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Agenda 12/12/2017 Item #16E 912/12/2017 EXECUTIVE SUMMARY Recommendation to approve and authorize the Chair to sign the Assumption Agreement with Water Treatment & Controls Technology, Inc., as it relates to Agreement No. 13-6162R. OBJECTIVE: To assign Agreement No. 13-6162R to Water Treatment & Controls Technology, Inc. through an Assumption Agreement. CONSIDERATIONS: On June 24, 2014 (Agenda Item 16.C.1) the County entered into an Agreement with Water Treatment & Controls Company for Chlorinator Equipment Maintenance for the Water Division. As of March 1, 2017, Water Treatment & Controls Company is functioning as a d/b/a under Water Treatment & Controls Technology, Inc. Water Treatment & Controls Technology, Inc. is now the successor in interest with respect to the Agreement. Staff was notified of ownership and company name change on March 23, 2017, and obtained the necessary documents from Water Treatment & Controls Technology, Inc., which have been reviewed and approved by the County Attorney’s Office. The Procurement Services Division is recommending approval of the assumption of this assumption. The proposed Assumption Agreement assigns all rights, duties, benefits, and obligations under the Agreement No. 13-6162R to Water Treatment & Controls Technology, Inc. FISCAL IMPACT: There is no fiscal impact associated with this action. GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact associated with this action. LEGAL CONSIDERATIONS: The County Attorney has reviewed this item and approved it as to form and legality. Majority support is required for approval. JAK RECOMMENDATION: To approve and authorize the Chair to sign the proposed Assumption Agreement with Water Treatment & Controls Technology, Inc., as it relates to Agreement No. 13-6162R. Prepared by: Priscilla Doria, Procurement Strategist, Procurement Services Division ATTACHMENT(S) 1. Assumption & Exhibit A (PDF) 2. Backup Support (PDF) 12/12/2017 COLLIER COUNTY Board of County Commissioners Item Number: 16.E.9 Doc ID: 4203 Item Summary: Recommendation to approve and authorize the Chair to sign the Assumption Agreement with Water Treatment & Controls Technology, Inc., as it relates to Agreement No. 13-6162R. Meeting Date: 12/12/2017 Prepared by: Title: – Procurement Services Name: Priscilla Doria 11/13/2017 2:54 PM Submitted by: Title: – Procurement Services Name: Ted Coyman 11/13/2017 2:54 PM Approved By: Review: Administrative Services Department Paula Brethauer Level 1 Division Reviewer Completed 11/13/2017 2:59 PM Procurement Services Opal Vann Level 1 Purchasing Gatekeeper Completed 11/13/2017 3:15 PM Procurement Services Ted Coyman Additional Reviewer Completed 11/14/2017 8:56 AM Procurement Services Sandra Herrera Additional Reviewer Completed 11/14/2017 4:23 PM County Attorney's Office Jeffrey A. Klatzkow Level 2 Attorney Review Completed 11/15/2017 4:19 PM Administrative Services Department Len Price Level 2 Division Administrator Review Completed 11/16/2017 12:50 PM Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 11/16/2017 1:27 PM Office of Management and Budget Laura Wells Additional Reviewer Completed 11/16/2017 2:16 PM County Attorney's Office Scott Teach Level 3 County Attorney's Office Review Completed 11/17/2017 2:37 PM County Manager's Office Leo E. Ochs Level 4 County Manager Review Completed 11/29/2017 2:47 PM Board of County Commissioners MaryJo Brock Meeting Pending 12/12/2017 9:00 AM EXHIBIT A Co 7e -r C0.14nt