Agenda 01/23/2024 Item #16K 4 (To approve and accept an insurance settlement to settle subrogation claim)16. K.4
01/23/2024
EXECUTIVE SUMMARY
Recommendation to approve an insurance settlement whereby the County will receive $10,000 to settle and
release its claim against James Fortunato for costs incurred to repair bridge damage, and to authorize the
County Manager or designee to execute the release.
OBJECTIVE: To approve and accept an insurance settlement to settle a subrogation claim.
CONSIDERATIONS: On November 10, 2020, James Fortunato was traveling eastbound on Immokalee Road
when he suffered a medical episode and lost consciousness. His vehicle traveled through the Livingston Road
intersection and collided with a crosswalk sign and the concrete railing of the bridge at the northeast corner of the
intersection.
To effectuate repairs of the bridge, the County paid contractor Infinite Construction, LLC $42,600.00, design
professional KCI Technologies, LLC $2,814.00, and used $22.44 worth of materials, for total paid costs of
$45,436.44. County staff estimates additional costs of 2,901.65 in man hours, $560.75 in equipment costs, and
$7,334.83 in administrative overhead, subtotaling $10,797.23 in County costs, for a grand total of $56,233.67.
James Fortunato's insurance carrier Geico offered policy limits of $10,000 to satisfy and release the claim.
The Board may choose to bring litigation against James Fortunato to potentially obtain the $10,000 policy limits
and a judgment for the total damages, plus litigation costs. However, based on County background investigation
and financial representations made by James Fortunato and his attorney, it is unlikely that any money beyond
Geico's $10,000 insurance policy limits would be recovered, and litigation of this claim would likely cost the
County more than it would yield.
James Fortunato requested that the Board accept the maximum insurance settlement offered in lieu of litigation. In
support of this request, James Fortunato provided an affidavit of indigency (attached) stating that he earns $800
weekly, has $9,000 of debt, a $12,000 vehicle, $2,000 in the bank, and has a retirement account with $29,487 in it
(retirement accounts are generally protected from creditors under federal and state law).
The County Attorney's Office and Risk Management Director support this settlement and recommend Board
approval because James Fortunato is essentially judgment proof and does not have enough assets for the County to
seize should it obtain a judgment against him, and further pursuit of this claim will likely cost the County more than
it would yield.
FISCAL IMPACT: The County will recoup funds in the amount of $10,000. These funds will be deposited in
Road Maintenance Cost Center 163620 within Transportation Operations Fund (1001).
GROWTH MANAGEMENT IMPACT: None.
LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires majority vote for
approval. -DDP
RECOMMENDATION: To approve an insurance settlement whereby the County will receive $10,000 to settle
and release its claim against James Fortunato for costs incurred to repair bridge damage, and to authorize the
County Manager or designee to execute the release.
Prepared by: Derek D. Perry, Assistant County Attorney
Michael K. Quigley, Risk Management Division Director
ATTACHMENT(S)
1. Fortunato - Affidavit of Indigency (PDF)
Packet Pg. 1022
16. K.4
01/23/2024
2. Fortunato - Geico Release (PDF)
3. Fortunato - Policy Limits (PDF)
4. Fortunato - Claim (PDF)
5. Fortunato crash report (PDF)
Packet Pg. 1023
16. K.4
01/23/2024
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.K.4
Doe ID: 27652
Item Summary: Recommendation to approve an insurance settlement whereby the County will receive $10,000 to
settle and release its claim against James Fortunato for costs incurred to repair bridge damage, and to authorize the
County Manager or designee to execute the release.
Meeting Date: 01/23/2024
Prepared by:
Title: Legal Assistant — County Attorney's Office
Name: Rosa Villarreal
01/04/2024 8:3 8 AM
Submitted by:
Title: County Attorney — County Attorney's Office
Name: Jeffrey A. Klatzkow
01/04/2024 8:3 8 AM
Approved By:
Review:
Risk Management Michael Quigley Additional Reviewer
Transportation Management Services Department Trinity Scott
Road Maintenance
County Attorney's Office
Office of Management and Budget
Office of Management and Budget
County Attorney's Office
County Manager's Office
Board of County Commissioners
Marshal Miller
Additional Reviewer
Derek D. Perry
Level 2 Attorney Review
Debra Windsor
Level 3 OMB Gatekeeper Review
Christopher Johnson Additional Reviewer
Jeffrey A. Klatzkow Level 3 County Attorney's Office Review
Amy Patterson
Level 4 County Manager Review
Geoffrey Willig
Meeting Pending
Completed
01/04/2024 9:37 AM
Additional Reviewer
Completed
01/04/2024 3:31 PM
Completed
01/04/2024 4:38 PM
Completed
01/16/2024 10:07 AM
Completed
01/16/2024 10:21 AM
Completed
01/16/2024 10:47 AM
Completed
01/16/2024 11:09 AM
Completed
01/17/2024 1:44 PM
01/23/2024 9:00 AM
Packet Pg. 1024
16. K.4.a
IN FORMA PAUPERIS RELIEF
AFFIDAVIT OF INDIGENCY BY DEFENDANT
I,;,respectfully request that the Collier County Board of County
Commissioners accept the maximum insurance settlement offered in lieu of litigation. I am
unable to make full payment or to give security to repay the full cost of the claim. I have not
divested myself of any property, monies, or any items of value for the purpose of avoiding
payment of said claim. I am hereby submitting the following financial affidavit of indigency in
support of this request.
