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Agenda 01/14/2025 Item #11D (Award ITB #24-8284 "Caxambas Hurricane Ian Permanent Fuel Tank Installation" to Don Wood Inc.)Proposed Agenda Changes Board of County Commissioners Meeting January 14, 2025 Add -on Item 10B: *** This item is to be heard at 11 AM. *** Recommendation to approve the Guaranteed Maximum Price ("GMT") First Amendment to Agreement No. 21-7919-ST, Construction Management at Risk ("CMAR" ), with DeAngelis Diamond Construction LLC, for construction services for the Collier County Behavioral Health Center project (formerly the Mental Health Facility) in the amount of $49,856,251, authorize the Chairman to sign the attached amendment, and approve the necessary Budget Amendment. (Fund 3018, Project 50239). (Commissioner Saunders Request) Move Item16F4 to 11D: Recommendation to award Invitation to Bid ("ITB") No. 24-8284, "Caxambas Hurricane Ian Permanent Fuel Tank Installation" to Don Wood Inc., in the amount of 5667,164.00, approve an Owners Allowance of $123,504.00 for potential unforeseen conditions, and authorize the Chairman to sign the attached Agreement (Project No. 50280). (Commissioner McDaniel's Request) Move Item 16F6 to 11E: Recommendation to authorize expenditures for the sole source purchase of ProlakelKeeton aerators and related materials from Keeton Industries, Inc., through a waiver from the competitive process in the amount of $250,000 per fiscal year from Keeton Industries, Inc., through Fiscal Year 2029. (Commissioner McDaniel's Request) Notes: Item 16A14 the table should read $2,200, 000 for the Estimated Value and $1,164, 021 for the Estimated Value per acre for the "Category C"property located at 1063 Shadoit laivn. (Staffs Request) Items 9C and 9D are companions to Item 9B, not Item 9A TIME CERTAIN ITEMS: Add on Item 19B: *** This item is to be heard at 11 AM. *** Central Receiving Facility Guaranteed Maximum Price (GMP) IJ1312025 9:53 Phi 1/14/2025 Item # 16.F.4 ID# 2024-2262 Executive Summary Recommendation to award Invitation to Bid (“ITB”) No. 24-8284, “Caxambas Hurricane Ian Permanent Fuel Tank Installation” to Don Wood Inc., in the amount of $667,164.00, approve an Owners Allowance of $123,504.00 for potential unforeseen conditions, and authorize the Chairman to sign the attached Agreement (Project No. 50280). OBJECTIVE: Approval to award an Invitation to Bid to build a new permanent fuel system at Caxambas Park. CONSIDERATIONS: This project involves installing a new permanent fuel system at Caxambas Park. Hurricane Ian destroyed the previous permanent fuel system. The new fuel system will include a new above-ground REC-90 fuel tank, two credit card-capable fuel dispensers, a Feeder-Root fuel management system, new conduit and related work for fuel, low voltage, electrical lines, a new point-of-sale system, and all related site work. On July 12, 2024, the Procurement Services Division issued ITB No. 24-8284, “Caxambas Hurricane Ian Permanent Fuel Tank Installation.” The County received three bids by the September 18, 2024, submission deadline, as summarized below: Staff reviewed the bids received and found all three bidders responsive and responsible, with Don Wood, Inc. (“Don Wood”) as the lowest, responsive, and responsible bidder. Staff recommends the attached agreement be awarded to Don Wood for the total bid amount of $667,164.00. In addition, staff has allocated $123,504 as an Owner’s Allowance for unforeseen site conditions that might be encountered during construction and asks that the amount be approved as part of the Purchase Order issued to commence the work. Use of the allowance will be as directed by the County, with proper supporting documentation to be submitted by the contractor for any