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Backup Documents 12/13/2022 Item #16C 9 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 b C 9 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 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. ** 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 Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. 2. 3. County Attorney Office County Attorney Office 7-37 111�`�l LZ 4. BCC Office Board of County Commissioners LA ,/O�Sf lZ/6 /7Z 5. Minutes and Records Clerk of Court's Office rF r lat(i5(aa /0;. 31 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 Alicia Abbott Phone Number 239-877-3961 Contact/Department CC: pen'cuw:" dvil e(f 1.1 554 e� &,p� Agenda Date Item was 12/13/20/2 / Agenda Item Number 16C9 Approved by the BCC Type of Document(s) Work Order, Payment& Performance Number of Original Attached Bonds Documents Attached PO number or account 70085.22.4 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(instead of stamp)? X 2. Does the document need to be sent to another agency for additional signatures? If yes, X provide the Contact Information (Name;Agency;Address; Phone)on an attached sheet. 3. Original document has been signed/initialed for legality. (All documents to be signed by X 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 X 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 X 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 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 uploaded to the agenda. 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 12/13/22 and all changes made during N/A is not the meeting have been incorporated in the attached document. The County Attorney / an option for Office has reviewed the changes, if applicable. / l/tl ' 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 an option for Chairman's signature. AV/11, this line. I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04;Revised 1.26.05;2.24.05;11/30/12;4/22/16;9/10/21 WORK ORDER/PURCHASE ORDER Contract#20-7800"UNDERGROUND CONTRACTOR SERVICES" Contract Expiration Date:dune 21, 2026 This Work Order is for professional services for work known as: Project Name: NRO Wellheld Infrastructure Replacement—Well No 10 Project No: 70085.22.4 The work is specified in the proposal dated September 7,2022 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: DOUGLAS N HIGGINS INC. Scope of Work:As detailed in the attached proposal and the following: * Task I Perform all Tasks as described in the Request for Quote,Addendum I, and as listed in the attached quote. * Task II Allowance Schedule of Work: Complete work within 240 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#20-7800 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): ❑O Negotiated Lump Sum(NLS)0 bump Sum Plus Reimbursable Costs (LS+RC) ® Time & Material (T&M) 0 Cost Plus Fixed Fee (CPFF), as provided in the attached proposal. Task I $503,380.00 (NLS) Task II $60,000.00 (T&M) TOTAL FEE S563,380.00 abbott aM r 10-18-2022 PREPARED BY: — Alicia Abbott, El., PMP, Project Manager Date Engineering& Project Management D4..•,.ow.., DV'E.e."'"9JWOCS., n!N.vw BullertBenjamin a,0,.fl.W.PPM U... A¢w..,gI.PDD PM.wq aM P�owe Y.r�yvmM.W.PUD.DU.DMrw.DG•0[c. APPROVED BY: DD. Dn.:mn., ° a-Nbae Benjamin N. Bullert, P.F.,Principal Project Manager Date Engineering& Project Management D.