13-I. POST AWARD DOCUMENTS.pdf

BOND NO.

PUBLIC CONSTRUCTION BOND FORM

Name of Contractor:

Principal Business Address:

Telephone:

Facsimile:

Name of Surety:

Principal Business Address:

Telephone:

Facsimile:

Obligee of Property Being Improved:

Pasco County Board of County Commissioners Attn: Purchasing Department 7536 State Street, Suite 221

New Port Richey, Florida 34654 Telephone No. (727) 847 - 8194

Contracting Public Entity (if different from Owner):

Contract Number Assigned by Public Entity (BOCC No.):

(Solicitation No.):

Description of Project (including if applicable, a legal description and the street address of the property being improved and a general description of the improvement):

See Attachment ("Legal Description")

PUBLIC CONSTRUCTION BOND

BY THIS BOND, We _________________________________________, as Principal and _______________________________, a corporation, as Surety, are bound to Board of County Commissioners, Pasco County, Florida, herein called Owner, in the sum of $ _________________, for payment of which we bind ourselves, our heirs, personal representatives, successors, and assigns, jointly and severally.

THE CONDITION OF THIS BOND is that if Principal:

1. Performs the contract dated _________________, (This date is to be filled in by Board Records on the date of contract award) between Principal and Owner for construction of

, (hereinafter the “Contract”), the Contract being made a part of this bond by reference, at the times and in the manner prescribed in the Contract; and

2. Promptly makes payment to all claimants, as defined in Section 255.05(1), Florida Statutes, supplying Principal with labor, materials or supplies used directly or indirectly by Principal in the prosecution of the work provided for in the contract; and

3. Pays Owner all losses, damages, expenses, costs, and attorney’s fees, including appellate proceedings, that Owner sustains because of a default by Principal under the Contract;

and

4. Performs the guarantee of all work and materials furnished under the Contract for the time specified in the contract, then this bond is void; otherwise, it remains in full force.

Any action instituted by a claimant under this bond for payment must be in accordance with the notice and time limitation provisions in Section 255.05(2), Florida Statutes.

Any changes in or under the Contract documents (including extension of time, alternatives or additions to the terms of the Contract or specifications referred to within), and compliance or noncompliance with any formalities connected with the Contract or the changes does not affect Surety’s obligation under this bond, and it does hereby waive notice of any such changes, extension of time, alterations or additions to the terms of the Contract or to work or to the specifications.

THIS BOND IS DATED THIS __ day of _______________________________, 20 . (This date to be filled in by Board Records on the date of contract award).

ATTEST: PRINCIPAL:

BY: _(SEAL)

Witness Signature Authorized Signature

Printed Name of Witness Printed Name

Witness Signature Title

Printed Name of Witness

-OR-

ATTEST: PRINCIPAL:

BY: _______(SEAL)

Witness Signature As Attorney at Fact (Attach Power)

Printed Name of Witness Printed Name

Witness Signature Business Address

Printed Name of Witness Business Telephone No.

NOTARY ACKNOWLEDGMENT

STATE OF }

} ss

COUNTY OF }

The foregoing instrument was acknowledged before me on ________________, 20_____, by means of:

physical presence, or online notarization

[as applicable, complete one (1) of the four (4) choices below]:

(1) FOR A CORPORATION OR LIMITED LIABILITY COMPANY:

[Name] , who executed the foregoing instrument as [Title] ____ of [Corporation or Company Name] , a:

corporation, or limited liability company organized under the laws of [State] __ , and who severally and duly acknowledged the execution of such instrument as aforesaid on behalf of the corporation or limited liability company.

(2) FOR AN INDIVIDUAL ACTING IN HIS OR HER OWN RIGHT:

[Name] _____________________________________________________________.

(3) FOR A PARTNERSHIP:

[Name] ______Partner (or Agent), on behalf of [Name of Partnership]

, a [State] partnership.

(4) FOR AN INDIVIDUAL ACTING AS PRINCIPAL BY AN ATTORNEY IN FACT:

[Name] , as attorney in fact.

Said person is (check one below):

Personally known to me, or Has produced as identification.

Signature of person taking acknowledgment

[Notary Stamp or Seal] Print Notary’s Name (This line is required to be completed by §117.05, F.S.)

ATTEST: SURETY:

BY: _____ ______(SEAL)

Witness Signature Authorized Signature

Printed Name of Witness Printed Name

Witness Signature Business Address

Printed Name of Witness Business Telephone Numer

-OR-

BY: (SEAL)

Witness Signature As Attorney at Fact (Attach Power)

Printed Name of Witness Printed Name

Witness Signature License Number of Agent

Printed Name of Witness

COUNTERSIGNED (if applicable):

Signed Agency Name

Agent’s License No. Agency Mailing Address

Agency Telephone No.