The undersigned, with knowledge that there are criminal penalties for false statements,
Smakes the following statement regarding my dependents, marital status, income, assets,
liabilities/debts, and other relevant financial information:
• I have dependents. fLnclude only those persons you list on your U.S. income tax return.)
Marital Status: Marrie Sing Annual Spouse Income: $ N0 _
• I have a net income of $ eekly two weeks semi-monthly
monthly yearly other
• I have other income paid weekly every two weeks semi-monthly monthly yearly other
(Check "Yes" and fill in the amount ifyou have this kind of income, otherwise check "No')
Second
$
Veterans' Benefits
Y $ mift
NiL—)
Social S nefits
Workers' Compensation
For ou:
Yes $
❑
Income from absent family
Yes $
No
For child ren
Yes $
No
Stocks/Bonds
Yes $
No-r
Unemploymeat Comp.
Yes S
No ,/
Rental Income
Yes $
No
Union Payments
Yes $
No ,r
Dividends or Interest
Yes $
No ,(
Retirement/Pensions
Yes $
No -(
Other Kinds of Income
Yes $
No
Trusts
Yes $
No
Gifts
Yes $
No
• I have other assets:
(Check "Yes" and fill in the amount ifyou have this kind of income, otherwise check "No')
Cash
Yes $
No
Savings account
Yes $
Noy/
Bank account(s)
Yes $ Jo0o
No
Stocksibonds
Yes °1 4` }
No
CDs or Money Markets
Yes $
No-,/
Homestead Real Property
Yes $
No--/
Boats*
Yes $
NoJ
Motor Vehicle
Yes $ lX c,,) o
No
Other kinds of assets
Yes $
No
Non -homestead real estate
Yes $
Noq
*Show loans on these assets in paragraph S.
I DO DO NOT expect to receive more assets in the near future. The asset is
• I have total liabilities and debts of $ q ,0 , as follows:
Motor Vehicle Yes $ 1 No Home Yes $ No
Packet Pg. 1025
16. K.4.a
Other Real Property
Yes $
No -4
Child Support
Yes $
No
Credit Cards
Yes $ p
No
Medical Bills
Yes $ 4 mo
No
Monthly Medicine
Yes $
No Y
Other Kinds of Debts
Yes $
No V
• The following information and/or narrative is relevant to my financial status and inability to
renav said claim:
(ov
c c
S Cc'v
Under penalties of perjury, I declare that I have read the foregoing affidavit and that the
facts stated in it are true.
Printed Name
STATE OF FLORIDA
COUNTY OF ( u
This affidavit was sworn to and subscribed before me by means of physical
day of DIO U Q4L e 4- 20'A by A
Iq
known or produced s ification.
[Affix Notarial Seal)
ROCHELLEBOVILL
MY COMMISSION # HH 127712
EXPIRES: May 9, 2025
nF ,• Bonded Thru Notary Public Underwriters
presence this c26k4
who is personally
R�YA
Notary Signature
lkdlc1)'� ILA
Notary Printed Name
Packet Pg. 1026
16. K.4.b
GEICOn
geico.com
Attn: Florida Claims, P.O. Box 9091
Macon, GA 31208-9091
GEICO Indemnity Company
11 /28/2023
Collier County Board Of County Commissioners
To Whom It May Concern
Po Box 110259
Lakewood Rch, FL 34211-0004
Company Name: GEICO Indemnity Company
Claim Number: 866782936 0000 005
Loss Date: Tuesday, November 10, 2020
Policyholder: Morgan Mueller
Driver: James Fortunato
To Whom It May Concern,
Enclosed please find the Property Damage Release in the amount of $10,000.00. This is for full
and final settlement of any property damage claim including but not limited to vehicle damage,
personal property damage, loss of use, loss of income and any rental expenses.
In order to resolve the claim and forward a check, the Release must contain a signature of the
owner of the vehicle and any others having an interest in the property damage.
As a condition of this settlement, no other property damage, loss of use, loss of income or rental
expense payments will be or have been expected, requested, solicited or compromised with our
insured, our insured driver or any other person considered an insured under the above claim. If
this is not the case, please return or destroy the Release and call me to discuss how we will
proceed with resolution of this matter.
EC1344 (08/2023) 1 Packet Pg. 1027
Once signed and notarized, please upload an image of the release via geico.com, the GEIC 16.K.4.b
mobile app, or you may mail the release to the above address.
Sincerely,
Shauna Mckean
863-619-2030
Claims Department
For your protection, Florida law requires the following to appear on this form:
Any person who knowingly and with intent to injure, defraud, or deceive any insurer
files a statement of claim or an application containing any false, incomplete, or
misleading information is guilty of a felony of the third degree.