$iy bred by Mclea NaUh.. ON,E.MMIne+.Mciunec0llwcoUMyt°ov. McLeanMatthew O: l APPROVED BY: DW:°D12.,D.,.,1:2S e2-0e.00 Matthew McLean, P.h., Director Date Engineering& Project Management K 10172022 16 C9 i b by_p Digitally signed by libby_p APPROVED BY: Date:2022.10.19 08:42:25 oa'oo' Pam Libby,Distribution Manager Date brogdon h DDate:igitally signed2022.1o.24 by11b:54:3rogdons 0400 h APPROVED BY: — Howard Brogdon,Water Director Date APPROVED BY: CUrryAmld Digitally signed by CurryAmia Date:2022.10.31 10:13:54-04'00' Antis Curry, Financial Operations Support Director Date • Digitally signed by CurryAmia APPROVED BY:Cu rryAm Id Date:2022.11.01 09:55:16-04'00' Dr. George Yilmaz,Public Utilities Administrator Date 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 ffilly 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: DOUGLAS N HIGGINS,INC ; 1 Mi o e Bona�a ge►' Dale- y , 10172022 0 16C9 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 Crystal K. Kinzel, Interim Clerk COLLIER COU , • 62). ' By: /0"./a,....-e-77"" By'. � � - Dated: � f d /� 2 Willi I L. McDaniel,Jr.,Chairman vv - (SEAL) Attest as to Chairman's Name of Firm: Douglas N. Higgins, Inc. signature only. ,'�./ -,..,77 First Witness • naturt - r1s�� f b r t`i��k• 4�e�1'� 1r{t�1�"�t��� �c �J,'s � tType/print signature and title �1 TType/print witness namet Second Witness > • TType/print witness namet Approved as to Form and Legality: -Ae+isturt County Attorney 4�Pu`ly 44—it R Print Name 1 6 C 9 Date: August 2,2022 From: Alicia Abbott, Project Manager Cotter County 239-252-2644, Telephone Number liciiI.Abt,,tra col.I'.L!i ouno,flAtov Public Utilities Department Engineering & Project Management Division To: Potential Bidders REQUEST FOR QUOTATIONS FOR MULTIPLE PROJECTS UNDER CONTRACT Agreement 20-7800 Underground Contractor Services __ Selected Vendors: Quality Enterprises USA., Inc. Haskins, Inc. Douglas N. Higgins, Inc. Mitchell &Stark Construction Co., Inc. Southwest Utility Systems, Inc. PWC, LLC Coastal Concrete Products Kyle Construction, Inc. Cougar Contracting, LLC. As provided in the referenced contract,the County Division is soliciting quotes for the referenced project. NRO Well#10 RFQ Due Date: Monday, September 5, 2022 @ 3:00 PM Monday,August 15, 2022 @ 10:00 A.M—On Site at Pre-Quote Meeting (Non-Mandatory): NRO#10-Vanderbilt Beach Road. Q&A Deadline: Friday,August 26, 2022, at 5:00p.m. Number of Days to Substantial Completion: 210 days Calendar Days from NTP Number of Days to Final Completion: 240 Calendar days from NTP Scope Provided Yes Plans and Specs: Yes Liquidated Damages: Liquidated Damages$509 per day Payment&Performance Bonds If over$200,000.00 Your quotation response for this project is due via e-mail to Alicia Abbott(Alici.Abhol��i;cc_�Iliercuunl+fl.gc}J no later than the date and time specified above. We will not accept any quotation responses later than the noted time and date. 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 rr Thone Number/Fax Number j f ' 4Signat re President Title 1 y /.A.Daniel Higgins ir7 Print Name Date 16C9 NORTH RO WELL#10 ITEM DESCRIPTION QUANTITY UNIT Unit Price MOBILIZATION/DEMOBILIZATION (10%OF 1 1 LS BASE BID MAX.) $ 50,000.00 2 WELL PLUG 1 LS $30,000.00 3 BACKFILL VAULT 1 LS $45,000.00 4 CONCRETE WORK 1 LS $74,000.00 5 WELLHEAD(PIPING,VALVES, INSTL.,ETC.) 1 LS $192,380.00 6 ELECTRICAL(WIRE,PANELS,CONDUIT, ETC.) 1 LS $75,000.00 7 SITE GRADING(57 STONE OVER MIRAFI) 1 LS $37,000.00 SUBTOTAL I 8 OWNERS ALLOWANCE (TIME&MATERIALS)* T&M $ 60,000.00 'TOTAL PRICE FOR PROJECT J $ 563,380.00 Firm:Douglas N.Higgins,Inc. Contractor's Signature and Date: f1i �r�~ ( 7 r.), '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. 