additional allowance work that is authorized and completed. The County’s engineering consultant, LJA Engineering, Inc. (“LJA”), contacted many of Don Wood’s project references and determined that Don Wood has sufficient relevant experience with similar projects to demonstrate that they possess the required experience to complete the project successfully. The low bid for this project is approximately 8% higher than the LJA’s Engineer’s Opinion of a Probable Construction Cost of $617,520. Don Wood, Inc., is a Florida corporation formed in 1967, and is registered with the Florida Department of Business and Professional Regulation as a Construction Business and a Certified Pollutant Storage Contractor with current active registrations. LJA Engineering, Inc. and staff recommend that Don Wood, Inc. be awarded the Caxambas Hurricane Ian Permanent Fuel Tank Installation Project as set forth above. FISCAL IMPACT: Funding in the amount of $790,668 is available in the FEMA Grants Fund (1813), Project 50280 (Hurricane Ian). Partial FEMA reimbursement is anticipated less any insurance proceeds. GROWTH MANAGEMENT IMPACT: There is no Growth Management impact associated with this Executive Summary. Page 5333 of 6405 1/14/2025 Item # 16.F.4 ID# 2024-2262 LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires majority vote for Board approval. —SRT RECOMMENDATIONS: Recommendation that the board award ITB No. 24-8284, “Caxambas Hurricane Ian Permanent Fuel Tank Installation,” to Don Wood Inc., in the amount of $667,164.00, approve an Owners Allowance of $123,504.00, and authorize the Chairman to sign the attached Agreement (Project No. 50280). PREPARED BY: Camden Smith, Project Manager II, Facilities Management ATTACHMENTS: 1. 24-8284 NORA 2. 24-8284 VS_Don Wood Inc 3. DELORA 4. SunBiz_Don Wood, Inc. 5. 24-8284 Bid Tabulation 6. 24-8284 COIs in Compliance_Don Wood_12.4.24 Page 5334 of 6405 Page 5335 of 6405 Page 5336 of 6405 Page 5337 of 6405 Page 5338 of 6405 Page 5339 of 6405 Page 5340 of 6405 Page 5341 of 6405 Page 5342 of 6405 Page 5343 of 6405 Page 5344 of 6405 Page 5345 of 6405 Page 5346 of 6405 Page 5347 of 6405 Page 5348 of 6405 Page 5349 of 6405 Page 5350 of 6405 Page 5351 of 6405 Page 5352 of 6405 Page 5353 of 6405 Page 5354 of 6405 Page 5355 of 6405 Page 5356 of 6405 Page 5357 of 6405 Page 5358 of 6405 Page 5359 of 6405 Page 5360 of 6405 Page 5361 of 6405 Page 5362 of 6405 Page 5363 of 6405 Page 5364 of 6405 Page 5365 of 6405 Page 5366 of 6405 Page 5367 of 6405 Page 5368 of 6405 Page 5369 of 6405 Page 5370 of 6405 Page 5371 of 6405 Page 5372 of 6405 Page 5373 of 6405 Page 5374 of 6405 Page 5375 of 6405 Page 5376 of 6405 Page 5377 of 6405 Page 5378 of 6405 Page 5379 of 6405 Page 5380 of 6405 Page 5381 of 6405 Page 5382 of 6405 Page 5383 of 6405 Page 5384 of 6405 Page 5385 of 6405 Page 5386 of 6405 Page 5387 of 6405 Page 5388 of 6405 Page 5389 of 6405 Page 5390 of 6405 Page 5391 of 6405 Page 5392 of 6405 Page 5393 of 6405 Page 5394 of 6405 Page 5395 of 6405 Page 5396 of 6405 Page 5397 of 6405 Page 5398 of 6405 Page 5399 of 6405 Page 5400 of 6405 Page 5401 of 6405 Page 5402 of 6405 Page 5403 of 6405 Page 5404 of 6405 Page 5405 of 6405 Page 5406 of 6405 Page 5407 of 6405 Page 5408 of 6405 Page 5409 of 6405 Page 5410 of 6405 Page 5411 of 6405 Page 5412 of 6405 Page 5413 of 6405 Page 5414 of 6405 Page 5415 of 6405 Page 5416 of 6405 Page 5417 of 6405 Page 5418 of 6405 Page 5419 of 6405 Page 5420 of 6405 Page 5421 of 6405 Page 5422 of 6405 Page 5423 of 6405 Page 5424 of 6405 Page 5425 of 6405 Page 5426 of 6405 Page 5427 of 6405 Page 5428 of 6405 Page 5429 of 6405 Page 5430 of 6405 Page 5431 of 6405 Page 5432 of 6405 Page 5433 of 6405 Page 5434 of 6405 Page 5435 of 6405 Page 5436 of 6405 Page 5437 of 6405 Page 5438 of 6405 