Backup Documents 11/08/2022 Item #16A 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
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 he 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 routing lines#1 through#2,complete the checklist,and forward to the County Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3 County Attorney Office County Attorney Office n / l+��ILL
4. BCC Office Board of County
Commissioners Lz',n7 #145I /( IS(?.Z
5. Minutes and Records Clerk of Court's Office / I
flotv
it 1 22— 1D:
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 Jaime Cook/GMD Development Review Phone Number 239.252.6290
Contact/ Department
Agenda Date Item was 11/08/2022 Agenda Item Number 16.A.4.
Approved by the BCC
Type of Document Excavation Performance Agreement Number of Original
Attached Documents Attached
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)
I. Does the document require the chairman's original signature? JC
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 JC
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 JC
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 JC
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 11/08/2022 and all changes made c' N/A is not
during the meeting have been incorporated in the attached document. The County an option for
Attorney's Office has reviewed the changes, if applicable. v this line.
9. Initials of attorney verifying that the attached document is the version approved by the N/A is not
BCC,all changes directed by the BCC have been made, and the document is ready for the d )O an option for
Chairman's signature. this line.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16A 4
MEMORANDUM
Date: November 16, 2022
To: Jamie Cook, Division Director
GMD - Development Review
From: Martha Vergara, Sr. Deputy Clerk
Minutes & Records Department
Re: Excavation Performance Agreement
Contractor: SD San Marino, LLC
Attached for your records is a scanned copy of the document referenced above, (Item
#16A4) adopted by the Board of County Commissioners on Tuesday, November 8,
2022.
The original document will be held in the Minutes and Record's Department for the
Board's Official Record.
If you have any questions, please feel free to call me at 252-7240.
Thank you.
Attachment
16A 4
EXCAVATION PERFORMANCE AGREEMENT
THIS EXCAVATION PERFORMANCE AGREEMENT entered into this Pth day of
Novcmbefi 2022 between SD SAN MARINO, LLC, a Florida limited liability company, hereinafter
referred to as "Developer," and the Board of County Commissioners of Collier County, Florida,
hereinafter referred to as the "Board".
WHEREAS, Developer has applied for an excavation permit in accordance with Section
22-106, et al. of the Collier County Code of Laws and Ordinances, and the Collier County Land
Development Code, including but not limited to Section 3.05.10 (collectively, the "Excavation
Regulations"); and
WHEREAS, the Excavation Regulations require the Developer to post appropriate
guarantees and execute an Excavation Performance Security Agreement stating applicant will
comply with the Excavation Regulations and Excavation Permit No. PL20210003121 (the
"Excavation Permit").
NOW, THEREFORE, in consideration of the foregoing premises and mutual covenants
hereinafter set forth, Developer and the Board do hereby covenant and agree as follows:
1. Developer agrees to comply with the Excavation Regulations and the Excavation
Permit (the "Excavation Work").
2. Developer herewith tenders its excavation performance security (attached hereto
as Exhibit"A" and by reference made a part hereof) in the amount of$134,911.20.
3. In the event of default by Developer or failure of Developer to complete the
Excavation Work within the time required by the Excavation Regulations and
Excavation Permit, Collier County, may call upon the excavation performance
security to insure satisfactory completion of the Excavation Work.
4. The Excavation Work shall not be considered complete until Developer notifies the
County that the Excavation Work is complete and the final Excavation Work is
reviewed and approved by the County Manager or designee for compliance with
the Excavation Regulations.
5. The County Manager or designee shall, within sixty (60) days of receipt of
notification by Developer in writing that the Excavation Work is complete, either: a)
notify Developer in writing of his approval of the Excavation Work; or b) notify the
Developer in writing of his refusal to approve the Excavation Work, therewith
specifying those conditions which Developer must fulfill in order to obtain the
County Manager's approval of the Excavation Work.