16C9 Exhibit C-1 ❑ this exhibit is not applicable PUBLIC PAYMENT BOND Bond No. 35BCSAQ4408 Contract No. 20-7800 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,CT NM S (Business Address) are held and firmly bound to Collier County Board of County Commission Oblige in the sum of Five Hundred Sixty Three Thousand Three Hundred Eighty and 00/100-- ($ 563,380.00 ) 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_day of September , 20 22 with Oblige for NRO Well#10 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. IN WITNESS WHEREOF, the above parties have executed this instrument this 16th day of September , 20 22 , the name of under-signed representative, pursuant to authority of Its governing body. Page 18 of 33 Multi-Contractor Award Agreement[2021 ver,11 169 Signed, sealed and delivered in the presence of: PRINCIPAL: Douglas N. Higgins,Inc. { By: [ G to In Name: ally A. e Witn ses a t Pr p Its: Vice President STATE OF Michigan COUNTY OF Washtenaw The foregoing instrument was acknowledged before me by means of ® physical presence or ❑ online notarization,this of September 20 22 , by- Kelly A.Wilkie , as Vice President of Douglas N.Higgins.inc. , a Michigan corporation, 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. .y j �.C.�• My Commission Expires: 242-it r (Signature of otary Public-State of Flsrida)Michigan Name: David J.Wilkie (Legibly Printed) (AFFIX OFFICIAL SEAL) Notary Public, State of Michigan Commission No.: nBvio J WiLKIE Notary Public,Michigan SURETY; County of Washtenaw ATTEST: My Comm.Expires 05/20/2024 I lartford Accident and Indemnity Company (Printed Name) One Hartford Plaza Hartford,CT 06115 (Business Address) (Authorized Signature) Witness as to Surety (Printed Name) OR Page 20 of 33 Multi-Contractor Award Agreement[2021_ver,11 1 1 C9 ( AsneylnFact) oleyr ,IAitD.chr`Power of Attorney) Witnesses SarayusNair 24 Frank Lloyd Wright Dr.,Suite J4100 ^, Ann Arbor,MT 48105 (Business Address) Theresa J Foley (Printed Name) 587.318-3843 (Telephone Number) STATE OF Michigan COUNTY OF Washtenaw The foregoing Instrument was acknowledged before me by means of© physical presence or ❑ online notarization,this 18th of September 20 22 , by Theresa J Foley , as Attorney-In-Fact of Hartford Accident and Indemnity Company, a Connecticut corporation, on behalf of the corporation. He/she Is personally known to me OR has produced Rersonally known as identification and did (did not)take an oath. ' Ad -- My Commission Expires: y f 24 2--y (Signature of ktary Public-State ofiater)c Michigan David J.Wilkie Name: (Legibly Printed) ,(AFFIX OFFICIAL SEAL) an Michi Notary Public, State of g Commission No.: DAVID J.WILKIE Notary Public,Michigan County of Washtenaw My Comm.Expires 05/20/2024 Page 21 of 33 Multi-Contractor Award Agreement(2021 ver.1 16Cq ❑ this exhibit is not applicable EXHIBIT C-2 PUBLIC PERFORMANCE BOND Bond No. 35BCSAQ4408 Contract No. _20-7800 KNOW ALL MEN BY THESE PRESENTS: That Douglas N.Higgins.Inc. , as Principal, and Hartford.Accident and Indemnity f nmpanjr___ _ as Surety, located at One Hartford Plaza.Hartforrt,CT nrt i S — (Business Address)are held and firmly bound to Collier County Board of CoL_Tnty Commitei as Oblige in the sum of Five Hundred Sixty Three Thousand Three Hundred Eighty and 00/100-- ($ 563,380.00 ) 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_day of September 20 22 ,with Oblige for NRo Well sto 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 22 of 33 Mulll-Contractor Award Agreement t2021 vecl) 16c9 Thiso instrumentsiosad shalltt bt e construed in of limitations under Sectiopects n 255 05,, Fllorlaw bond.ida Statutelt s is expressly not appl understoodto th bond. the time provisions and statute 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 16th day of September , 20 22 , 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 PRINCIPAL: in the presence of: f-. . , .