Page 5439 of 6405 Page 5440 of 6405 Page 5441 of 6405 Page 5442 of 6405 Page 5443 of 6405 Page 5444 of 6405 Page 5445 of 6405 Page 5446 of 6405 Page 5447 of 6405 Page 5448 of 6405 Page 5449 of 6405 Page 5450 of 6405 Page 5451 of 6405 Page 5452 of 6405 Page 5453 of 6405 Page 5454 of 6405 Page 5455 of 6405 Page 5456 of 6405 Page 5457 of 6405 Page 5458 of 6405 Page 5459 of 6405 Page 5460 of 6405 Page 5461 of 6405 Page 5462 of 6405 Page 5463 of 6405 Page 5464 of 6405 Page 5465 of 6405 Page 5466 of 6405 Page 5467 of 6405 Page 5468 of 6405 Page 5469 of 6405 Page 5470 of 6405 Page 5471 of 6405 Page 5472 of 6405 Page 5473 of 6405 Page 5474 of 6405 Page 5475 of 6405 Page 5476 of 6405 Page 5477 of 6405 Page 5478 of 6405 Page 5479 of 6405 Page 5480 of 6405 Page 5481 of 6405 Page 5482 of 6405 Page 5483 of 6405 Page 5484 of 6405 Page 5485 of 6405 Page 5486 of 6405 Page 5487 of 6405 Page 5488 of 6405 Page 5489 of 6405 Page 5490 of 6405 Page 5491 of 6405 Page 5492 of 6405 Tab 2 - Appendix H2 – Template - DELORA Vendor Reference Check Log - rev 02-14-20 VENDOR REFERENCE CHECK LOG Solicitation No.: 24-8284 Reference Check by: Dominick Amico, P.E. Solicitation Title: Caxambas Boat Ramp Fuel Tank Date: 9/27/24 Bidder’s Name: Don Wood, Inc. Phone: 239-597-3111 Design Entity: LJA Engineering, Inc. REFERENCED PROJECT: Project Name: Fuel Site Closures 24-0309- ITB-C Project Location: 2 site-Largo and St. Pete Project Description: Decommission 2 site to remove 8K ASTs Completion Date: September 2024 Contract Value: $75.000.00 Project Owner/Title: Pinellas County Board of County Commissioners Owner’s Address: POB 2438 Clearwater, FL 33757 Phone: 727-582-3038 Owner’s Contact Person: John Neal, PM E-Mail: janeal@pinellascounty.org 1. Was project completed timely and within budget? (If not, provide detail) 2. Was the submittal/review process performed satisfactorily? (If not, provide detail) 3. Was the construction process performed satisfactorily? (If not, provide detail) 4. Did the process run smoothly? Were there any changes? Describe below. 5. Was the contract closeout process performed satisfactorily? (If not, provide detail) 6. Any warranty issues since closeout? Were they responded to and performed satisfactorily? 7. Additional comments: Yes Yes Yes Yes without changes Yes, but delayed due to rain which extended punch list completion. No warranty issues. Page 5493 of 6405 Tab 2 - Appendix H2 – Template - DELORA Vendor Reference Check Log - rev 02-14-20 VENDOR REFERENCE CHECK LOG Solicitation No.: 24-8284 Reference Check by: Dominick Amico, P.E. Solicitation Title: Caxambas Boat Ramp Fuel Tank Date: 9/27/24 Bidder’s Name: Don Wood, Inc. Phone: 239-597-3111 Design Entity: LJA Engineering, Inc. REFERENCED PROJECT: Project Name: HCA Florida Hospital Osceola 10,000-gallon UST Install Project Location: Kissimmee, FL Project Description: 10K UST Install Completion Date: May 2024 Contract Value: $472,737.00 Project Owner/Title: HCA Osceola-Coastal Mechanical Owner’s Address: 2425 E Landstreet Rd., Orlando, FL 32824 Phone: 386-689-3297 Owner’s Contact Person: Luke Bauer, PM E-Mail:lbauer@coastalmechanical.com 1.Was project completed timely and within budget? (If not, provide detail) 2.Was the submittal/review process performed satisfactorily? (If not, provide detail) 3.Was the construction process performed satisfactorily? (If not, provide detail) 4.Did the process run smoothly? Were there any changes? Describe below. 5.Was the contract closeout process performed satisfactorily? (If not, provide detail) 6.Any warranty issues since closeout? Were they responded to and performed satisfactorily? 