Administrative Services Department ProCLlrei3'ment Ser,,ices Division PLEASE RETURN FORM & ADDITIONAL REQUIRED DOCUMENTS TO: Collier County Procurement Division: 3295 Tamiami Trail East, Naples, Florida 34112-4901 Email: Purops(OcolherEov.net MERGER/ACQUISITION REQUEST FORM: For all Board approved contracts, the Hoard of County Commissioners shall approve ail assignments of contracts requested by the predecessor contracting party, per (Procurement Ordinance (19) (8)).upon receipt of all proper documentation, Collier County Procurement will draft an Assumption Agreementwhich will be presented at the next available board meeting for Board approval and execution. Please select one of the following reasons: ❑ Merged with another company ❑ Sold to or bought out by another company [Dj1hange in Business Organization (Corporation to LLC, Sole Proprietor to Partnership, Etc.} Rr New Owner ❑ Other ADDITIONAL Documentation cannot be in the names of affilates, subsidiaries or parent companies. You will be notified if any REQUIRED additional information is needed based on the particulars of your firm's merger or acquisition. DOCUMENTS 1. Formal documentation of the acquisition/merger, signed by the Corporate Officer(s), showing the effective date of purchase, and/or a detailed Asset Purchase Agreement; 2. Official documentation of the new FEID number or statement that there has been no change to FEID number; 3. W-9 showing new company name; 4. Current Certification from the Florida Department of State, Division of Corporations showing firm's new name; 5. A current professional liability insurance certificate in the new name; 6. Department of Homeland Security's E -Verify MOU or profile page; and 7. Notarized corporate resolution listing the signatory as authorized to sign. Vendor Number (if known) OLD BUSINESS NAME AND INFORMATION NEW BUSINESS NAME AND INFORMATION Legal Name (as registered with the I115) Legal Name (as registered with the IRS) Water Treatment & Controls Company Water Treatment & Controls Technology, Inc. Assumed Name (doing business as) Assumed Name (doing business as) Water Treatment & Controls Company FEIN TAX ID 52-1402868 FEIN -TAX ID 81-4595108 Business Street Address 9900A N. Palafox St. Business Street Address 9900A N. Palafox St. Pensacola, FL 32534 Pensacola, FL 32534 Mailing Address/Remittance (if different from above) Mailing Address/Remittance (if different from above) Contact Name: Raymond F. Ross II Contact Name: Raymond F. ROSS II Phone Number: 850 474-1805 Phone Number: (850)474-1805 Email: chip@watertc.com Email: chip@watertc.com By submitting this form, you certify that: (a) you are authorized to represent the business listed above; (b) all the information you have provided above is true and correct; and (c) you are instructing and authorizing Collier County BCC to update the Vendor fife in our County SAP System. Your Name (Print Name) & Title Raymond F. Ross ll, Vice President & General Manager Signature Date i 10-26-17 Phone/ Email (8 0) 474-1805 - chip@watertc.com me se.la q� srzo� request Form Version 1) 10/20/2o17 Barbara Birgel 'rom: Barbara B' I < cola watertc.com> Sent: Thursday, April 06, 2017 2:02 PM To: bccapderk@co ierc er . Subject: ACH Information Change Attachments: 350712084430_0001.pdf; WTC W-9 Form for 2017.pdf; Bank Spec Sheet.pdf Importance: High Good afternoon. We have switched banking facilities so we need to have our ACH information updated. I have attached a letter explaining the situation, our new banking information, and