--, Douglas N.Higgins,Inc. ---.---/,,,,, ,,,,/ .--z-----, , ., , . ii, ., By: he,,t L(+64.GU.k... Witness p as to Principal Name: Kelly A.1 kie Its: Vice President STATE OF Michigan COUNTY OF Washtenaw The foregoing Instrument was acknowledged before me by means of t1 physical presence or ❑ online notarization,this of September 20 22 , by Kelly A.Wilkie , as vice an corporation, on behalf of the corporation, a Michigan President of Douglas N.Higgins,Inc, , 8 He/she Is personally known to me OR has produced PefrsonaUvKnown as identification and did (did not) take an oath. t%(."iliac ., My Commission Expires: (Signature of Notary Public-State of Florida)Michigan Name: David J.Wilkie (Legibly Printed) (AFFIX OFFICIAL SEAL) Notary Public, State of Michigan Commission No.: DAVID J.WILKIE Notary Public,Michigan County of Washtenaw My Comm,Expires 05/20/2024 Page 23 of 33 Multi-Contractor Award Agreement(2021_ver.1] ATTEST: SURETY: Hartford Accident and Indemnity Company (Printed Name) One Hartford Plaza --•-- ___H.aLtfoxtLOT 06115 ------.. (Business Address) (Authorized Signature) Witness as to Surety (Printed Name) f,...OtfiT Ryan coley As Attorne in Fact (Attac.h.Power of Attorney) I Witnesses sarayu S Nair 24 Frank Lloyd Wright Dr.,Suite 14100 Ann Arbor,MI 48105 (Business Address) Theresa J Foley (Printed Name) 567-318-3843 (Telephone Number) STATE OF Michigan COUNTY OF Washtenaw The foregoing Instrument was acknowledged before me by means of LI physical presence or 0 online 16th September 20 22 byTheresa J Foley , as Attorney-In-Fact notarization, this of P � of Hartford Accident and Indemnity Company a Connecticut corporation, on behalf of the corporation. He/she Is personally known to me OR has produced Pe'sonally Known as identification and did (did not) take an oath. /A/h.-Li My Commission Expires: (Sig ature of( otary Public-State of;ttirfdz)MICHIGAN Name: David J.Wilkie (Legibly Printed) (AFFIX OFFICIAL SEAL) Notary Public, State of Michigan Commission No.: DAVID J.WILKIE Notary Public,Michigan County of Washtenaw My Comm.Expires 0512012024 Page 24 of 33 Mulll-Conlractor Award Agreemont 12021_var.11 16C9 Direct Inquiries/Claims to: THE HARTFORD POWER OF ATTORNEY BOND,T-11 One Hartford Plaza Hartford,Connecticut 06155 Uond C l iarns(udtheh ar,tiur t r:,€st call:868-266-3488 or fax:860-757-5835 KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: HYLANT GROUP INC/TROY Agency Code: 35-351588 • X Hartford Fire Insurance Company,a corporation duly organized under the laws oldie 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, Theresa J. Foley, Nicholas R Hylant, Jennifer A. Jarosz, Jamie Laurencelle, Saraya S. Nair, Kristie A. Pudvan, Judy K. Wilson, Kathy S Zack of TROY, 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(ies) 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 23, 2016 the Companies have caused these presents to be signed by its Assistant 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. rl 1 " . L96 T 1*p c4� <!4 Lam, c N'I,,co� iS, ::V f 1 y. 4. r+elatt gar r Sp 70,t_r ;\ SB79 lei \`i t9�� r � •`R.t,.M -""}a a'1.,. J r ,1''f 'M.sa:, ' it,: r% Shelby Wiggins,Assistant Secretary Joelle L. LaPierre,Assistant Vice President STATE OF FLORIDA ss. Lake Mary COUNTY OF SEMINOLE On this 20th day of May,2021,before me personally came Joelle LaPierre,to me known,who being by me duly sworn,did depose and