Packet Pg. 1028
RELEASE IN FULL OF ALL PROPERTY DAMAGE CLAIMS 16.K.4.b
CLAIM #: 866782936 0000 005
I/we, Collier County Board of County Commissioners, Releasor(s) of 3299 Tamiami Trail East, Ste. 800, City of
Naples, State of FL, being over the age of majority, for and in consideration of a payment in the amount of ten
thousand and 00/100 Dollars ($10,000.00), lawful money of the United States of America do for myself/ourselves,
my/our heirs, executors, administrators, successors and assigns, hereby remise, release,and forever releases, acquits
and discharges Morgan Muller, James Fortunato and GEICO Indemnity Company Releasee(s), successors and
assigns, and/or his, her or their associates, heirs, executors and administrators, and all other persons, firms or
corporations of and from any and every claim, demand, right or cause of action, of whatever kind or nature, on
account of or in any way growing out of any and all property damage resulting or to result from an accident that
occurred on or about the loth day of November, 2020, at or near Collier County, FL including, but not limited to,
all liability for contribution and/or indemnity.
AS A FURTHER CONSIDERATION FOR THE MAKING OF SAID SETTLEMENT AND PAYMENT, IT
IS EXPRESSLY WARRANTED AND AGREED:
(1) That I/we understand fully that this is a final settlement and disposition of the disputes both as to the legal
liability for said accident, casualty, or event and as to the nature and extent of the property damage which I/we have
sustained and I/we understand that liability is denied by Morgan Muller, James Fortunato and GEICO Indemnity
Company Releasee(s), and it is covenanted and agreed between the Releasor(s) and Releasee(s) herein that this
release and settlement is not to be construed as consent or an admission of liability on the part of said Releasee(s);
that this release and settlement agreement shall not be used by said Releasor(s) or any one on his behalf as a defense
or estoppel in any action which is now pending or may be brought hereafter by said Releasee(s) against said
Releasor(s) or his agents and servants, and any claim of whatever kind or nature the Releasee(s) might have other
than property damage arising from said accident is expressly reserved to them.
(2) That I/we do hereby for myself/ourselves, my/our heirs, executors, administrators, successors, assigns and next
of kin covenant to indemnify and save hold harmless the Releasee(s) from any and every claim or demand of every
kind or character for property damage arising from said accident which may ever be asserted.
(3) That no promise, agreement, statement or representation not herein expressed has been made to or relied upon
by me/us and this release contains the entire agreement between the parties.
(4) Each party to this release is responsible for their own attorney fees and costs, if any.
THE UNDERSIGNED HAS READ THE FOREGOING RELEASE AND FULLY UNDERSTANDS AND
VOLUNTARILY ACCEPTS THE SUMS OFFERED AS A FULL AND FINAL SETTLEMENT OF ALL
PROPERTY DAMAGE CLAIMS.
IN WITNESS WHEREOF, I/we have hereunto set my/our hand and seal this day of
20
Releasor(s) Signature
STATE
COUNTY
On this day of 20, before me personally appeared
me to be the person(s) named in and who executed the above release and acknowledged that
executed the same as
free act and deed.
(OFFICIAL TITLE)
For your protection, Florida law requires the following to appear on this form:
Any person who knowingly and with intent to injure, defraud, or deceive any insurer
files a statement of claim or an application containing any false, incomplete, or
misleading information is guilty of a felony of the third degree.
to
own
Packet Pg. 1029
16.K.4.c
GEICOn
geico.com
Attn: Florida Claims, P.O. Box 9091
Macon, GA 31208-9091
GEICO Indemnity Company
12/29/2023
Office Of County Attorney Jeffrey A. Klatzkow
3299 E Tamiami Trail STE 800
Naples, FL 34112
Company Name: GEICO Indemnity Company
Claim Number: 866782936 0000 005
Loss Date: Tuesday, November 10, 2020
Policyholder: Morgan Mueller
Driver: James Fortunato
Dear Office Of County Attorney Jeffrey A. Klatzkow,
Please see the enclosed Statement of Insurance Disclosure and a Certified Copy of the Policy
Sincerely,
Shane Killebrew
863-619-4085
Claims Department
Encl: FL Statement of Insurance Disclosure
EC0846 (11/2023) 1 Packet Pg. 1030
STATEMENT OF INSURANCE DISCLOSURE 16.K.4.c
STATE OF FLORIDA
POLK COUNTY: ss
I, Scott Land, Claims Manager of GEICO Indemnity Company, Incorporated under the laws of the
State of Nebraska, do hereby certify that the attached is a true and correct copy of policy contract
number 6002006218, issued to Morgan Mueller effective 05/24/2020 thru 11/24/2020, afforded
o
the following coverage:
Coverage for losses sustained by anyone other than an insured is limited to:
o
Bodily Injury Not Applicable
y
Property Damage (Includes Loss of Use) $10,000.00
Coverage for losses sustained by an insured:
r
Uninsured Motorist Not Applicable
Personal Injury Protection $1000 Deductible, applies to Named Insured and
a,
Dependent Relatives
Additional Personal Injury Protection Not Applicable
Medical Payments Coverage Not Applicable
Collision Not Applicable
Comprehensive Not Applicable
Rental Reimbursement Not Applicable
0
Emergency Road Service Available
MBI Not Applicable
o
U
on the following vehicle: 2006 FORD ECONO E250, VIN 1FTNE24W86DA70221, during the
above policy period.