Agency Fax No.

} ss

COUNTY OF }

The foregoing instrument was acknowledged before me on ________________, 20_____, by means of:

physical presence, or online notarization

[as applicable, complete one (1) of the four (4) choices below]:

(1) FOR A CORPORATION OR LIMITED LIABILITY COMPANY:

[Name] , who executed the foregoing instrument as [Title] ____ of [Corporation or Company Name] , a:

corporation, or limited liability company organized under the laws of [State] __ , and who severally and duly acknowledged the execution of such instrument as aforesaid on behalf of the corporation or limited liability company.

(2) FOR AN INDIVIDUAL ACTING IN HIS OR HER OWN RIGHT:

[Name] _____________________________________________________________.

(3) FOR A PARTNERSHIP:

[Name] ______Partner (or Agent), on behalf of [Name of Partnership]

, a [State] partnership.

(4) FOR AN INDIVIDUAL ACTING AS PRINCIPAL BY AN ATTORNEY IN FACT:

[Name] , as attorney in fact.

Said person is (check one below):

Personally known to me, or Has produced as identification.

Signature of person taking acknowledgment

[Notary Stamp or Seal] Print Notary’s Name

PAYMENT BOND FORM

Name of Contractor:

Principal Business Address:

Telephone:

Facsimile:

Name of Surety:

Principal Business Address:

Telephone:

Facsimile:

Obligee of Property Being Improved:

Pasco County Board of County Commissioners Attn: Purchasing Department 7536 State Street, Suite 221

New Port Richey, Florida 34654 Telephone No. (727) 847 - 8194

Contracting Public Entity (if different from Owner):

Contract Number Assigned by Public Entity (BOCC No.):

(Solicitation No.):

Description of Project (including if applicable, a legal description and the street address of the property being improved and a general description of the improvement):

See Attachment ("Legal Description")

PAYMENT BOND

I. KNOW ALL PERSONS BY THESE PRESENTS: That ___________________________, as Principal, whose address is , and

, as Surety, whose address is _________, are held and firmly bound unto the Board of County Commissioners, Pasco County, Florida, as Obligee in the sum of $ __________, for the payment whereof we bind ourselves, our heirs, executors, personal representatives, successors and assigns, jointly and severally, firmly by these presents.

II. WHEREAS, the Principal has entered into a contract with Obligee, dated the _____ day of ____, 20 ____ , (This date will be filled in by Board Records on the date of contract award) for ____________________________________________________________________________; in accordance with drawings and specifications, which contract is by reference made a part hereof, and is hereinafter referred to as the Contract.

III. A. NOW THEREFORE, THE CONDITION OF THIS BOND IS THAT IF THE PRINCIPAL:

1. Shall promptly make payments to all claimants as defined in section 255.05(1), Florida Statutes, supplying the Principal with labor, materials, or supplies, as used directly or indirectly by the Principal in the prosecution of the work provided for in the Contract; and

2. Shall pay the Obligee for all losses, damages, expenses, costs, and attorney's fees, including those resulting from appellate proceedings, that the Obligee sustains because of a default by the Principal in contravention to the Contract in regard to payment for such labor, materials, or supplies furnished to the Principal; then this Bond is void; otherwise, this Bond remains in full force and effect.

B. BE IT FURTHER KNOWN:

1. Any changes in or under the Contract and compliance or noncompliance with any formalities connected with the said Contract or alterations which may be made in the terms of the said Contract, or in the work to be done under it, or the giving by the Obligee of any extension of time for the performance of the said Contract, or any other forbearance on the part of the Obligee or Principal to the other, shall not in any way release the Principal and the Surety, or either or any of them, their heirs, their personal representatives, their successors or their assigns from liability hereunder, notice to the Surety of any such changes, alterations, extensions or forbearance being hereby waived.

2. Certain claimants seeking the protection of this Bond must timely comply with the strict requirements set forth in section 255.05, Florida Statutes, and as otherwise provided by law.

3. As concerns payment for labor, materials and supplies, as affects certain claimants, no legal action shall be instituted against the Principal or Surety on this Bond after one (1) year from the performance of labor or the completion of delivery of the materials or supplies as is specifically mandated pursuant to section 255.05, Florida Statutes.

(The remainder of this page is intentionally left blank)

THIS PAYMENT BOND IS DATED THIS __ day of _______________________________, 20 . (This date to be filled in by Board Records on the date of contract award).

