Other_Contract_Forms.pdf

OTHER

CONTRACT

FORMS

CONSENT OF SURETY FORM PAGE CS-1

SARASOTA COUNTY GOVERNMENT

CONSENT OF SURETY TO FINAL PAYMENT

SURETY:

BOND NO.:

OWNER: SARASOTA COUNTY BOARD OF COUNTY COMMISSIONERS

PROJECT TITLE: POTABLE WATER LOOPING – JACKSON ROAD & US 41

CONTRACT #

CONTRACTOR:

EFFECTIVE DATE OF BOND:

In accordance with the provisions of the Contract referenced above between the above Owner and Contractor, the Surety Company named below:

SURETY COMPANY NAME:

SURETY COMPANY ADDRESS:

under Bond with the Contractor named below:

CONTRACTOR NAME:

CONTRACTOR ADDRESS:

Hereby approves final payment by the Owner to the Contractor and agrees that final payment does not relieve the Surety of its obligations under the Bond to the Owner named below:

SARASOTA COUNTY COMMISSION

1 APEX ROAD

SARASOTA, FL 34240

IN WITNESS WHEREOF, the Surety has hereto set its hands on this date_________, 20__

Surety

Signature of Authorized Representative

Printed Name and Title Attest/Witness:

(Seal):________________________

Attached: Notarized Power of Attorney

LOCAL HIRING INITIATIVE FORM PAGE LHI-1

SARASOTA COUNTY

LOCAL HIRING INITIATIVE

Participation Form

Instructions:

In Sarasota County’s Local Hiring Initiative Resolution No. 2013-127, the CONTRACTOR is encouraged to work with Career Source Suncoast (formerly known as Suncoast Workforce, Inc.), or any other agency designated by the State of Florida as a Workforce development agency, to increase employment opportunities for local residents. Local residents are defined as “residents of Sarasota County,” but that definition may be expanded to include Manatee and Charlotte Counties if the requisite skill set is not available in Sarasota County.

Resolution No. 2013-127 establishes an aspirational goal for contractor and subcontractors to hire 15% minimum local residents as the new hires for construction and construction related projects.

The CONTRACTOR shall complete the information below to provide information on any new hires needed by the Contractor or their subcontractor(s) to complete the Project.

This information must be submitted as part of the monthly pay requests.

Date: ____________________________ Project Name: _____________________ Contract Number: _________________ Contractor: _____________________ Submitted by: ____________________

Report on New Hires – Please indicate Any New Hires during the past month.

- By checking this box, the CONTRACTOR hereby acknowledges Sarasota County’s Local Hiring Initiative and indicates that no New Hires were required by the CONTRACTOR or their subcontractor(s) to complete the Project.

County of Resident

Number of New Hires Required to Complete Project

Number New Hires Local Residents

Cumulative New Hires to Date (Include previous months totals)

Sarasota Manatee Charlotte Other

RELEASE OF LIEN PAGE RL-1

Standard Form For CONTRACTOR’S FINAL AFFIDAVIT & RELEASE of LIEN

STATE OF FLORIDA, COUNTY OF ______________

Before me, the undersigned authority, personally appeared , who, after being by me first duly sworn, deposes and says that:

1. He is of , (Title of Officer) (Name of Company) doing business in the State of Florida, hereinafter called "Contractor".

2. Contractor pursuant to a Contract dated ____________________________, hereinafter referred to as "Contract", with Sarasota County, Florida, hereinafter referred to as "County", has heretofore furnished or caused to be furnished labor, material and services for the construction of certain improvements as more particularly set forth in said contract.

3. Contractor represents that all work to be performed under the aforesaid Contract has been fully completed and that all persons and firms who furnished material, labor and/or services incident to the completion of said work have been paid in full except to the following:

(Write in "None" if all persons and firms have been paid in full)

NAME ADDRESS AMOUNT DUE

4. The undersigned affiant for and in consideration of final payment to him in the amount of $___________________, and all other previous payments paid by County to contractor, does hereby for and in behalf of the Contractor, waive, release, remise and relinquish the contractor’s right to claim, demand or impose a lien or liens for work done or materials and/or services furnished or any other class of lien whatsoever, on any of the premises owned by County on which improvements have been completed in connection with the aforementioned contract.

5. The affiant herein does hereby represent that he has authority to execute a full and final Release of Lien for and in behalf of the Contractor as set forth above.

6. The affiant herein makes this Affidavit and Release of Lien for the express purpose of inducing County to make final disbursement and payment to the Contractor in the amount of $_______________________.