E
Number of Listed Vehicles: Not Applicable'
Policy and Coverage Defenses Known Are: None Known At This Time
Additional Insurance Coverage: None Known To GEICO Indemnity Company At This Time
Additional Insured(s) Under Section I, Liability Coverage: None Known At This Time
The attached Policy Declaration sheet was recreated based on records retained in our computer
data files. The amendments, endorsements, and policy contract are standard forms with
information particular to this policy. Attached is a specimen copy of the policy contract noted
above. These documents are true and correct to the best of my knowledge and belief. This
statement shall be amended immediately upon discovery of facts calling for an amendment.
Pursuant to Fla. Stat. 92.525(1)(c), under penalties of perjury, I declare that I have read the
foregoing Statement of Insurance Disclosure and that the facts stated in it are true.
Adjuster: Shane Killebrew
Claim Number: 866782936 0000 005
Claims Manager
Packet Pg. 1031
16. K.4.d
RISK MANAGEMENT INVOICE
COLLIER COUNTY ROAD MAINTENANCE DIVISION
4800 DAVIS BLVD
NAPLES, FL. 34104
(239)252-8924 TELEPHONE
TAR #: 3271
DATE OF ACCIDENT: 11/10/2020
DATE OF COMPLETION: 4/11/2022
PROJECT/LOCATION: Immokalee Rd & Livingston Rd
ACTIVITY: Removal and replacement of damaged concrete bridge rail materials (Accident Remediation)
AUTHORIZATION: Marshal Miller, Superintendent
Road Maintenance Division
DEPOSIT REIMBURSEMENT
CHECK TO: 101-163620-369130
Man Hours
Cost
$ 2,901.65
Equipment
Cost
$ 560.75
Material
Cost
$ 22.44
Vendors
Cost
$ 45,414.00
Total
Cost
$ 48,898.84 Submitted By:
Admin. Ovhd.
0.15 %
$ 7,334.83
TOTAL $ 56,233.67
Approved By:
Samantha Roe
Operations Coordinator
Marshal Miller, Superintendent
Road Maintenance Division
Packet Pg. 1032
16. K.4.d
Work Order Detail
7843 Michael Stone Road Maintenance
Task Count: 2
Description: Bridge o34039 repairs due to crash
Task Information
Completed 100.00% $48,898.84
477138 On -Call Guardrail1215 Important Completed $722.76
Services
Notes: 11/11/2020 Geo and James B, Respond to a call of an accident at Immokalee RD and Livingstone
RD, Vehicle Damage bridge concrete apron, added asphalt on apron depression, We secure the
area with a water barricade and clean up all broken concrete debris. accident report in picture
attachment. crash report fhp#88352364.
1/18/22 Changed to WO number 7843 per M. Stone. Was originally WO 5075 for on call services.
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16. K.4.d
Work Order Detail
590702
Notes
Riper Blvd
Supervision, Bridge 34039 Important Completed $48,176.08
Inspection
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Packet Pg. 1034
Road Maintenance Task Report co*e�rC'0 16.K.4.d
Gmwth Managmerd Deparlrrmt
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Unr4ersiry aFSaaSh Fbdda, Coumy of Callier, Esd, HERE, Garm in, GeaTeahnalagies, Inc., NC,P4 USGS
S
S
D Start Date
Stop
Date Issue
Activi Asset
Priority
477138 11/11/2020 12/31/2020 On -Call Services Guardrail 1215 Important _
Status Completed Location
Description
Street
Details
Intersecting Street LIVINGSTON RD
Notes 11/11/2020 Geo and James B, Respond to a call of an accident at Immokalee RD and Livingstone
RD, Vehicle Damage bridge concrete apron, added asphalt on apron depression, We secure the
area with a water barricade and clean up all broken concrete debris. accident report in picture
attachment. crash report fhp#88352364.
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Packet Pg. 1035
Road Maintenance Task Report co ler C a. 16.K.4.d
Growth Management Depatnent
1/18/22 Changed to WO number 7843 per M. Stone. Was originally WO 5075 for on call services.