a new W-9 form for your reference. If you have any questions, please give me a call or email me. Thank you, Barbara Birgel Inside Sales Representative Water Treatment & Controls Company 9900A North Palafox Street Pensacola, FL 32534 --PH (850) 474-1805 iX (850) 474-1776 Water Treatment & Controls Co, April 06, 2017 To: Finance Collier County Public Works 3299 Tamiami Trail East, Ste. 700 Naples, FL 34112 RE: Doing Business As (D/B/A) Update Dear (850) 474-1805 (800) 826.7699 (850) 474-1770 FAX 9900A N. PALAFOX S'1`RN.',T- PENSACOLA, FLORIDA 32534 We have some exciting news here at Water Treatment & Controls Company- we have undergone a business restructuring and our company is now functioning as a D/B/A under a new corporate entity. While we remain the same dedicated management and service team as you have experienced during our opportunities to serve you, we are always looking to improve our type and quality of services provided. It is with this intention that we have restructured our business operations. We wanted to update you as to these developments and provide the following current information: Corporate Entity: Florida Corporate Registration: FEIN: Address Remains: Office Tel Remains: Office Fax Remains: General Manager: Water Treatment & Controls Technology, Inc. D/B/A Water Treatment & Controls Co. P16000094949 81-4595108 9900A North Palafox St. Pensacola, Florida 32534-1227 850-474-1805 850-474-1776 Raymond F. "Chip" Ross, II (chip@waterte.com) Please let me know if there is additional information or contact that is needed at this time in order to complete our update. I have also enclosed a new W-9 Form for your files. We have always been honored by your trust in Water Treatment & Controls and we look forward to continuing to provide you with exceptional equipment and service. ,.Barbara Birgel Water Treatment & Controls Company Enc. Water Treatment & Controls Co. Caller your TIN in Vie appropri2ta box. The Flit! provided roast match the name giaen c n line i 3ra vt3id Sossa3 srcurisy number backup withhottiing. For individuals, this is qenerally your social security rtia€ober (55N). Hovvevcr, for a resi-cleat �aliert, sole proprii or disregarded entity, ace the fart 1 instructions ora pager 3- Tor other FFT entities, it is your eaanployer idenriiication number (EIN). If you do rot haver. number, see dour: to yet a � EE Mop pane 3. or Note. If the account is in mora than ;an =, n2r-ne, see the instructions for line i and Ina cha t on page 4 for Ereaploy®r jdentifiaata®n nu ober � guidelines on "'hose number to enter. FT- F—F-T- —, �E1l�il�f�i:] Ungar penalties of perjury, 1 certify that, 1. The nurrit,er shown on this farm is my correct iaxpayer denttfication number (or I am waiting for a m5mber to be issued to tie): and 2. 1 arta not subiect to backup wtithholoing because: la) I urn excin-pt from backrip withholding, or (b) I have: not been notified by the internal Revenue Service QfdS) that Fam srrEJtect to hackup withholding as a result of a fai3ure-to report all €`nterest'oruividends, or (r) the IRS has notified me that I am nn lnrger subject to backup withholding; and 3. 