say:that (s)he resides in Seminole County, State of Florida; that (s)he is the Assistant Vice President of the Companies, the corporations described in and which executed the above instrument;that(s)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(s)he signed his/her name thereto by likeauthority. . , ,k . ..:. i-c-4-4-e---c- 'f4 '7`• Jessica Ciccone .';,,.r,C: ' My Commission HH 122280 Expires June 20,2025 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 September 16, 2022 . Signed and sealed in Lake Mary, Florida. fly IM I�"� �4 1C((t• � M`ra z'w "'' >, t 9 0 T ~ r carrvV? r,^I t ".:1,Kcaamolurro d s :.� . , Ill(, rlt,4 10' 1 . 1 ;'3 ;i 1H/9 ` 29tq i %. tr 04 r ,..N ' 1f(;4L'1'/V )Keith D. Dozois,Assistant Vice President i 6 C 9 ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MM`DD"YYY) 9/16/2022 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 have ADDITIONAL INSURED provisions or 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 CONTACT Hylant Group Inc-Ann Arbor PHONE FAX 24 Frank Lloyd Wright Dr J4100 (Nc.No,Exu:734-741-0044 (No,no):734-741-185 Ann Arbor MI 48105 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC II INSURERA:Valley Forge Insurance Co 20508 • INSURED HIGGI.5 INSURER B:Continental Insurance Company 35289 Dougnc, 3390 Travis N PHiointe, Suite INSURER Allied World Assurance Co Inc(US) 19489 3390 Pointe, Suite A Ann Arbor MI 48108 INSURER D:American Casualty Co of Reading PA 20427 INSURERS: Transportation Insurance Co 20494 INSURER F: I • COVERAGES CERTIFICATE NUMBER:1007223428 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 ADDLISUBR - POLICY EFF I POLICY EXP LTR INSD I WVD POLICY NUMBER IMM/DD/YYYYI IMM/DD/YYYY) LIMITS D X COMMERCIAL GENERAL LIABILITY Y • U1061922047 4/1/2022 4/1/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE f X OCCUR DAMAGE TO RENTED ---- PREMISES(Ea occurrence) $500,000 X Includes XCU MED EXP(Any one person) $15,000 X Inc!contractual PERSONAL 8 ADV INJURY $1,000,000 __ GENII.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 I OTHER: $ A AUTOMOBILE LIABILITY BUA1061922033 4/1/2022 4/1/2023 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS ( ) x HIRED x NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ B X UMBRELLA LIAB X OCCUR U1061922050 4/1/2022 4/1/2023 EACH OCCURRENCE $8,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $8,000,000 DED I Ni RETENTIONS0 $ c WORKERS AND EMPLOYOERSEN COMPENSATION Y_I N WC7012265571 4/1/2022 4/1/2023 X STATUTE ERH • ANYPROPRIETOR/PARTNERIEXECUTIVE - E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? I N I N/A • (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 C Professional/ 0312-7992 4/1/2022 4/1/2023 2,000,000 Each Claim g Pollution 4,000,000 Aggregate • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addilional Remarks Schedule,may he attached it more space is required) Job-NRO Well#10. Additional Insured for General Liability and Automobile Liability,primary and non-contributory basis,as required by written contract subjecl to the terms conditions,and exclusions of the policies— Collier County Board of County Commissioners. With regard to General Liability,Automobile Liability,and Worker's Compensation policies,a 30 day notice of cancellation will be provided to the Certificate Holder for any insurer initiated cancellation, 10 days will be provided in the event of non-payment of premium. - 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 (.1),{,„,,,,.,ct V. . L.),,:,)-1.0211,-\ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) • The ACORD name and logo are registered marks of ACORD