-2. Additional Insured for General Liability,primary and non-contributory,as required by written contract-Collier County Board of County Commissioners. A 30 day prior written notice of any Insurer Initiated cancellation,except non-payment of premium, will be given. A 10 day prior written notice will be given for non-payment. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Collier County Board of County Commissioners 3295 Tamiami Trail East AUTHORIZED REPRESENTATIVE Naples FL 34112 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016f03) The ACORD Hanle and logo are registered marks of ACORD