ATTEST: PRINCIPAL:

____ BY: (SEAL)

Witness Signature Authorized Signature

Printed Name Printed Name

Witness Signature Title

Printed Name

ATTEST: PRINCIPAL:

BY: _(SEAL)

Witness Signature As Attorney at Fact (Attach Power)

Printed Name of Witness Printed Name

Witness Signature Business Address

Printed Name of Witness Business Telephone

NOTARY ACKNOWLEDGMENT

STATE OF }

} ss

COUNTY OF }

The foregoing instrument was acknowledged before me on ________________, 20_____, by means of:

[___] physical presence, or [___] online notarization

[as applicable, complete one (1) of the four (4) choices below]:

(1) FOR A CORPORATION OR LIMITED LIABILITY COMPANY:

[Name] , who executed the foregoing instrument as [Title] ____ of [Corporation or Company Name] , a:

[___] corporation, or [___] limited liability company organized under the laws of [State] __ , and who severally and duly acknowledged the execution of such instrument as aforesaid on behalf of the corporation or limited liability company.

(2) FOR AN INDIVIDUAL ACTING IN HIS OR HER OWN RIGHT:

[Name] _____________________________________________________________.

(3) FOR A PARTNERSHIP:

[Name] ______Partner (or Agent), on behalf of [Name of Partnership]

, a [State] partnership.

(4) FOR AN INDIVIDUAL ACTING AS PRINCIPAL BY AN ATTORNEY IN FACT:

[Name] , as attorney in fact.

Said person is (check one below):

[___] Personally known to me, or [___] Has produced as identification.

Signature of person taking acknowledgment

[Notary Stamp or Seal] Print Notary’s Name

ATTEST: SURETY:

BY: __(SEAL)

Witness Signature Authorized Signature

Printed Name of Witness Printed Name

Witness Signature Business Address

Printed Name of Witness

BY: _(SEAL)

Witness Signature As Attorney at Fact (Attach Power)

Printed Name of Witness Printed Name

Witness Signature License Number of Agent

Printed Name of Witness

COUNTERSIGNED (if applicable):

Signed Agency Name

Agent’s License No. Agency Mailing Address

Agency Telephone No.

Agency Fax No.

} ss

COUNTY OF }

The foregoing instrument was acknowledged before me on ________________, 20_____, by means of:

physical presence, or online notarization

[as applicable, complete one (1) of the four (4) choices below]:

(1) FOR A CORPORATION OR LIMITED LIABILITY COMPANY:

[Name] , who executed the foregoing instrument as [Title] ____ of [Corporation or Company Name] , a:

corporation, or limited liability company organized under the laws of [State] __ , and who severally and duly acknowledged the execution of such instrument as aforesaid on behalf of the corporation or limited liability company.

(2) FOR AN INDIVIDUAL ACTING IN HIS OR HER OWN RIGHT:

[Name] _____________________________________________________________.

(3) FOR A PARTNERSHIP:

[Name] ______Partner (or Agent), on behalf of [Name of Partnership]

, a [State] partnership.

(4) FOR AN INDIVIDUAL ACTING AS PRINCIPAL BY AN ATTORNEY IN FACT:

[Name] , as attorney in fact.

Said person is (check one below):

Personally known to me, or Has produced as identification.

Signature of person taking acknowledgment

[Notary Stamp or Seal] Print Notary’s Name

ENDORSEMENT

Named Insured Endorsement #

Policy Symbol Policy # Policy Period Effective Date of Endorsement

Issued by (Name of Insurance Company)

It is agreed that this policy is hereby amended as indicated. All other terms and conditions of this policy remain unchanged.

1. AMENDMENT -- NOTICE OF CANCELLATION OR MATERIAL CHANGE (DESIGNATED CONTRACT)

Only with respect to your contract scheduled herein, should any of the above -described policies be canceled or materially changed before the expiration date thereof, the Issuing Company will mail 30 days’ prior written notice to the Certificate Holder named therein.

2. AMENDMENT -- ADDITIONAL INSURED (DESIGNATED CONTRACT)

Only with respect to your contract scheduled herein, Pasco County Board of County Commissioners has been named as Additional Insured as respects the General and Automobile Liability Policies described herein.

3. AMENDMENT -- LIMITS OF LIABILITY

The limits of liability apply specifically to any liability claims arising during the course of this project.