6. In the event Developer shall fail or neglect to fulfill its obligations under this
Agreement, upon certification of such failure, the County Manager or designee
may call upon the excavation performance security to secure satisfactory
completion, repair and maintenance of the Excavation Work. The Board shall have
the right to construct and maintain, or cause to be constructed or maintained,
pursuant to public advertisement and receipt and acceptance of bids, the
Excavation Work. The Developer, as principal under the excavation performance
1 6 A 1
security, shall be liable to pay and to indemnify the Board, upon completion of such
construction, the final total cost to the Board thereof, including, but not limited to,
engineering, legal and contingent costs, together with any damages, either direct
or consequential, which the Board may sustain on account of the failure of
Developer to fulfill all of the provisions of this Agreement.
7. All of the terms, covenants and conditions herein contained are and shall be
binding upon Developer and the respective successors and assigns of Developer.
IN WITNESS WHEREOF, the Board and Developer have caused this Agreement to be
executed by their duly authorized representatives this 8th day of November, 2022.
SIGNED IN THE PRESENCE OF: SD SAN MARINO, LLC
Sign: j;.1 ---- a Florid I' • ed ' bi ' ompany
1'rn re 9ct,'
Printed Na a Keith Gel , Vice President
Sign:&j -1
f ykL\ c ,A\c=Li
Printed Name
ATTEST: 1,;' r''''."Q:I BOARD OF COUNTY COMMISSIONERS
CRYSTALK. KINZEL,.CLERK COLLIER COI' f 'IDA
By: (- €). A ft- "fr
.X...
Attest -pti, I'1 Wi1 m L. McDaniel, Jr., Chairman
signature-only.L H 5 N'
Ap ved as to Form and Legality:
Derek D. Perry cL
le
Assistant County Attorney \20
coA
16A 4
Exhibit "A"
co
16A 4
Bond No. LICX1214757
PERFORMANCE BOND FOR EXCAVATION WORK
KNOW ALL PERSONS BY THESE PRESENTS: that
SD San Marino, LLC
2639 Professional Circle, Suite 101
Naples, FL 34119
(hereinafter referred to as "Owner") and
Lexon Insurance Company
10002 Shelbyville Road, Suite 100
Louisville, KY 40223
615-553-9500
(hereinafter referred to as "Surety") are held and firmly bound unto Collier County, Florida,
(hereinafter referred to as "County") in the total aggregate sum of One Hundred Thirty Four
Thousand Nine Hundred Eleven and 20/100 Dollars($134,911.20) in lawful money of the United
States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs,
executors, administrators, successors and assigns, jointly and severally, firmly by these
presents. Owner and Surety are used for singular or plural, as the context requires.
THE CONDITION OF THIS OBLIGATION is such that whereas, the Owner has submitted for
approval by the Board a certain excavation permit no. PL20210003121, and that certain
excavation permit shall include specific improvements which are required by Collier County
Ordinances and Resolutions (hereinafter "Land Development Regulations"). This obligation of
the Surety shall commence on the date this Bond is executed and shall continue until the date
of completion of the work and approval by the County of the specific improvements described
in the Land Development Regulations (hereinafter the "Guaranty Period") or until replaced by
a new bond in the event of a change of Ownership.
NOW,THEREFORE, if the Owner shall well,truly and faithfully perform its obligations and duties
in accordance with the Land Development Regulations during the guaranty period established
by the County, and the Owner shall satisfy all claims and demands incurred and shall fully
indemnify and save harmless the County from and against all costs and damages which it may
suffer by reason of Owner's failure to do so, and shall reimburse and repay the County all outlay
and expense which the County may incur in making good any default, then this obligation shall
be void, otherwise to remain in full force and effect.
PROVIDED, FURTHER, that the said Surety, for value received hereby, stipulates and agrees that
no change, extension of time, alteration, addition or deletion to the proposed specific
improvements shall in any way affect its obligation on this Bond, and it does hereby waive
notice of any such change, extension of time, alteration, addition or deletion to the proposed
specific improvements.