Ldavis
Labor Log
Date
Labo NOW
Rate Name
11/11/2020
15539 Blackburn James
Overtime 1
11/11/2020
01381 Gonzalez Geovanny
Overtime 1
11/11/2020
15539 Blackburn James
Overtime 1
11/11/2020
15539 Blackburn James
Overtime 1
11/11/2020
15539 Blackburn James
Overtime 1
11/11/2020
15539 Blackburn James
Overtime 1
11/17/2020
01360 Stone Michael
Standard
11/17/2020
01360 Stone Michael
Standard
Equipment Log
Date Equipment
11/11/2020
CC2-1886
11/11/2020
CC2-2112
11/11/2020
CC2-2028
11/11/2020
CC2-2112
11/11/2020
CC2-1886
11/17/2020
CC2-2075
11/17/2020
CC2-2075
Material Log
Date Material
11/11/2020 RM0006
11/11/2020 RM0005
11/11/2020 801-240
Description
2019 Freightliner Water Truck
2019 4WD FORD F150 SC 4X4
2019 4WD Ford F350 CC
2019 4WD FORD F150 SC 4X4
2019 Freightliner Water Truck
2019 4WD Ford F150
2019 4WD Ford F150
AHoursj
0.75
3.50
0.25
0.50
0.75
2.00
1.00
1.00
9.75
Usage
0.75
0.00
0.75
3.50
0.00
1.00
1.00
7.00
se Order Quantity
Cold Mix Asphalt by the Bag
1.00
issued by each (2 locations,
Row 0 & concrete building)
Oil Dry Absorbent
1.00
Water Bulk
200.00
202.00
Other Log
at Vendor Name Costi Notes
Total 0
Task Cost
Labor Cost Ma Other Cost
Cost A
33.68
241.22
11.23
22.46
33.68
89.82
67.24
67.24
Total 566.57
Cost
41.25
0.00
12.00
52.50
0.00
14.00
14.00
Total 133.75
Cost
14.06
8.38
0.00
Total 22.44
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Road Maintenance Task Report
16. K.4.d
Coder Cou
Growth Management Depar"nt
566.57
133.75
22.44
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Task ID Issue qActivity Asset
adiL AW 7 lq� M��
590702 Supervision, Inspection Bridge 34039 Important
Status Completed Location
Description
Street LIVINGSTON RD
Intersecting Street Immokalee Rd
Details Project 66066.6 / Bid 21-7929 Livingston Rd Bridge Repairs -
Notes Traffic Accident #3271
Labor Log
DatJW Labor
Rate Name
Hours
Cost
1/12/2022 01360 Stone Michael
Standard
1.50
106.14
1/18/2022 01360 Stone Michael
Standard
4.50
318.42
1/20/2022 01360 Stone Michael
Standard
5.50
389.18
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Road Maintenance Task Report coJerc. I 16.KAd
Growth Management Depatnent
Labor Log
Date Labor
AWate Nam
1
1 /24/2022
01360
Stone
Standard
2.00
141.52
1/25/2022
Michael01360
Stone
Standard
1.50
106.14
1/31/2022
Michae101360
Stone
Standard
2.00
141.52
2/1/2022
Michae101360
Stone
Standard
2.00
141.52
2/2/2022
Michae101360
Stone
Standard
1.00
70.76
3/16/2022
Michae101360
Stone
Standard
1.00
70.76
3/21/2022
Michae101360
Stone
Standard
1.00
70.76
3/22/2022
Michae101360
Stone
Standard
3.00
212.28
3/28/2022
Michae101360
Stone
Standard
3.00
212.28
3/29/2022
Michae101360
Stone
Standard
2.00
141.52
4/4/2022
Michae101360
Stone
Standard
3.00
212.28
33.00 Total 2335.08
Equipment Log
1/18/2022
CC2-2075
2019 4WD Ford F150
4.50
63.00
1/20/2022
CC2-2075
2019 4WD Ford F150
5.50
77.00
1/24/2022
CC2-2075
2019 4WD Ford F150
2.00
28.00
1/25/2022
CC2-2075
2019 4WD Ford F150
1.50
21.00
1/31/2022
CC2-2075
2019 4WD Ford F150
2.00
28.00
2/1/2022
CC2-2075
2019 4WD Ford F150
2.00
28.00
2/2/2022
CC2-2075
2019 4WD Ford F150
1.00
14.00
3/16/2022
CC2-2075
2019 4WD Ford F150
1.00
14.00
3/21/2022
CC2-2075
2019 4WD Ford F150
1.00
14.00
3/22/2022
CC2-2075
2019 4WD Ford F150
3.00
42.00
3/28/2022
CC2-2075
2019 4WD Ford F150
3.00
42.00
3/29/2022
CC2-2075
2019 4WD Ford F150
2.00
28.00
4/4/2022
CC2-2075
2019 4WD Ford F150
2.00
28.00
30.50
Total 427.00
Material Log
Date Material Description Purchase Order ost
0 Total 0
Other Log
Vendor Name
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Packet Pg. 1039
Road Maintenance Task Report co c `ler co HK.ql
Gmwth Managernent Depadment
Other Log
Dat
4/4/2022
4/4/2022
Task Cost
Labor Cost
2335.08
Vendor Name Cos Notes
42600.00 Invoice for Repair- proj #66066.6
2814.00 Invoice Number 84428 (design/ei
Total 45414.00
Equipment Cost Material Cost
427.00 0.00
Other Cost Total Cost _A
45414.00 48176.08
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Packet Pg. 1040
16.K.4.d
EXHIBIT F: CERTIFICATE OF SUBSTANTIAL COMPLETION
OWNER'S Project No. 66066.6 Design Professional's Project No. NIA
PROJECT: "21-7929 Livingston Road Bridge Repairs (034039)"
CONTRACTOR Infinite Construction, LLC.