CONTRACT SCHEDULE AND DESCRIPTION OF PROJECT

Note: Attach additional sheets if needed

Authorized Agent _______ Date ____________________

CONTRACTOR APPLICATION FOR PAYMENT

FROM PASCO COUNTY

(Please See Instructions at Page 8)

Section 1 – General Information and Current Payment Status

Project Title:

Bid No.

Task Name (if applicable):

Payment Application No.

For Period From: ____To:

CONTRACTOR:

Address:

Remittance Name:

Address:

If CONTRACTOR is requesting payment via electronic funds transfer (EFT), please complete the following:

Account Name:

Account No.

Bank Name:

ABA Route No.

AAR SUMMARY

AAR No. Date Approved by COUNTY ADMINISTRATOR or his designee

Additive Deductive

TOTALS

CHANGE ORDER SUMMARY

C.O. No. Date Approved by Pasco BCC Additive Deductive

TOTALS

CONTRACT STATUS

Initial Contract Price $

Net Change by Change Orders (Additive Total Minus Deductive Total)

Contract Price to Date $

Value of Work in Place $

Value of Stored Materials $

Total Earned $

Retainage At % $

Total Earned Less Retainage $

Less Previous Payments $

Less $

Current Payment Total $

Section 2 – Contractor Certification

The undersigned authorized representative certifies, on behalf of the above-referenced CONTRACTOR, and under penalty of perjury:

1. All amounts and items shown on this application are correct, and the requested Current Payment Total is $_______________________________;

2. Any work performed, or materials supplied have been in accordance with the Contract Documents for the above-referenced Project;

3. The CONTRACTOR has clear title to any materials and equipment for which the CONTRACTOR is requesting payment as stored materials;

4. All amounts paid by the COUNTY to the CONTRACTOR in previous progress payments have been applied by the CONTRACTOR and its SUBCONTRACTORS to promptly pay, in proportionate amounts, all SUBCONTRACTORS, sub-subcontractors, suppliers, and others who have contributed work, equipment, or materials listed included in line items listed in the Schedule of Values of the previous Payment Applications, except as indicated on Attachment 1 hereto, which is incorporated herein by reference, and consists of page(s);

5. The CONTRACTOR shall apply any sums paid by the COUNTY from this Application for Payment to SUBCONTRACTORS, sub-subcontractors, suppliers, and others who have contributed work, equipment, or materials included in line items listed in the Schedule of Values attached hereto (less retainage, if applicable), except as indicated on Attachment 2 hereto, which is incorporated herein by reference, and consists of __ page(s).

ATTEST: CONTRACTOR:

By: ___ By:

Title: ___ Title:

} ss

COUNTY OF }

The foregoing instrument was acknowledged before me on ________________, 20_____, by means of:

physical presence, or online notarization

[as applicable, complete one (1) of the four (4) choices below]:

(1) FOR A CORPORATION OR LIMITED LIABILITY COMPANY:

[Name] , who executed the foregoing instrument as [Title] ____ of [Corporation or Company Name] , a:

corporation, or limited liability company organized under the laws of [State] __ , and who severally and duly acknowledged the execution of such instrument as aforesaid on behalf of the corporation or limited liability company.

(2) FOR AN INDIVIDUAL ACTING IN HIS OR HER OWN RIGHT:

[Name] _____________________________________________________________.

(3) FOR A PARTNERSHIP:

[Name] ______Partner (or Agent), on behalf of [Name of Partnership]

, a [State] partnership.

(4) FOR AN INDIVIDUAL ACTING AS PRINCIPAL BY AN ATTORNEY IN FACT:

[Name] , as attorney in fact.

Said person is (check one below):

Personally known to me, or

Has produced as identification.

Signature of person taking acknowledgment

[Notary Stamp or Seal]

Section 3 – Certification by Pasco County and PROFESSIONAL

Based on on-site observations and the data comprising this Application for Payment, the undersigned certifies that the Work in the above-referenced Project has progressed to the point indicated herein and to the best of my knowledge, information, and belief, is in accordance with the Contract Documents, thereby entitling the CONTRACTOR to payment of the amount certified herein.

Pasco County Inspector:

By: Date:

PROJECT MANAGER*:

By: Date:

* The PROJECT MANAGER may be a Pasco County Project Engineer or other appropriate County staff member.

PROFESSIONAL**

By: Date: __________

** The PROFESSIONAL may be the County Engineer, Assistant Engineering Services Director, Division Engineer, other appropriate County staff member, or a private professional consultant.

INSTRUCTIONS FOR COMPLETING APPLICATION FOR PAYMENT

This form will be completed by the CONTRACTOR each time payment is requested in connection with the Project. This Application for Payment shall be accompanied by a Schedule of Values providing line-item detail for the project, Attachment 1, and Attachment 2.