PROVIDED FURTHER, that it is expressly agreed that the Bond shall be deemed amended
automatically and immediately,without formal and separate amendments hereto, so as to bind
the Owner and the Surety to the full and faithful performance in accordance with the Land
Development Regulations. The term "Amendment," wherever used in this Bond, and whether
[21-EIS-04499/1645092/1] Page 1 of 3 ��,0
1 6 A 4
Bond No. LICX1214757
referring to this Bond, or other documents shall include any alteration, addition or modification
of any character whatsoever.
IN WITNESS WHEREOF, the parties hereto have caused this PERFORMANCE BOND to be
executed this 3rd day of August, 2022.
Witnesses: Owner:
&rYC.,40 11,14161 - SD San Marino, LLC
Signature
E, ,14 l 'J)\\3 .,k By:
Print Name ith Gelder, ice President
>— (Provide Pr er Evidence of Authority)
Signature d
t_42-7 C �r
Print Name
Notarial Acknowledgement
STATE OF FLORIDA
COUNTY OF COLLIER
The foregoing instrument was acknowledged before me by means ofX physical presence or
❑ online notarization, this '74 ' day of August 2022, by Keith Gelder as Vice President for
SD San Marino, LLC, whois personally known or ❑ has produced as
identification.
✓.111Vv 1?I
[sign ure of Notary Public]
[the Notary Public's official seal]
' 0-Cti•H\ t'1 se` 4)
[printed name of Notary Public]
4 1 JUDITH M SEALE
4 1' Notary Public•State of Florida
' ` Commission#HH 046417
oa'n. My Comm.Expires Sep 28,2024
,,,. Bonded through National Notary Assn.
[21-EIS-04499/1645092/1] Page 2 of 3 0
16A 4
Bond No. LICX1214757
Witnesses: G� Surety:
'� .T�1 11748 i(4LIQ Lexon Insurance Company
Signature J
Kelsy Hoagland By: ,g.,--47t)6- —
Print ame Susan Ritter, Attorney-in-Fact
d0(-6 (Provide Proper Evidence of Authority)
Sign ure
Lynnette Long
Print Name
Notarial Acknowledgement
STATE OF Kentucky
COUNTY OF Jefferson
The foregoing instrument was acknowledged before me by means of physical presence
this 3rd day of August, 2022, by Susan Ritter as Attorney-in-Fact for Lexon Insurance Company
who is personally known to me.
Theresa Pickerrell
NOTARY PUBLIC
-J<�k��,,, „ f ' STATE AT LARGE, KENTUCKY
1� /�"C/� ID#633720
[signature of Notary Public] MY COMMISSION EXPIRES OCT.26,2023
[the Notary Public's official seal]
Theresa Pickerrell
[printed name of Notary Public]
[21-EIS-04499/1645092/1] Page 3 of 3 O
16A 4
ko, SOMPO INTERNATIONAL
Acammemommi POWER OF ATTORNEY
11078
KNOW ALL BY THESE PRESENTS, that Endurance Assurance Corporation, a Delaware corporation, Endurance American Insurance Company, a Delaware
corporation, Lexon Insurance Company, a Texas corporation, and/or Bond Safeguard Insurance Company, a South Dakota corporation, each, a "Company" and
collectively,"Sompo International,"do hereby constitute and appoint: Brook T.Smith,Raymond M.Hundley,Jason D.Cromwell,James H.Martin,Barbara Duncan,
Mark A Guidry,Jill Kemp,Lynnette Long,Amy Smith,Deborah Neichter,Theresa Pickerrell,Beth Frymire,Leigh McCarthy,Michael Dix,Susan Ritter,Ryan Britt,Kelsy
Hoagland as true and lawful Attorney(s)-In-Fact to make,execute,seal,and deliver for,and on its behalf as surety or co-surety;bonds and undertakings given for any and
all purposes,also to execute and deliver on its behalf as aforesaid renewals,extensions,agreements,waivers,consents or stipulations relating to such bonds or undertakings
provided,however,that no single bond or undertaking so made,executed and delivered shall obligate the Company for any portion of the penal sum thereof in excess of the
sum of ONE HUNDRED MILLION Dollars($100,000,000.00).