7.Additional comments: Page 5494 of 6405 VENDOR REFERENCE CHECK LOG Solicitation No.: 24-8284 Reference Check by: Dominick Amico, P.E. Solicitation Title: Caxambas Boat Ramp Fuel Tank Date: 9/27/24 Bidder’s Name: Don Wood, Inc. Phone: 239-597-3111 Design Entity: LJA Engineering, Inc. REFERENCED PROJECT: Project Name: Orange County Fleet-Apopka Service Center 15,000-gallon UST Replacement FDEP Facility ID 48-8627845 Project Location: Apopka, FL Project Description: 15K UST Replacement Completion Date: July 2024 Contract Value: $418,233.00 Project Owner/Title: Board of County Comm, Orange County Owner’s Address: 400 E South St., Orlando, FL 32801 Phone: 407-836-0051 Owner’s Contact Person: Randy Nixon, PM E-Mail: Randy.Nixon@ocfl.net 1. Was project completed timely and within budget? (If not, provide detail) Yes 2. Was the submittal/review process performed satisfactorily? (If not, provide detail) Yes 3. Was the construction process performed satisfactorily? (If not, provide detail) Yes 4. Did the process run smoothly? Were there any changes? Describe below. Yes 5. Was the contract closeout process performed satisfactorily? (If not, provide detail) Currently Ongoing 6. Any warranty issues since closeout? Were they responded to and performed satisfactorily? Not as of Yet 7. Additional comments: This project referenced is part of an ongoing overall project consisting of the replacement of USTs at (3) County locations. The work at the Apopka Service Center has been completed. Tab 2 - Appendix H2 – Template - DELORA Vendor Reference Check Log - rev 02-14-20 10/4/24 Page 5495 of 6405 VENDOR REFERENCE CHECK LOG Solicitation No.: 24-8284 Reference Check by: Dominick Amico, P.E. Solicitation Title: Caxambas Boat Ramp Fuel Tank Date: 9/27/24 Bidder’s Name: Don Wood, Inc. Phone: 239-597-3111 Design Entity: LJA Engineering, Inc. REFERENCED PROJECT: Project Name: Orange County Fleet-Ocoee Service Center 15,000 gallon UST Replacement. FDEP Facility ID 48-9045992 Project Location: Ocoee, FL Project Description: 15K UST Replacement Completion Date: May 2024 Contract Value: $411,639.00 Project Owner/Title: Board of County Comm, Orange County Owner’s Address: 400 E South St., Orlando, FL 32801 Phone: 407-836-0051 Owner’s Contact Person: Randy Nixon, PM E-Mail: Randy.Nixon@ocfl.net 1. Was project completed timely and within budget? (If not, provide detail) Yes 2. Was the submittal/review process performed satisfactorily? (If not, provide detail) Yes 3. Was the construction process performed satisfactorily? (If not, provide detail) Yes 4. Did the process run smoothly? Were there any changes? Describe below. Yes 5. Was the contract closeout process performed satisfactorily? (If not, provide detail) Currently Ongoing 6. Any warranty issues since closeout? Were they responded to and performed satisfactorily? Not as of Yet 7. Additional comments: This project referenced is part of an ongoing overall project consisting of the replacement of USTs at (3) County locations. The work at the Ocoee Service Center has been completed. Tab 2 - Appendix H2 – Template - DELORA Vendor Reference Check Log - rev 02-14-20 10/4/24 Page 5496 of 6405 Tab 2 - Appendix H2 – Template - DELORA Vendor Reference Check Log - rev 02-14-20 VENDOR REFERENCE CHECK LOG Solicitation No.: 24-8284 Reference Check by: Dominick Amico, P.E. Solicitation Title: Caxambas Boat Ramp Fuel Tank Date: 10/17/24 Bidder’s Name: Don Wood, Inc. Phone: 239-597-3111 Design Entity: LJA Engineering, Inc. REFERENCED PROJECT: Project Name: MHC Riverwatch-Loggerhead Marina Project Location: St. Petersburg, FL Project Description: 12K UST closure and 12K AST Install Completion Date: August 2024 Contract Value: $146,973.00 Project Owner/Title: Owner’s Address: Phone: 772-274-5508 Owner’s Contact Person: Luke Crawford E-Mail: 1. Was project completed timely and within budget? (If not, provide detail) Yes 2. Was the submittal/review process performed satisfactorily? (If not, provide detail) N/A 3. Was the construction process performed satisfactorily? (If not, provide detail) The primer and pain on the AST (above ground tank) is satisfactory however the crew did not finish the Underneath of the tank. Therefore, the contractor must return to complete the work. 4. Did the process run smoothly? Were there any changes? Describe below. Yes, except for extended schedule. 