1 arts a t1.S. citizen Or other U.S. person iciefined bek- tw), -ilei 4. The FATCA code(s) entered on this corm (if any, indicating that 1 air exermpi from FATC)A reporting is correct. Cer&€fivation instructions. You must cross out item 2 above if you have been notified by the IFIS that you ars currently subject to backup withhoidi€ag because you have failed to rk°port A interaat and dividends can your tax return. For real esta_e transactions, itern 2 does nut apply. For mortgage interest paid, acquisition or FbPricionment of secured properly, cancellation of debt. contributior:s to an individual retirement arranger:aent (IRA)r and lea e€ally; payments Cather Baan interest and divil you are rot requ.irta4 to sign the cerdf's.a?ian, but you must prnvie'a your correct Tits'. See the Insttuotions on page 3. j -,r Signatureaf� ✓ / F/ wf �` U.S, person i� `-��' ✓'�F ,�;t.�, Date >R su rel In trued Sention references are tc thr ;^term€ leuer,,ue Core t,cdaas nthenoe noted Future det°etopnn nts. irl'crma-ion about de�aelopnrs7fs affect ting Form W -9. (such a5 iegisiaihzr enautett ;after ;ve release it) t ai csraru�.irsnvJlr�9. An Indi¢ldual or en6w (Form W-9 recuestca:) who is r€_rkuired to fife anintormAtnr reg€-im xfth the IRS roust obtain your correct taxptayor identification number!TIN) which may to yuur social security number(SSN), ii dividua, taxpayer ide'.'ItlfiCaiion number OTIM), accobon lnxpayer tdentification nurrror {ATIN), or empkoyer iden,lficiaion numbs; (EIPbi, to report or; sr.. Hfo;rrimion return the amount paid to you, or other arrrourt repWabFe on an in°.Qrrl iqc retL M- Exarn its of Wormation r2hUrrs inclods, W. are toot limited W. We fo4owinsg: • Forms 1099 -INT (ntens° eamoi 7r pard) . Form 1099 -DIV (rdiyiderao, iretrrdir,g ahcse from s'UQ4ca OF nwtual `sent+s) renin 7099-MISC-(various -,yrpes of irrcome, pi awaros, o; grass proceals) Forms 1090-s (stack or mutual fund saie-, and certaitr other t ansactiona by ProifFkryl ® Form 1009-S r0mceeds from real estate Iran-acJi?0ro) a Form t U99 -K (rnechani carr end `bird par -,y retwon, transact2Dns) Fenno 1098 (home mortgage in:ereift 109eE(student Joan Merest), IM-'= (tcitfon) • Fcrm ?099-C (canoed debt) • Fomi 1091)-A (acquisition or abanrorimml of secured property) U3,, F,:rrrn VV -13 only ityou ars a U,S. pe-,ior. (ociurimg a asidant elle ), :0 provide your correct TEN - €r you ring rot rePcrm Form W-9 to the rel w fh a TIN, Wu rareg)it tie suru,'ec., to backup wi,r#;.holding, See lVhar is backup withholding? on Pays 2. IIP sgning rig+ lled-out `ori, you: 1. Certify thkr, rhe TIN you arr., Living is currec; (or you are wai:;ng far a 1:,;Mb a, to be iasuacij, 2- Certify 9ha! you are not subject to backup vithhc4ai tg, cr 3. Ciairn exerni fruit badup ta'rthiialdinn if you area U - S. c:xerr=.pt r.xiyoe if aPpficab e, yo a ,are also ccr `ying °,hal as a U.S. pe :cors, ypr elJccablr �, 3ra ci any panne -'ship drrconae from ma U.S. trade ❑r ausinesa Is oe; subject :c ina w:•i'tit -inio rig tax on foreign paetnors' share of effeovely Income, ar: v. C'er'tify tflat 1i coda(s) rarrt'arad on this Poria (k any; indicatincg that you are exeraipt f sown the i=ATCA eepor_iri9, ;s carreci, See Whit is FATCAmperting? on page 2 for further information. Cat. NO. 101M Furrri M 9 (Rev- 12-201,=) Fou" for Taxpayer Give Form to the {f,ay. December IdentificationNumber n Certification ner.th ro not flefiartrnentofitheTreasury oftheTre-a send t S�I'!C$ �'&6'$i1@ 1$$�. IRS. In t a rrat ii Service I harm {as shi:wn of-: your income :ax retired. Name is recui,ed on this line; do nni leave this line bkaryK. Water Treatment & Controls Technology, Inc. 2 Business namaldls3'e+ua ded edit; name, 4 d4ferentfrorn 6bowt Water Treatment & Gonti Company --'--- _- 3 L'Pvsck approzariata box fir°edata€ tax chissifscatk ri; chock only e of the btlowing sevon boxes: 4 ExQmp icrns (cedes apply only tc Q r } indhridual/sole prmrietrx' or S orneration S Carparstion � Partnership � Tn:aklastate r:ertain eriwflas, nor 1nd;v;cluais; sea irst:.tci=teras an Paye 3): CL 2 s:n;19le-mernher LLC Limited Siabilit corn ars Freer".he tax class feation '-C aerpU elle.