Section 1: This section will be completed by the CONTRACTOR. The CONTRACTOR must provide all the information indicated on the form as a condition of processing and payment.

Section 2: This section will be completed by the CONTRACTOR. In this section, the CONTRACTOR shall provide certification with respect to the representations made in Section 1. The certification will be provided in accordance with the Contract Documents.

Section 3: This section must be completed by Pasco County Staff and/or the PROFESSIONAL designated by the COUNTY. The approval of the PROJECT MANAGER will always be provided. If the Pasco County Inspector or the PROFESSIONAL are not responsible for the activities to be certified, “N/A” shall be inserted in the designated signature space.

Attachment 1 - Application for Payment

Name of Entity Relationship Amount in Dispute

Corresponding Line-Item Reference to Schedule of

Values

Explanation

-or-

This page is not applicable, as no outstanding payment disputes exist with respect to any prior Application for Payment.

Contractor Signature

Attachment 2 - Application for Payment

NOTE: Attach additional sheets if needed -or-

This page is not applicable, as no outstanding payment disputes exist with respect to any prior Application for Payment.

Contractor Signature

Name of Entity Relationship Amount in Dispute

Application from Payment No. and

Corresponding Line-Item Reference to Schedule of

Values

Explanation

CONTRACTOR’S AFFIDAVIT OF PAYMENT OF

DEBTS AND CLAIMS

Note: The General Contractor shall attach this statement to the Application for Final Payment.

KNOW ALL MEN BY THESE PRESENTS that

(Name of General Contractors Principal, Officer or Authorized Representative) the _______________________________________________________ ___ (Title of General Contractors Principal, Officer or Authorized Representative) of ________________________________________________________ ___ (Name of General Contractor) whose principal address is

(Address of General Contractor) on penalty of perjury, hereby affirms that pursuant to the provisions of the contract for

Project No:

Project Name:

All monies owed all subcontractors and material suppliers have been paid in full and that no outstanding debts or claims against the above Project exist.

ATTEST: PRINCIPAL, OFFICER or AUTHORIZED REP.:

Witness Signature

Witness Signature

} ss

COUNTY OF }

The foregoing instrument was acknowledged before me on ________________, 20_____, by means of:

physical presence, or online notarization

[as applicable, complete one (1) of the four (4) choices below]:

(1) FOR A CORPORATION OR LIMITED LIABILITY COMPANY:

[Name] , who executed the foregoing instrument as [Title] ____ of [Corporation or Company Name] , a:

corporation, or limited liability company organized under the laws of [State] __ , and who severally and duly acknowledged the execution of such instrument as aforesaid on behalf of the corporation or limited liability company.

(2) FOR AN INDIVIDUAL ACTING IN HIS OR HER OWN RIGHT:

[Name] _____________________________________________________________.

(3) FOR A PARTNERSHIP:

[Name] ______Partner (or Agent), on behalf of [Name of Partnership]

, a [State] partnership.

(4) FOR AN INDIVIDUAL ACTING AS PRINCIPAL BY AN ATTORNEY IN FACT:

[Name] , as attorney in fact.

Said person is (check one below):

SUBCONTRACTOR'S WAIVER OF RIGHT TO

CLAIM AGAINST THE PAYMENT BOND

(Attachment to General Contractor's Application for Payment No. )

(PROGRESS PAYMENT)

Note: The General Contractor shall attach this statement to each Application for Payment beginning with the second Application for Payment. This statement is applicable to each subcontractor whose work appeared on the prior Application for Payment for which the General Contractor has been paid.

The undersigned:

(Name of Subcontractor Representative), the (Title of Subcontractor Representative) of (Name of Subcontractor), the principal address for which is _____, in consideration of receipt of the sum of $____________________, hereby waives its right to claim against the payment bond for labor, services or materials furnished through __________________ (insert date) to _____________________(insert date) for improvements to the following described Pasco County, Florida project:

Project No.

Project Name:

General Contractor:

This waiver does not cover any retention, or any labor, services, or materials furnished after the date specified.

Dated: __________________ Subcontractor Representative:

Signature

SUBCONTRACTOR'S WAIVER OF RIGHT TO

CLAIM AGAINST THE PAYMENT BOND

(Attachment to General Contractor's Application for Payment No. ____)

(FINAL PAYMENT)

Note: The General Contractor shall attach this statement to each Application for Payment beginning with the second Application for Payment. This statement is applicable to each subcontractor whose work appeared on the prior Application for Payment for which the General Contractor has been paid.