5. Was the contract closeout process performed satisfactorily? (If not, provide detail) Not yet closed out. 6. Any warranty issues since closeout? Were they responded to and performed satisfactorily? Not yet within warranty period. 7. Additional comments: Work was average and completed part of the job. Team worked consistently when on site. Job was not completed as they missed the prep of the bottom portion of tank and have yet to complete. Payment is withheld to date. Page 5497 of 6405 Document Number FEI/EIN Number Date Filed State Status Last Event Event Date Filed Event Effective Date Department of State / Division of Corporations / Search Records / Search by Entity Name / Detail by Entity Name Florida Profit Corporation DON WOOD, INC. Filing Information 315614 59-1167805 04/06/1967 FL ACTIVE AMENDMENT 09/17/2024 NONE Principal Address 6501 OLD WINTER GARDEN ROAD ORLANDO, FL 32835-1299 Changed: 02/06/2006 Mailing Address 6501 OLD WINTER GARDEN ROAD ORLANDO, FL 32835-1299 Changed: 02/06/2006 Registered Agent Name & Address DIAZ ROSARIO, LUIS A 6501 OLD WINTER GARDEN RD ORLANDO, FL 32835 Name Changed: 01/27/2022 Address Changed: 03/27/1997 Officer/Director Detail Name & Address Title PRESIDENT D C Florida Department of State 11/5/24, 3:09 PM Detail by Entity Name https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=DONWOO…1/3Page 5498 of 6405 DIAZ ROSARIO, LUIS A 6501 OLD WINTER GARDEN ROAD ORLANDO, FL 32835-1299 Title V COLVIN, KIRK P 1107 WINEBERRY CT OCOEE, FL 34761 Annual Reports Report Year Filed Date 2022 01/27/2022 2023 01/24/2023 2024 01/05/2024 Document Images 09/17/2024 -- Amendment View image in PDF format 01/05/2024 -- ANNUAL REPORT View image in PDF format 01/24/2023 -- ANNUAL REPORT View image in PDF format 01/27/2022 -- ANNUAL REPORT View image in PDF format 01/04/2021 -- ANNUAL REPORT View image in PDF format 01/06/2020 -- ANNUAL REPORT View image in PDF format 06/14/2019 -- ANNUAL REPORT View image in PDF format 02/05/2018 -- ANNUAL REPORT View image in PDF format 01/04/2017 -- ANNUAL REPORT View image in PDF format 01/04/2016 -- ANNUAL REPORT View image in PDF format 01/06/2015 -- ANNUAL REPORT View image in PDF format 01/10/2014 -- ANNUAL REPORT View image in PDF format 01/18/2013 -- ANNUAL REPORT View image in PDF format 01/12/2012 -- ANNUAL REPORT View image in PDF format 02/01/2011 -- ANNUAL REPORT View image in PDF format 01/05/2010 -- ANNUAL REPORT View image in PDF format 02/12/2009 -- ANNUAL REPORT View image in PDF format 04/14/2008 -- Off/Dir Resignation View image in PDF format 04/14/2008 -- Off/Dir Resignation View image in PDF format 01/11/2008 -- ANNUAL REPORT View image in PDF format 01/05/2007 -- ANNUAL REPORT View image in PDF format 10/05/2006 -- Amendment View image in PDF format 02/06/2006 -- ANNUAL REPORT View image in PDF format 01/10/2005 -- ANNUAL REPORT View image in PDF format 01/12/2004 -- ANNUAL REPORT View image in PDF format 02/06/2003 -- ANNUAL REPORT View image in PDF format 02/04/2002 -- ANNUAL REPORT View image in PDF format 02/08/2001 -- ANNUAL REPORT View image in PDF format 01/28/2000 -- ANNUAL REPORT View image in PDF format 11/5/24, 3:10 PM Detail by Entity Name https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=DONWOO…2/3Page 5499 of 6405 02/15/1999 -- ANNUAL REPORT View image in PDF format 