^, S S cur anon. P --partnership) X, Fxprnpt payee code ( f any) A Note. For'a si;;glr_rtiemaer LLC that is disregardad, do not chock CLC: check'he apprrpriate box in the line above for Exemption from 'ATCo" repcding the tax classification of the sirgie-marruber owner. code ;if acv} Ok-Aher Ise e laasrucsrogsi 9, .-m.':iett ttxturtvr:<.vl [wM, �? itis w��:3 e1 G Addams (number, street, and apt. on suite no_) Rmgaestur's name and address {opt',onal) 9900A N Palafox Street S {;ity, state; enc ZIP code, Pensacola, ~L 32534 7 List aceourt nurroer(s) hem (option alj Taxpayer Identification Number (TIN) Caller your TIN in Vie appropri2ta box. The Flit! provided roast match the name giaen c n line i 3ra vt3id Sossa3 srcurisy number backup withhottiing. For individuals, this is qenerally your social security rtia€ober (55N). Hovvevcr, for a resi-cleat �aliert, sole proprii or disregarded entity, ace the fart 1 instructions ora pager 3- Tor other FFT entities, it is your eaanployer idenriiication number (EIN). If you do rot haver. number, see dour: to yet a � EE Mop pane 3. or Note. If the account is in mora than ;an =, n2r-ne, see the instructions for line i and Ina cha t on page 4 for Ereaploy®r jdentifiaata®n nu ober � guidelines on "'hose number to enter. FT- F—F-T- —, �E1l�il�f�i:] Ungar penalties of perjury, 1 certify that, 1. The nurrit,er shown on this farm is my correct iaxpayer denttfication number (or I am waiting for a m5mber to be issued to tie): and 2. 1 arta not subiect to backup wtithholoing because: la) I urn excin-pt from backrip withholding, or (b) I have: not been notified by the internal Revenue Service QfdS) that Fam srrEJtect to hackup withholding as a result of a fai3ure-to report all €`nterest'oruividends, or (r) the IRS has notified me that I am nn lnrger subject to backup withholding; and 3. 1 arts a t1.S. citizen Or other U.S. person iciefined bek- tw), -ilei 4. The FATCA code(s) entered on this corm (if any, indicating that 1 air exermpi from FATC)A reporting is correct. Cer&€fivation instructions. You must cross out item 2 above if you have been notified by the IFIS that you ars currently subject to backup withhoidi€ag because you have failed to rk°port A interaat and dividends can your tax return. For real esta_e transactions, itern 2 does nut apply. For mortgage interest paid, acquisition or FbPricionment of secured properly, cancellation of debt. contributior:s to an individual retirement arranger:aent (IRA)r and lea e€ally; payments Cather Baan interest and divil you are rot requ.irta4 to sign the cerdf's.a?ian, but you must prnvie'a your correct Tits'. See the Insttuotions on page 3. j -,r Signatureaf� ✓ / F/ wf �` U.S, person i� `-��' ✓'�F ,�;t.�, Date >R su rel In trued Sention references are tc thr ;^term€ leuer,,ue Core t,cdaas nthenoe noted Future det°etopnn nts. irl'crma-ion about de�aelopnrs7fs affect ting Form W -9. (such a5 iegisiaihzr enautett ;after ;ve release it) t ai csraru�.irsnvJlr�9. An Indi¢ldual or en6w (Form W-9 recuestca:) who is r€_rkuired to fife anintormAtnr reg€-im xfth the IRS roust obtain your correct taxptayor identification number!TIN) which may to yuur social security number(SSN), ii dividua, taxpayer ide'.'ItlfiCaiion number OTIM), accobon lnxpayer tdentification