The undersigned:

(Name of Subcontractor Representative), the (Title of Subcontractor Representative) of (Name of Subcontractor), the principal address for which is _____, in consideration of receipt of the sum of $____________________, hereby waives its right to claim against the payment bond for labor, services or materials furnished through __________________ (insert date) to _____________________(insert date) for improvements to the following described Pasco County, Florida project:

Project No.

Project Name:

General Contractor:

This waiver does not cover any retention, or any labor, services, or materials furnished after the date specified.

Dated: __________________ Subcontractor Representative:

Signature

CHANGE ORDER NO.

CONTRACT:

(Title)

CONTRACTOR:

BID NO. TASK (if applicable)

CONTRACT DATE:

TIME CHANGE EXTRA WORK CREDIT OTHER

The CONTRACTOR is hereby authorized and directed to make the following changes and modifications to the aforesaid Contract in accordance with all requirements applicable thereto.

DESCRIPTION OF CHANGE:

COST COMPACT: FINAL COMPLETION DATES:

REASON FOR CHANGE:

The initial Contract Price (FINALTOTAL BID PRICE) was $

Net change by previous Change Orders $

The Contract Price prior to this Change Order was $

The Contract Price will be: increased decreased unchanged by this Change Order $

The Contract Price including this Change Order $_________

The Final Completion Milestone prior to this Change Order:

The time for the Final Milestone will be: extended reduced unchanged by days.

The Final Completion Milestone as of this Change Order:

The CONTRACTOR waives any and all claims to additional time extension and/or monetary compensation resulting from these changes and all costs associated with and addressed by this Change Order. Except to the extent expressly modified by this Change Order, the aforesaid Contract and all terms and conditions therein, as amended by all previous Change Orders, is reaffirmed in its entirety and shall remain in full force and effect.

IN WITNESS WHEREOF, this Change Order No. to has been executed by the parties hereto or by their authorized representatives.

ATTEST: COUNTY: Pasco County, Florida

By: By:

Nikki Alvarez-Sowles, Esq. CHAIRMAN Clerk & Comptroller

Date of County Approval: _________

CONTRACTOR:

By:

Authorized Signature (SEAL)

Title:

Date:

} ss

COUNTY OF }

The foregoing instrument was acknowledged before me on ________________, 20_____, by means of:

physical presence, or online notarization

[as applicable, complete one (1) of the four (4) choices below]:

(1) FOR A CORPORATION OR LIMITED LIABILITY COMPANY:

[Name] , who executed the foregoing instrument as [Title] ____ of [Corporation or Company Name] , a:

corporation, or limited liability company organized under the laws of [State] __ , and who severally and duly acknowledged the execution of such instrument as aforesaid on behalf of the corporation or limited liability company.

(2) FOR AN INDIVIDUAL ACTING IN HIS OR HER OWN RIGHT:

[Name] _____________________________________________________________.

(3) FOR A PARTNERSHIP:

[Name] ______Partner (or Agent), on behalf of [Name of Partnership]

, a [State] partnership.

(4) FOR AN INDIVIDUAL ACTING AS PRINCIPAL BY AN ATTORNEY IN FACT:

[Name] , as attorney in fact.

Said person is (check one below):

CHANGE ORDER NO.

CONTRACT:

(Title)

CONTRACTOR:

BID NO. TASK (if applicable)

CONTRACT DATE:

TIME CHANGE EXTRA WORK CREDIT OTHER

The CONTRACTOR is hereby authorized and directed to make the following changes and modifications to the aforesaid Contract in accordance with all requirements applicable thereto.

DESCRIPTION OF CHANGE:

COST COMPACT: FINAL COMPLETION DATES:

REASON FOR CHANGE:

The initial Contract Price (FINALTOTAL BID PRICE) was $

Net change by previous Change Orders $

The Contract Price prior to this Change Order was $

The Contract Price will be: increased decreased unchanged by this Change Order $

The Contract Price including this Change Order $_________

The Final Completion Milestone prior to this Change Order:

The time for the Final Milestone will be: extended reduced unchanged by days.

The Final Completion Milestone as of this Change Order:

The CONTRACTOR waives any and all claims to additional time extension and/or monetary compensation resulting from these changes and all costs associated with and addressed by this Change Order. Except to the extent expressly modified by this Change Order, the aforesaid Contract and all terms and conditions therein, as amended by all previous Change Orders, is reaffirmed in its entirety and shall remain in full force and effect.

IN WITNESS WHEREOF, this Change Order No. to has been executed by the parties hereto or by their authorized representatives.