Contract For bridge repairs.
Contract Date November 29, 2021
This Certificate of Substantial completion applies to all Work under the Contract documents or to the following specified
parts thereof:
To Collier County Board of County Commissioners
OWNER
And
To KCI Technologies, Inc. (formerly: Bridging Solutions LLC.
Substantial Completion is the state in the progress of the Work when the Work (or designated portion) is
sufficiently complete in accordance with the Contract Documents so that the Owner can occupy or utilize the
Work for its intended use. The Work to which this Certificate applies has been inspected by authorized
representatives of OWNER, CONTRACTOR AND DESIGN PROFESSIONAL, and that Work is hereby declared to be
substantially complete in accordance with the requirements of the Contract Documents on:
March 30 2022
DATE OF SUBSTANTIAL COMPLETION
A tentative list of items to be completed or corrected is attached hereto. This list may not be all-inclusive, and the failure
to include an item in it does not alter the responsibility of CONTRACTOR to complete all the Work in accordance with
the Contract Documents. The items in the tentative list shall be completed or corrected by CONTRACTOR within 30
days of the above date of Substantial Completion.
The responsibilities between OWNER and CONTRACTOR for security, operation, safety, maintenance, heat, utilities,
insurance and warranties shall be as follows:
Packet Pg. 1041
16.K.4.d
RESPONSIBILITIES:
OWNER: Not Applicable
CONTRACTOR: Not Applicable
The following documents are attached to and made a part of this Certificate:
This Certificate does not constitute an acceptance of Work not in accordance with the Contract Documents nor is it a
release of CONTRACTOR'S obligation to complete the Work in accordance with the Contract Documents.
Executed by Design Professional on 4-4-2022
By:
KCI Technologies, Inc.
Design Professional
pzdr�v--Q-�
Ralph Verrastro, PE
CONTRACTOR accepts this Certificate of Substantial Completion on 03130/2022
Infinite Construction, LLC.
CONTRACTOR
By:
Vili' Kirilinas, Vice President
OWNER accepts this Certificate of Substantial Completion on
Collier County Board of County Commissioners
OWNER
By:
Michael Stone, Field Inspector
Packet Pg. 1042
16.K.4.d
EXHIBIT G: FINAL PAYMENT CHECKLIST
Bid No.: 21-7929 Project No.: 66066.6 Date: 03/30/2022
Contractor: Infinite Construction, LLC.
The following items have been secured by the
for the Project known as 21-7929 Livingston Road Bridge Repair (#034039) and have been reviewed and found to
comply with the requirements of the Contract Documents.
Original Contract Amount: $42,600.00 Final Contract Amount: $42,600.00
Commencement Date: January 18, 2022
Substantial Completion Time as set forth in the Agreement: 60 Calendar Days.
Actual Date of Substantial Completion: March 30, 2022.
Final Completion Time as set forth in the Agreement: 30 Calendar Days.
Actual Final Completion Date: March 30, 2022.
YES
NO
NIA
NIA
1.
All Punch List items completed on
NIA
NIA
2.
Warranties and Guarantees assigned to Owner (attach to this form).
3.
Effective date of General one year warranty from Contractor is:
X
March 30 2022
4.
2 copies of Operation and Maintenance manuals for equipment and
NIA
NIA
system submitted (list manuals in attachment to this form).
NIA
NIA
5.
As -Built drawings obtained and dated:
NIA
NIA
6.
Owner personnel trained on system and equipment operation.
7.
Certificate of Occupancy No.:
NIA
NIA
issued on (attach to this form).
X
8.
Certificate of Substantial Completion issued on March 30, 2022
9.
Final Payment Application and Affidavits received from Contractor on:
X_
NIA
NIA
10.
Consent of Surety received on
NIA
NIA
11.
Operating Department personnel notified Project is in operating phase.
NIA
NIA
12.
All Spare Parts or Special Tools provided to Owner:
NIA
NIA
13.
Finished Floor Elevation Certificate provided to Owner:
14.
Other:
If any of the above is not applicable, indicate by NIA. If NO is checked for any of the above, attach explanation,
Acknowledgments:
By Contractor: Infinite Construction, LLC. (Company Name)
1/ x-4� � (Signature)
Vil_iia irilinas, Vic President (Typed Name & Title)
By Design
Professional: KCI Techno(locties LLC. (Firm Name)
(Signature)
Ralph Verrastro, Professional Engineer (Typed Name & Title)
By Owner: Growth Man ent -- Road Maintenance Division (Department Name)
(Signature)
Michael Ston . Sr. Field Inspector (Name & Title)
Packet Pg. 1043
16.K.4.d
ISO 9001:2008 CERTIFIED
KCI
TECHNOLOGIES
ENGINEERS - PLANNERS - SCIENTISTS - CONSTRUCTION MANAGERS
PO. Box 791479 - Baltimore, MD 21279-1479
Collier County Date: April 6, 2022
3299 Tamiami Trail E KCI Project No: 912107235
Suite 700 Invoice No: 844428 - FINAL
Naples, Florida 34112-5749
Attn: Accounts Payable
Bill via: email to: bccapclerk@collierclerk.com
Project Description: Livingston Road over Cocohatchee Canal Bridge Repairs (#034039)
Client Contract Number: 18-7432-ST
Client Purchase Order Number: 4500216785
Client Project Number: 66066.2.1
Progress Report: Performed due diligence on the qualifications of Infinite Construction. Reviewed project submittals and performed
three (3) intermittent on -call site inspections to review conformance with design concepts. Prepared and submitted a letter of
certification.