01/20/1998 -- ANNUAL REPORT View image in PDF format 03/27/1997 -- ANNUAL REPORT View image in PDF format 02/02/1996 -- ANNUAL REPORT View image in PDF format 02/21/1995 -- ANNUAL REPORT View image in PDF format Florida Department of State, Division of Corporations 11/5/24, 3:10 PM Detail by Entity Name https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=DONWOO…3/3Page 5500 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Caxambas Hurricane Ian Permanent Fuel Tank Installation Construction ITB No. 24-8284 BID TABULATION GENERAL BASE SCOPE Item No.Description Qty Unit Don Wood, Inc.Douglas N. Higgins, Inc.Capital Contractors, LLC ENGINEER 4.1 Mobilization 1 LS $37,500.00 $40,000.00 $84,275.00 $56,000.00 4.2 Civil Site Work 1 LS $46,500.00 $130,000.00 $868,000.00 $7,500.00 4.3 Mechanical 1 LS $459,660.00 $591,178.00 $147,500.00 $527,500.00 4.4 Landscape & Misc 1 LS $123,504.00 $110,000.00 $85,750.00 $26,520.00 TOTAL BID AMOUNT: $667,164.00 $871,178.00 $1,185,525.00 $617,520.00 *Staff has allocated $123,504 in Owner's 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 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. Don Wood, Inc.Douglas N. Higgins, Inc.Capital Contractors, LLC Yes/No Yes/No Yes/No Bid Schedule Yes Yes Yes Bid Response Form (Form 1)Yes Yes Yes Contractors Key Personnel Assigned to Project - (Form 2)Yes Yes Yes Material Manufacturers (Form 3)Yes Yes Yes List of Major Subcontractors (Form 4)Yes Yes Yes Statement of Experience of Bidder (Form 5)Yes Yes Yes* Trench Safety Act Acknowledgement (Form 6)Yes Yes Yes Bid Bond (Form 7)Yes Yes Yes Insurance and Bonding Requirements (Form 8)Yes Yes Yes Conflict of Interest Affidavit (Form 9)Yes Yes Yes Vendor Declaration Statement (Form 10)Yes Yes Yes Immigration Affidavit Certification (Form 11)Yes Yes Yes Addendums (6)Yes*Yes Yes Grants Package Yes*Yes Yes E-Verify Yes Yes Yes W-9 Yes Yes Yes SunBiz Yes Yes Yes License Yes Yes Yes Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5501 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5502 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5503 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5504 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5505 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5506 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5507 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5508 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5509 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5510 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5511 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5512 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5513 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5514 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5515 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5516 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5517 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5518 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5519 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5520 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5521 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5522 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5523 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5524 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5525 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5526 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5527 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5528 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5529 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5530 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5531 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5532 