COUNTY: Pasco County, Florida

By:

________________________, County Administrator

Date of County Approval: _________

CONTRACTOR:

By:

Authorized Signature (SEAL)

Title:

Date:

Approved for Legal Form & Sufficiency: _________________________ _

} ss

COUNTY OF }

The foregoing instrument was acknowledged before me on ________________, 20_____, by means of:

physical presence, or online notarization

[as applicable, complete one (1) of the four (4) choices below]:

(1) FOR A CORPORATION OR LIMITED LIABILITY COMPANY:

[Name] , who executed the foregoing instrument as [Title] ____ of [Corporation or Company Name] , a:

corporation, or limited liability company organized under the laws of [State] __ , and who severally and duly acknowledged the execution of such instrument as aforesaid on behalf of the corporation or limited liability company.

(2) FOR AN INDIVIDUAL ACTING IN HIS OR HER OWN RIGHT:

[Name] _____________________________________________________________.

(3) FOR A PARTNERSHIP:

[Name] ______Partner (or Agent), on behalf of [Name of Partnership]

, a [State] partnership.

(4) FOR AN INDIVIDUAL ACTING AS PRINCIPAL BY AN ATTORNEY IN FACT:

[Name] , as attorney in fact.

Said person is (check one below):

CONSENT OF SURETY TO CHANGE ORDER NO.

WHEREAS, the Board of County Commissioners of Pasco County, Florida (hereinafter the “COUNTY”), and (hereinafter the “CONTRACTOR”), entered into an Agreement on _____________ ____, 20____ , in connection with that certain Project known as:

______________________________________________________________, Bid.No. , FEMA No. N/A; and

WHEREAS, ___ (hereinafter the “SURETY”) is bound to the COUNTY through its Performance and Payment Bond dated , 20 , in the sum of $ ______ in connection with the aforesaid Project and Agreement; and

NOW, THEREFORE, the SURETY, through its authorized representative below, does hereby approve of and consent to the attached Change Order No.__ and agrees that said Change Order shall not relieve the SURETY of any obligations to the COUNTY as set forth in either of the aforesaid bonds.

Affirmed under penalty of perjury this ) day of _________________, 20 ______.

SURETY:

By:

Witness to All Authorized Signature

By:

Witness to All As Attorney in Fact

Agency (Power of Attorney attached)

} ss

COUNTY OF }

The foregoing instrument was acknowledged before me on ________________, 20_____, by means of:

physical presence, or online notarization

[as applicable, complete one (1) of the four (4) choices below]:

(1) FOR A CORPORATION OR LIMITED LIABILITY COMPANY:

[Name] , who executed the foregoing instrument as [Title] ____ of [Corporation or Company Name] , a:

corporation, or limited liability company organized under the laws of [State] __ , and who severally and duly acknowledged the execution of such instrument as aforesaid on behalf of the corporation or limited liability company.

(2) FOR AN INDIVIDUAL ACTING IN HIS OR HER OWN RIGHT:

[Name] _____________________________________________________________.

(3) FOR A PARTNERSHIP:

[Name] ______Partner (or Agent), on behalf of [Name of Partnership]

, a [State] partnership.

(4) FOR AN INDIVIDUAL ACTING AS PRINCIPAL BY AN ATTORNEY IN FACT:

[Name] , as attorney in fact.

Said person is (check one below):

Pasco County, Florida

ALLOWANCE AUTHORIZATION RELEASE (AAR)

CONTRACT: AAR No.

CONTRACTOR: FEMA No.

TASK (if applicable): Bid No.

The CONTRACTOR is hereby authorized and directed to make the following changes to the above contract, in accordance with all applicable requirements. The CONTRACTOR waives any and all other claims to additional time extensions and/or monetary compensation resulting from these changes and all costs associated with and addressed by this AAR.

DESCRIPTION OF ALLOWANCE WORK TO BE

PERFORMED

COST

IMPACT

DAYS

Amount: Days:

Allowance Work included in Contract: $

Total of All Previous AARs: $

Balance of Allowance Work Available: $

Total Allowance Work – This AAR: $

Remaining Allowance Work Balance: $

Whereupon this AAR No. ______ has been executed by the parties or by their respective authorized representatives effective upon execution by the COUNTY.