Professional Engineering Services October 21, 2021 through March 31, 2022
Project Phase Fee % Complete Fee Earned Prior Billing Current Billing Fee Remainder
Professional Services: $ 2,814.00 $ 2,814.00 $ - $ 2,814.00 $ -
Task 2.2 - Post Design $ 2,814.00 100% $ 2,814.00 $ 2,814.00 $ -
Total Professional Services: $ 2,814.00
Total Invoice: $ 2,814.00
Project Aging Summary
Inv No. Inv Date Inv. Amount Current Over 30 Over 60 Over 90 Over 120
Remit ACH payment to: KCI Technologies, Inc.
Routing (ABA): 061-000-104
Account Number: 1000168252970
SWIFT: SNTRUS3A
Remit Check payment to: KCI Technologies, Inc.
P. O. Box 791479
Baltimore. MD 21279-1479
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FLORIDA TRAFFIC CRASH REPORT HIGHWAY SAFETY & MOTOR VEHICLES,
LONG FORM ❑K SHORT FORM UPDATE TRAFFIC CRASH RECORDS
NEIL KIRKMAN BUILDING, TALLAHASSEE, FL 32399-0537
(Electronic Version)
Date of Crash Time of Crash I Date of Report Invest. Agency Report Number HSMV Crash Report Number
10/Novi202O 08:10 PM 10iNov/2020 08-10 PM 101Nov12020 08,44 PM FHPF20OFF048757 88352364
CRASH IDENTIFIERS
w
County Code
City Code
County of Crash
Place or City of Crash
Within City Limits
Time ReportedrOiN.Dispatched
64
0
COLLIER
UNINCORPORATED
No
101Nov12020v12020
08:13 PM8:16
PM
Time on Scene
Time Cleared Scene
Completed
Reason (if Investigation NOT Completed)
Notified By
1O1Nov12020
101NoW2020 09:32
Yes
Law Enforcement
08.33 PM
PM
ROADWAY INFORMATION
Crash Occured On Street, Road, Highway 0 Al Street Address# Al Laltilude�ffl1V�- and Longitude
CR-846 (IMMOKALEE RD) 26.2728399#9999-81.754260000000002
At Feet Or Miles Direction DFrom Intersection With Street, Road, Highway \� \\ () Or From Milepost #
CR-881 (LIVINGSTON RD)
Road System Identifier Type Of Shoulder e Of Intersecppn
144
4 County 3 Curb '`8 Four -Way Intersection
CRASH INFORMATION (Check if Pictures Taken) n
light Condition
Weather Condition
Roadway Surface Condition
School Bus
a Manner Of Collision
4 Dark -Lighted
1 Clear
1 Dry
1 No Ilk-' 77 Other, Explain in Narrative
First Harmful Event Type
First Harmful Event
First Harmful Event Locatio�
Within Int nge
First Harmful Event Relation to Junction
22
3 Shoulder
3 Intersection -Related
Contributing CircumstancesRoad
Contributing Circumslances Road
Conlributitng Circumstances Road
1 None
Contributing Circumstances: Environment
Contributing Circumstances: Environment
Contributing Circumstances. Environment
1 None
Work Zone Related
Crash In Work Zone
Type Of Work Zone
Workers In Work Zone
Law Enforcement In Work Zone
1 No
VEHICLE (Check if Commercial) n (' M117 .`J
Vehicle
Motor Vehicle Type
Hit and Run
Veh License Number ate
Re _ xpires
P ianent Reg_
VIN
1
1 Vehicle in Transport
1 No
NWVT64 FL
1Sep/2021
No
iFTNE24W86DA70221
Year
Make
Model
Style
Color
Extent of Dama
Est. Damage
Towe ue To Damage
Vehicle Removed By
Rotation
2006
FORD
E250
VAN
WHI
Disabli
I
1000 '�
Y
MORLEYS BODY SHOP
Rotation
Insurance Company
Iante Poli er
G EI CO
, 6002006218
Name of Vehicle Owner (Check Box If Business) Address (N r and t) City and State Zip Code
JAMES RYAN FORTUNATO QUAIL FOR LVD 0 NAPLES FL 34105-5591
Trailer
License Number
State
Reg_ Expires
Per t Reg
VIN
Year
Make
Length
Axles
One
Trailer
License Number
Stale
Reg_ Expires
Permanent Reg
V
Year
Make
Length
Axles
Two'
Vehicle
Direction
On Street, Road, Highway — At
Est. Speed
Posted Speed
Total Lanes
Traveling.