nurrror {ATIN), or empkoyer iden,lficiaion numbs; (EIPbi, to report or; sr.. Hfo;rrimion return the amount paid to you, or other arrrourt repWabFe on an in°.Qrrl iqc retL M- Exarn its of Wormation r2hUrrs inclods, W. are toot limited W. We fo4owinsg: • Forms 1099 -INT (ntens° eamoi 7r pard) . Form 1099 -DIV (rdiyiderao, iretrrdir,g ahcse from s'UQ4ca OF nwtual `sent+s) renin 7099-MISC-(various -,yrpes of irrcome, pi awaros, o; grass proceals) Forms 1090-s (stack or mutual fund saie-, and certaitr other t ansactiona by ProifFkryl ® Form 1009-S r0mceeds from real estate Iran-acJi?0ro) a Form t U99 -K (rnechani carr end `bird par -,y retwon, transact2Dns) Fenno 1098 (home mortgage in:ereift 109eE(student Joan Merest), IM-'= (tcitfon) • Fcrm ?099-C (canoed debt) • Fomi 1091)-A (acquisition or abanrorimml of secured property) U3,, F,:rrrn VV -13 only ityou ars a U,S. pe-,ior. (ociurimg a asidant elle ), :0 provide your correct TEN - €r you ring rot rePcrm Form W-9 to the rel w fh a TIN, Wu rareg)it tie suru,'ec., to backup wi,r#;.holding, See lVhar is backup withholding? on Pays 2. IIP sgning rig+ lled-out `ori, you: 1. Certify thkr, rhe TIN you arr., Living is currec; (or you are wai:;ng far a 1:,;Mb a, to be iasuacij, 2- Certify 9ha! you are not subject to backup vithhc4ai tg, cr 3. Ciairn exerni fruit badup ta'rthiialdinn if you area U - S. c:xerr=.pt r.xiyoe if aPpficab e, yo a ,are also ccr `ying °,hal as a U.S. pe :cors, ypr elJccablr �, 3ra ci any panne -'ship drrconae from ma U.S. trade ❑r ausinesa Is oe; subject :c ina w:•i'tit -inio rig tax on foreign paetnors' share of effeovely Income, ar: v. C'er'tify tflat 1i coda(s) rarrt'arad on this Poria (k any; indicatincg that you are exeraipt f sown the i=ATCA eepor_iri9, ;s carreci, See Whit is FATCAmperting? on page 2 for further information. Cat. NO. 101M Furrri M 9 (Rev- 12-201,=) National Bank (COID 182) demand deposit accounts 0? document design specifications, vont. Account info:rinalion The below information specific to your account will be completed by your account officer. Account name: Water Treatment & Controls Technology Inc. Address: 9900A North Palafox street CitylState: Pensacola, FL 32534 Account number: 4798160693 Starting serial number: Check routing transit number: 121000248 Deposit routing transit number: 518200392 Fractional routing transit number: 11-24 1210 Bank name: Wells Fargo Bank, H.A. 255 South Second Street Bank address: San Francisco, CA MAC N9301-041 Minneapolis,MN 55479 Note: if yon will be issuing payroll checks against this account in the states of California, Colorado, Florida, Georgia, or Utah, and need a Wells Fargo store address to print on your check stock to designate a location where your employees can negotiate the checks, the following store locations can be used: California Payable if Desired at any Wells Fargo branch in California, including 464 California Street San Francisco, CA 94104 Colorado Payable if Desired at any Wells Fargo branch in Colorado, including 1740 Broadway Denver, CO 8o214 Florida Payable if Desired at any Wells Fargo branch in Florida, including 1 Independent Drive Jacksonville, FL 32202 Georgia Payable if Desired at any Wells Fargo branch in Georgia, including 171 171h Street N.W. Atlanta, GA 30363 Utah Payable if Desired at any Wells Fargo branch in Utah, including 299 South Main Street Salt Lake City, UT 84111 National Bank (COIR 182) demand deposit accounts MICR document design specifications September 2014 Detail by Entity Name Flofida Deparimant