CONTRACTOR:

By: _(SEAL) Witness Signature

Printed Name:

Witness Signature Title:

Date:

COUNTY: Pasco County, Florida

By:

Printed Name:

Title:

Date:

APPROVED FOR LEGAL FORM AND SUFFICIENCY

PASCO COUNTY ATTORNEY’S OFFICE

By: Date:

CONSENT OF SURETY TO FINAL PAYMENT

WHEREAS, the Board of County Commissioners of Pasco County, Florida (hereinafter the “COUNTY”), and (hereinafter the “CONTRACTOR”), entered into an Agreement on _____________ ____, 20____ , in connection with that certain Project known as:

______________________________________________________________, Bid.No. , FEMA No. N/A; and

WHEREAS, ___ (hereinafter the “SURETY”) is bound to the COUNTY through its Performance and Payment Bond dated , 20 , in the sum of $ ______ in connection with the aforesaid Project and Agreement; and

NOW, THEREFORE, the SURETY, through its authorized representative below, does hereby approve of and consent to the Final Payment by the COUNTY to the CONTRACTOR, and agrees that said Final Payment shall not relieve the SURETY of any obligations to the COUNTY as set forth in either of the aforesaid bonds.

Affirmed under penalty of perjury this ) day of _________________, 20 ______.

SURETY:

By:

Witness to All Authorized Signature

By:

Witness to All As Attorney in Fact

Agency (Power of Attorney attached)

} ss

COUNTY OF }

The foregoing instrument was acknowledged before me on ________________, 20_____, by means of:

physical presence, or online notarization

[as applicable, complete one (1) of the four (4) choices below]:

(1) FOR A CORPORATION OR LIMITED LIABILITY COMPANY:

[Name] , who executed the foregoing instrument as [Title] ____ of [Corporation or Company Name] , a:

corporation, or limited liability company organized under the laws of [State] __ , and who severally and duly acknowledged the execution of such instrument as aforesaid on behalf of the corporation or limited liability company.

(2) FOR AN INDIVIDUAL ACTING IN HIS OR HER OWN RIGHT:

[Name] _____________________________________________________________.

(3) FOR A PARTNERSHIP:

[Name] ______Partner (or Agent), on behalf of [Name of Partnership]

, a [State] partnership.

(4) FOR AN INDIVIDUAL ACTING AS PRINCIPAL BY AN ATTORNEY IN FACT:

[Name] , as attorney in fact.

Said person is (check one below):

CONTRACTOR RESPONSIBILITY SURVEY FOR

ENGINEERING AND CONSTRUCTION SERVICES

In order to determine the lowest responsive and responsible bidder for this project, Pasco County mandates that the apparent lowest bidder provide the following survey when requested by the COUNTY. THE FAILURE OF A BIDDER TO PROVIDE TIMELY ALL INFORMATION

REQUESTED BY THE SPECIFIED DATE MAY RESULT IN A FINDING THAT THE BIDDER IS NOT

RESPONSIBLE. PASCO COUNTY MAY RELY ON THIS INFORMATION IN AWARDING THE

CONTRACT FOR THIS PROJECT, THEREFORE, ANY MATERIALLY FALSE, MISLEADING, OR

INCOMPLETE INFORMATION SUBMITTED BY A BIDDER MAY BE GROUNDS FOR REJECTION OF

A BID OR REVOCATION OF AN AWARDED BID IF THE MATERIAL FALSITY, MISLEADING

NATURE, OR INCOMPLETENESS OF THE INFORMATION SUBMITTED IS DISCOVERED BEFORE

BOARD APPROVAL OF THE CONTRACT, OR FOR THE TERMINATION OF THE CONTRACT FOR

CAUSE IF DISCOVERED AFTER BOARD APPROVAL OF THE CONTRACT. Any questions concerning the requested information may be directed to the Pasco County Purchasing Director.

Information and Documents to be provided

1. List all projects on which the BIDDER has worked in the last two (2) years. Please include, for each project, the job location, the cost and/or contract value, the name and telephone number of the owner’s representative, and the name and telephone number of the surety.

2. List all projects for which the BIDDER is currently under contract. Please include, for each project, the job location, the cost/contract value, the name and telephone number of the owner’s representative, and the name and telephone number of the surety. Also indicate whether the BIDDER is the prime contractor on the project, and whether all subcontractors have been paid to date in a timely fashion.

3. Provide a copy of the current resume of the project manager and full-time job superintendent for the BIDDER who will be used on this project for Pasco County, if the contract is awarded to the BIDDER.

4. Provide a critical path management plan within ten days of Notice to Proceed or date of pre-construction meeting whichever is later detailing the approach the BIDDER anticipates taking towards this project for Pasco County.

5. Provide a copy of a balance sheet and income statement for the most recent quarterly period of the fiscal year of the BIDDER.