East
CR-846 (IMMOK EE J
60
45
6
CMV Coniiguralion
Cargo Body Type
Area of Initial Impact
Most Damaged Area
as e
a s e2 r e-Urd—risge
CommGVWR/GCWR
Trailer Iype(lrailerone)
Trai&Type (lrailertwo)
I
s 1
A 17 a 19. overtum
. Trailer
20. Windshield
21.TrailerHaz.Mat.Release
HazMat.Pla umber
llt,
Class
Motor Carrier Name US
DOT Number
Motor Carrier Address City and Stale Zip Code Phone Number
Comm/Non-Commercial
Vehicle Body T
Vehicle Defects (one)
Vehicle Defects (two)
Emergency Vehicle Use
Specival Function of MV
17 Cargo Va 0,000 Ibs
1 None
1 No
1 No Special Function
(4,536,W or less)
Vehicle Maneuver Action
Traificway,
Roadway Grade
Roadway Alignment
Most Harmful Event
Most Harmful Event Detail
1 Straight Ahead
4 TVay, Divided,
1 Level
1 Straight
3 Collision with Fixed Object
22 Bridge Rail
Po Median Barrier
Traffic Control Device For This Ve cle First
(1) Sequence of Events
Second (2) Sequence of Events
Third (3) Sequence of Events
Fourth (4) Sequence of Events
1 No Controls ,I�
3 Collision with Fixed Object
35 Traffic Signal Support
22 Bridge Rail
24 Curb
ramoull rS CI.V I"rU
Person# Description Vehicle # Name Date of Birth Sex one Number Re -Exam
1 .Driver 1 JAMES RYAN FORTUNATO 161Sep11996 1 Male Yes
Address Qj City State Zip Code
320 QUAIL�6REST BLVD APT 403 NAPLES FL 34105
Driver License Number Stale Expires DLType Req End Injury Severity Ejection
F635456963360 FL 16/Sep12028 5 ElOperalor 3 No Req 3 Non -incapacitating 1 Not Ejected
Endorsement
HSMV 90010 S
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Date of Crash
Date of Report
Invest_ Agency Report Number
HSMV Crash Report Number
101Nov/2020 08:10 PM
101Nov12020 08:10 PM
FHPF20OFF048757
SB352364
Restraint System
Air Bag Deployed
Helmet Use
Eye Protection
Sealing Localion Seal
Sealing Location Row
Sealing Location Other
3 Shoulder and Lap Bell
3 Deployed -Front
1 Left
1 Front
Used
Drivers Actions at Time of Crash (first)
Drivers Actions at Time of Crash (second)
Driver Distracted By Vision
Obstruction
1 No Contributing Action
1 Not Distracted
1 Vision Not Obscured
Drivers Actions at Time of Crash (third)
Drivers Actions of Time of Crash (fourth)
Drivers Condition at Time of Crash
6 Seizure, Epilepsy, Black f9�
Suspected Alcohol Use
Alcohol Tested
Alcohol Test Type
Alcohol Test Result
BAG
Suspected Drug Use
Drug Tested
Drug Test Type
g Test Result
1 No
1 Test Not
1 No
1 Test Not Given
Given
Source of Transport to Medical Facility
EMS Agency Name or ID
EMS Run Number
Medical Facility Transported .
2 EMS
COLLIER COUNTY EMS
LEE MEMORIAL HOSPITAL
NON VEHICLE PROPERTY DAMAGE
Vehiclel Person# Property Damage - Other Than Vehicle Est_ Amount Business Owner's Name Address City & State Zip Code
CONCRETE BRIDGE RAIL 35000 Yes COLLIER COUNTY 4800 DA LVD NAPLES FL 34104
ROADANDBRIDGE
NON VEHICLE PROPERTY DAMAGE
Vehiclel Person# Property Damage - Other Than Vehicle Est. Amount Business Owner's Name Addref City & State Zip Code
CROSSWALK SIGNAL 5000 Yes COLLIER COUNTY DOT 4800 DAVIS BLVD NAPLES FL 34104
NARRATIVE d
ID Number Rank Name Troop / Post Officer Agency Phone Number Date Created
651 TPR L.C. LEMEN F FLORIDA HIGHWAY PATROL 239-344-1730 Nov 11, 2020
Vol was traveling east on CR-846 (Immokalee Rd). As Vol approached CR-881 ((Livingston Rd) D01 of Vol sufferededical episode that incapacitated D01. Vol traveled
in a northeast direction through the intersection of CR�46 and CR-881. Vol collided with a crosswalk sign and th¢ ncrete rail on the bridge at the northeast corner of
CR-846 and CR-881. Vol came to a final rest at the area of collision.
D01 has been submitted for a medial re -exam- A
REPORTING OFFICER
4651 1 TPR L.C. LEMEN
Page 2 of 3
GHWAY PATROL
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Date of Crash Date of Report Invesl_ Agency Report Number
101Nov/2020 08:10 PM 101Nov12020 08:10 PM FHPF20OFF048757
HSMV Crash Report Number
88352364
NOT TO SCALE
�UuES V ITFi CROSS WALK' SIGN
�
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