of State Department of State / Division of Corporation I Search Records Y Detail By Document Number / Detail by Entity Name Florida Profit Corporation WATER TREATMENT & CONTROLS TECHNOLOGY, INC. Filing Information Document Number FEIIEIN Number Date Filed State Status Principal Address 9900A N PALAFOX ST PENSACOLA, FL 32534 P16000094949 81-4595108 12/0112016 FL ACTIVE Mailing Address 4939 CROSS BAYOU BLVD NEWPORT RICHEY, FL 34652 Registered Agent Name & Address HANEY, R. REID 101 E. KENNEDY BLVD., STE. 3700 TAMPA, FL 33602 OfficerlDi rector Detail Name & Address Title D, President DEREMER, GARY A. 4939 CROSS BAYOU BLVD. NEW PORT RICHEY, FL 34552 Title VP ROSS, RAYMOND F., 11 942 CANDLESTICK CT. PENSACOLA, FL 32514 Title VP, Secretary Page I of 2 DIVISION OF CORPORATIONS http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetall?lnqui"pe—Entit... 10/26/2017 Detail by Entity Name PENICK, VICTORIA M. 6043 FALL RIVER DR. NEW PORT RICHEY, FL 34655 Annual Reports Report Year Filed Date 2017 02/23/2047 Document Imaiges Page 2 of 2 02/23/2017 -- ANNUAL REPORT View image in PDF lonnat 12/6112015 -- Domestic ProM View —9-i n PDF format ri—da Department of State, DME 1- or corporations httpJ/search. sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inqui"pe=Entit... 10/26/2017 "QRS® CERTIFICATE OF LIABILITY INSURANCEOATIS(MMIDOIYYYY) 0310812017 PRODUCER 888-404-9644 THIS CERTIFICATE IS ISSUED A$ A (NATTER OF INFORMATION LOU IS MORRISON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LOUIS MORRISON C & C CONSULTANTS HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO BOX 701340 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, SAINT CLOUD, FL 34770-1340 INSURERS AFFORDING COVERAGE NAIC # _ INSURED INSVRERA CRUM & FORSTER SPECIALTY INS. CO, 44520 WATER TREATMENT & CONTROLS TECHNOLOGY INC INSURER B OWNERS INSURANCE COMPANY- 3700 9900A NORTH PALAFOX STREET HNSURER PENSACOLA, FL 32534 INSURER D: r_n\/F PA n FS 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INER L 0011. POLICY NUMBER _ FFECTIVE LIMITS A Y GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY � CLAIMS MADE I�`J OCCUR EPK-115971 3/1117 7GENERALAGGREGATE EACH OCCURRENCE_X DDATAK6E-Tb'� P E $ 100,000 MED EXP(An one ersen) S 10,000 PERSONAL&ADV INJURY $ 1,000,000 $ 2,00000 GEN'L AGGREGATE LIMIT APPLIES P ERI PRODUCTS-COMPIOP AGG $ 2000,000 POLICY X' PRO- JECT LOC B Y AUTO X MOBILELIASILITY ANY AUTO 51-094773-00 311/17 3/1/18 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ALLOWNEDAUTOS SCHEDULED AUTOS 51-094773-01 3/1117 3/1/16 BODILYINJURY$ (Per person) X X HIREDAUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGELIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ A EXCESS IUMBRELLALIABILITY X OCCUR r-1 CLAWS MACE EFX-107003 311117 311118 EACH OCCURRENCE $ 15,000,000 AGGREGATE � $ 15,000,000 $ EXCESS OF GENERAL UAS1LIT'Y, DEDUCTIBLE X RETENTION $ 0 CONTRACTORS POLLUTION & PROrESSIONAL LIA5ILITY, AUTO LIABILITY, EMPI_DYFRS I IARII ITY $ $ WORKERS COMPENSATION WCSTATU - OTH- E ANO EMPLOYRS' LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ OFFIOERIMEMBER EXCLUDED? E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, describe under SPECIAL PROVISIONS Below EL DISEASE - POLICY LIMIT $ OTHER A CONTRACTORS POLL-UTIONHABIL.ITY EPK-115971 3/1117 3/1/18 $1,000,000 LIMIT/$2,000;000 AGG ERRORS &OMISSIONS LIABILITY $1,000,000 LIMIT/$2,000,000 AGG DESCRIPTION OF OPERATIONS I LOCATI ONS f VEHICLF3I EXCLUSIONS ADAED BY ENDORSEMENT I SPECIAL PROVISIONS COLLIER COUNTY IS INCLUDED AS ADDITIONAL INSURED FOR GENERAL LIABILITY AND AUTOMOBILE LIABILITY FOR ANY AND ALL WORK PERFORMED ON BEHALF OF THE COUNTY BY THE INSURED AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT t,:ltrt I I!