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5533 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5534 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5535 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5536 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5537 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5538 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5539 of 6405 Project Manager: Camden Smith Procurement Strategist: Rita Iglesias Notifications Sent: 2,073 Viewed: 663 Bids Received: 3 Opened By: Rita Iglesias Witnessed By: Barbara Lance Date: 9/18/2024 3:00 PM Page 5540 of 6405 INSURANCE REQUIREMENTS COVERSHEET Project Name Vendor Name Solicitation/Contract No. Attachments Risk Approved Insurance Requirements Risk Approved Insurance Certificate(s) Comments Attachments Approved by Risk Management Division Approval: Page 5541 of 6405 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD WOODD-1 OP ID: AD 12/04/2024 Jim Beam, CIC Monroe & Monroe Insurance Agency, Ltd. 2921 Galleria Dr., Suite 102 Arlington, TX 76011 Jim Beam, CIC 817-640-5035 817-640-0131 Mid-Continent Casualty Co. Don Wood, Inc. 6501 Old Winter Garden Road LLC 6501 Old Winter Garden Rd. Orlando, FL 32835 A X 1,000,000 X X 04GL1121214 07/31/2024 07/31/2025 100,000 A X -0- A X 1,000,000 2,000,000 X 2,000,000 X 2,000,000 X A 04XS235726 07/31/2024 07/31/2025 2,000,000 A 04CIM45170 07/31/2024 07/31/2025 Instl. 250,000 A Lsd/Rntd Equip 04CIM45170 07/31/2024 07/31/2025 500K Itm 500K Loc Project No. 24-8284 The General Liability policy includes a blanket additional insured endosement, which provides additional insured status to Collier County Board of County Commissioners, when there is a written "insured contract" between the named insured and those which require such status. COLLIE5 Collier County Board of County Commissioners 3295 Tamiami Trail E Naples, FL 34112 817-640-5035 23418 Pollution Liab Professional Liab Installation Fltr Page 5542 of 6405 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 12/4/2024 Alexander Insurance Agency 541 South Orlando Avenue,Suite 206 Maitland FL 32751 Jennifer Vann 407-629-5346 407-629-5407 jvann@alexfinancial.com License#:L029632 Travelers Casualty Ins Co Amer 19046 DONWOOD-01 Travelers Insurance Company 25658DonWood,Inc. 6501 Old Winter Garden Road Orlando FL 32835 1361389207 A 1,000,000 X BA4S287653 7/31/2024 7/31/2025 B X X 1,000,000EX2T5885187/31/2024 7/31/2025 RE:Project No.24-8284 Please see attached endorsement form(s): AUTO:CA T4 37 02 16;CA T4 74 02 16 Collier County Board of Commissioners 3295 Tamiami Trail East Naples FL 34112 USA Page 5543 of 6405 Don Wood, IncTravelers Casualty Insurance Company of AmericaPolicy #BA-4S287653-24-42-GTerm: 07/31/2024 - 07/31/2025 Page 5544 of 6405 Don Wood, IncTravelers Casualty Insurance Company of AmericaPolicy #BA-4S287653-24-42-GTerm: 07/31/2024 - 07/31/2025 Page 5545 of 6405 12/4/2024 LRA Insurance P.O. Box 948173 Maitland FL 32794 Danielle Coggon (407)838-3445 (407)838-3460 dcoggon@lrainsurance.com Don Wood, Inc. 6501 Old Winter Garden Road Orlando FL 32835 RetailFirst Insurance Company 10700 24/25 A 0520-61731 2/1/2024 2/1/2025 X 1,000,000 1,000,000 1,000,000 RE: Project No. 24-8284 Coullier County Board of County Commissioners 3295 Tamiami Trail E. Naples, FL 34112 John Lumbra/DCOGGE The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECT PRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person)$ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)LIMITS PER STATUTE OTH- ER E.L.EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes,describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S)AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INS025 (201401)Page 5546 of 6405