Such bonds and undertakings for said purposes,when duly executed by said attorney(s)-in-fact,shall be binding upon the Company as fully and to the same extent as if
signed by the President of the Company under its corporate seal attested by its Corporate Secretary.
This appointment is made under and by authority of certain resolutions adopted by the sole shareholder of each Company by unanimous written consent effective the 15th
day of June,2019,a copy of which appears below under the heading entitled"Certificate".
This Power of Attorney is signed and sealed by facsimile under and by authority of the following resolution adopted by the sole shareholder of each Company by
unanimous written consent effective the 15th day of June,2019 and said resolution has not since been revoked,amended or repealed:
RESOLVED,that the signature of an individual named above and the seal of the Company may be affixed to any such power of attorney or any certificate relating thereto
by facsimile,and any such power of attorney or certificate bearing such facsimile signature or seal shall be valid and binding upon the Company in the future with respect
to any bond or undertaking to which it is attached.
IN WITNESS WHEREOF,each Company has caused this instrument to be signed by the following officers, and its corporate seal to be affixed this 15th day of
June,2019.
Endurance Assurance Corporation Endurance American Lexon Insurance Company .. Bond Safeguard
)l �, • `-/' Insurapce-+Company /y' Insurance Corgpany
By.,' 1 G / - By: {C 1. f �f�' By i- f�� By: f r l
Richard Appel;ay. &.. enior Counsel Richard Appel,;„S,VP.•&,Senior Counsel Richard Appel; __;,;.Senior Counsel Richard Appeln„SVP&,.senior'dounsel
PSSurance'. °,(jean►ps4r aNcFc,,,' ,Jop INSUR
C;G cc .6 g r� G °',al ��k i., �rR 1 AS,/; SOUTH 01,
.-; SEAL SEAL ;o W SEAL i DAKOTA O'
s 9', 2002 ; __ c%'. 1996 O e i,�, l 4 1 p', INSURANCE 'U
uj•,DELAWARE•'JO, s 7 DELAWARE.'a3,� i V i i' �1; G' , COMPANY
'•a.. un a
, ..,., a`' an••.,..,ro.u,••D' ACKNOWLEDGEMENT ��,F''':. ,n0,,,..,,,,,S
On this 15th day of June,2019,before me,personally came the above signatories known to me,who being duly sworn,did depose and say that he/ttiay'�`"ff onicer of each
of the Companies;and that he executed said instrument on behalf of each Company by authority of his offs under th by ws of each Company,:' f:'......."
O.
TE.0 SIE —
wrury
By. K PUlI
Amy aylor,Not ublic My Commissi n Expires 5/9/23,;
CERTIFICATE °Eyes:
I,the undersigned Officer of each Company,DO HEREBY CERTIFY that:
1. That the original power of attorney of which the foregoing is a copy was duly executed on behalf of each Company and has not since been revoked,amended or modified;
that the undersigned has compared the foregoing copy thereof with the original power of attorney,and that the same is a true and correct copy of the original power of
attorney and of the whole thereof,
2. The following are resolutions which were adopted by the sole shareholder of each Company by unanimous written consent effective June 15,2019 and said resolutions
have not since been revoked,amended or modified:
"RESOLVED,that each of the individuals named below is authorized to make,execute,seal and deliver for and on behalf of the Company any and all bonds,
undertakings or obligations in surety or co-surety with others: RICHARD M.APPEL,BRIAN J.BEGGS,CHRISTOPHER DONELAN,SHARON L.SIMS,
CHRISTOPHER L.SPARRO,MARIANNE L.WILBERT
;and be it further
RESOLVED,that each of the individuals named above is authorized to appoint attorneys-in-fact for the purpose of making,executing,sealing and delivering bonds,
undertakings or obligations in surety or co-surety for and on behalf of the Company."
3.The undersigned further certifies that the above resolutions are true and correct copies of the resolutions as o recorded and o,the whole thereof.
IN WITNESS WHEREOF,I have hereunto set my hand and affixed the corporate seal this g'"p"" day of .:f_i,- II 20-Lv!!