-IUA I t NLJLUtK CANCELLATION COLLIER COUNTY BOARD OF COMMISSIONERS 3327 TAMIAMI TRAIL EAST NAPLES, FL 34112 SH OU LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE �OriiaMY1 u'I9nH-2UUV AC:VKU CQRPORATiON. All rights reserved - The ACORD name and loon are renistered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DAY%(MMrODrYYYY) D 3/20/201 7 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 9,ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED ,'iEPRESENTATWE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: it the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, sub)ect 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 endorsements . PRODUCER QQNTACT NAME: Thomas VVIIIns Gehring Group, Inc PHONE 561-626.6797 - 561-BZf3�g74 11505 Fairchild Gardens Avenue, Suite 102 "IAIL ADDRESS; thomas.willlns ehrin rou .ccm Palm Beach Gardens, FL 33410 -,---• INSURED INSURER A: Continental Indemnity Com Water Treatment &Controls Technology, Inc. INSURER 9: c : 9900A N. Pafafox Street - Pensacola FL 32534 r4jKkRE: OI REVIS-- - -- INSURER F., ,.,... OVERAGES CERTIFICATE NUMBER: ON 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 WTH 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. R TYPEOF INSURANCE POLICY EFP Pi. S EXP R POLICY NUMBER M D DlYYYY � �LIMITS ------._.-.._ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE � OCCUR - MED EXP (Any one person) $ PERSONAL & ADV INJURY $ — GEN`L AGGREGATE LIMITAPPLIES PER: ------ AGGREGATE $ POLICY 0GENERAL LOC — PRODUCTS - COMPIOP AGO $— JET OTHER: -----, = AUTOM03l1.E LIABILITY COMBINED SINGLE LIMIT $ qNY AUTO Ea awidenC BODILY INJURY (Per person) $ �- OWNED SCHEDULEI) AUTOS ONLY AUTOS HIRED NON -OWNED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS ONLY PRDPERTYDAMAGE Per accident $ $ — UMBRELLA OCCUR EXCE'SLIAB CLAIMS -MADE EACH OCCURRENCE $ — — E $ DED RETENTION $ f1, WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 73 -894357 -01 -DB 1 0/31/201 6 $ OTH- ANYPROPRIETOWPARTNERJEXECUTIVE YIN E ER OFFICERIMEMBER EXCLUDED? ❑ NIA (Martdafory In NH) 7"1,000.000 CCIDENT $ 1,aDa,DaD ff yes, descrihe under E -EA EMPLOYEE $ 1 DESCRIPT{ON OF OPERATEONS below ,aaa'000 E -POLICY LIMIT _ g 1 ,000.000 DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (ACORD 101, Addittonal Remarks Schedule, may be attached irmors space Is required) CERTIFICATE HOLDE TION COLLIER COUNTY BOARD OF COMMISSIONERS SHOULD ANY OF THE A13OVEDESCRIBED POLICIESBECANCELLED BEFORE 3327 TAMIAMi TRAIL EAST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NAPLES, FL 34112 ACCORDANCE WITH THE POLICY PROVISIONS. AUT14ORIZED REPRESENTATIVE -� Thomas Wllins i/L+31�1�GG7� 01988-2015 ACORD CORPORATION. AN rights reserved. ACO RD 25 (2018103) The ACORD name and logo are registered marks of ACORD Company ID Number: 318696 Information Required for the E -Verify Program Information relating to your Company: Water. Treatment & Controls Technology, Inc. ompany Name I 9900A N. Palafox Street Pensacola, FL 32534 I Company Facility Address Company Alternate Address I County or Parish FSCAMMA Employer identification Number 814595108 Orth American industry Classification Systems Code 423 Parent Company Number of Employees 10 to 19 i Number of Sites Verified for 1 Page 14 of 17 E -Verify MOU for Employers i Revision Date ©6;01113