"""11111111q11111WI lie
By:
Danie S. arie retary
NOTICE: U.S.TREASURY DEPARTMENTS OFFICE OF FOREIGN ASSETS CONTROL(OFAC)
No coverage is provided by this Notice nor can it be construed to replace any provisions of any surety bond or other surety coverage provided. This Notice provides information concerning
possible impact on your surety coverage due to directives issued by OFAC. Please read this Notice carefully.
The Office of Foreign Assets Control(OFAC)administers and enforces sanctions policy, based on Presidential declarations of"national emergency". OFAC has identified and listed
numerous foreign agents,front organizations,terrorists,terrorist organizations,and narcotics traffickers as"Specially Designated Nationals and Blocked Persons". This list can be located
on the United States Treasury's website-httos://www.treasurv.4ov/resource-center/sanctions/SDN-List.
In accordance with OFAC regulations,if it is determined that you or any other person or entity claiming the benefits of any coverage has violated U.S.sanctions law or is a Specially
Designated National and Blocked Person,as identified by OFAC,any coverage will be considered a blocked or frozen contract and all provisions of any coverage provided are immediately
subject to OFAC. When a surety bond or other form of surety coverage is considered to be such a blocked or frozen contract,no payments nor premium refunds may be made without
authorization from OFAC. Other limitations on the premiums and payments may also apply.
Any reproductions are void.
Surety Claims Submission:LexonClaimAdministration((dsomoo-in0.com
Telephone:615-553-9500 Mailing Address:Sompo International;12890 Lebanon Road;Mount Juliet,TN 37122-2870 0
G
16A 4
Exhibit "B "
coP
2022 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT FILED 1 6 A 4
DOCUMENT# L15000161696 Apr 20, 2022
Entity Name: SD SAN MARINO, LLC Secretary of State
4135719253CC
Current Principal Place of Business:
2639 PROFESSIONAL CIR#101
NAPLES, FL 34119
Current Mailing Address:
2639 PROFESSIONAL CIR#101
NAPLES, FL 34119 US
FEI Number: 47-5189790 Certificate of Status Desired: No
Name and Address of Current Registered Agent:
COLEMAN,YOVANOVICH&KOESTER, P.A.
4001 TAMIAMI TRL N#300
NAPLES,FL 34103-3556 US
The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida.
SIGNATURE:
Electronic Signature of Registered Agent Date
Authorized Person(s) Detail :
Title MGR Title VP
Name STOCK, BRIAN K Name FERRY,JOHN
Address 2639 PROFESSIONAL CIR#101 Address 2639 PROFESSIONAL CIR#101
City-State-Zip: NAPLES FL 34119 City-State-Zip: NAPLES FL 34119
Title VP
Name GELDER, KEITH
Address 2639 PROFESSIONAL CIRCLE STE
101
City-State-Zip: NAPLES FL 34119
I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under
oath;that lam a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605,Florida Statutes;and
that my name appears above,or on an attachment with all other like empowered.
SIGNATURE:BRIAN STOCK MANAGER 04/20/2022
Electronic Signature of Signing Authorized Person(s) Detail Date
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP l i A 3
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Hie completed routing slip and original documents are to be tin-warded to the('aunty Attorne% Office
al 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#1 through#2 as appropriate for additional signatures,dates,and/or information needed. lithe 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
2.
3. County Attorney Office County Attorney Office
0 0 r 121,� 22
4. BCC Office Board of County
Commissioners llu,1k,/Z./( 12/4Z
5. Minutes and Records Clerk of Court's Office
nAAJ
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact inibmiation is needed in the event one()idle addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Lucia Martin—Development Review Phone Number X 2279
Contact/ Department
Agenda Date Item was 11/08/2022 Agenda Item Number 16.A.3
Approved by the BCC
Type of Document Plat Number of Original 1
Attached Documents Attached
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? LM
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. LM
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 LM
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 LM
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
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 11/08/2022 and all changes made Rre
during the meeting have been incorporated in the attached document. The County 0 or =c r
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 V n ,
Chairman's signature. V
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12