7. This Affidavit and Release of Lien is made by affiant with full knowledge of the applicable laws of the State of Florida. In addition to such rights as may be afforded to County under said applicable laws, affiant expressly agrees to indemnify and save County harmless from any and all actual costs and expenses, including reasonable attorney’s fees, arising out of claims by laborers, subcontractors or materialmen who might claim that they have not been paid for services or material furnished by or through the contractor in connection with the work performed under the aforementioned Contract.

RELEASE OF LIEN PAGE RL-2

Name of Corporation

By: _______________________________________ President

(CORPORATE SEAL)

ATTEST:

Name of Corporation

Secretary

Sworn to and subscribed before me this day

(date)

Notary Public

(NOTARY SEAL)

My Commission Expires:_______________________

STORED MATERIALS AFFIDAVIT PAGE SMA-1

STORED MATERIALS AFFIDAVIT

STATE OF FLORIDA, COUNTY OF __________________

Before me, the undersigned authority, personally appeared , who being duly sworn, says that he is a subcontractor for of , General Contractor for Project, and that all materials billed on the attached invoice are being held in the subcontractor’s warehouse at , Florida, for this project, and are fully insured against loss or damage.

(Subcontractor Firm Name) By:

(Name of Representative)

(Title of Representative)

SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF , 20

Notary Public:

My commission expires:

FOR

General Contractor for this project states that the stored materials constitute a part of the Performance, payment and guarantee bond, and are for this project only.

SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF , 20

Notary Public:

My commission expires:

SARASOTA COUNTY GOVERNMENT

PERFORMANCE AND PAYMENT BOND

In compliance with F.S. Chapter 255.05(1)(a)

15 July 09 Revision

PERFORMANCE AND PAYMENT BOND PAGE PB-1

BOND NO.:

CONTRACTOR NAME:

CONTRACTOR ADDRESS:

CONTRACTOR PHONE NO.:

SURETY COMPANY:

SURETY AGENT:

OWNER NAME: Sarasota County Board of County Commissioners OWNER ADDRESS: 1 Apex Road Sarasota FL 34240

OWNER PHONE NO.: 941-861-5000

BOND AMOUNT:

CONTRACT NO.: (if applicable)

DESCRIPTION OF WORK: Project consists of the installation of approximately 3,500 feet of 6-inch, 8-inch and 12-inch potable water lines that will connect and loop portions of the County’s potable water distribution system that require more than routine flushing to maintain water quality standards.

PROJECT ADDRESS: US 41/Reynolds Street and US 41/Cass Way to Cass Street. N Jackson Road/Batello to Hughey Kimal.

LEGAL DESCRIPTION: Sec 21, Twp 37S, Rge 18E Sec 13, Twp 39S, Rge 19E

By this bond, we, _____________________________________, as Principal and

________________________________, a corporation, as Surety, are bound to Sarasota

County Board of County Commissioners, herein called Owner, in the sum of

$_________________________________, for payment of which we bind ourselves, our

In compliance with F.S. Chapter 255.05(1)(a)

15 July 09 Revision

PERFORMANCE AND PAYMENT BOND PAGE PB-2

heirs, personal representatives, successors, and assigns, jointly and severally.

The conditions of this bond is that if Principal:

1. Performs the Contract dated , between principal and Owner for construction of Potable Water Looping -Jackson Road & US 41, Bid #262810FB 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 payments 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 work; 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 changes in or under the contract documents and compliance or noncompliance with any formalities connected with the contract or the changes does not affect surety’s obligation under this bond.

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.

In compliance with F.S. Chapter 255.05(1)(a)

15 July 09 Revision

PERFORMANCE AND PAYMENT BOND PAGE PB-3

In witness whereof, the said Principal and Surety have signed and sealed this instrument this

(date)

Principal

By:

As President

(SEAL)

Surety

By:

Approved as to form and execution:

By: ____________________________________________ Attorney to Board of County Commissioners of Sarasota County, Florida

Any Claims under this bond may be addressed to (name and address of Surety):

Telephone No: ___________________________________________

Name and address of agent or representative in Florida if different from above:

Telephone No: ___________________________________

County Change Order Request Form

County’s Designated Agent for this Project:

Name: Click or tap here to enter text. Position: Click or tap here to enter text.

Address: Click or tap here to enter text.

Phone: Click or tap here to enter text. Email: Click or tap here to enter text.

Instructions: This form is used by the County’s Designated Agent for ALL Change Order Requests. Each step must be completed in its entirety and stored in the County’s current Project Management Information System.

No Work associated with this Request is to be started until written County Approval, as described herein, is given.

A request for a Change Order price quote resulting in a Contract Modification must be processed through either an IFCA or a Contract Amendment, depending on amount of the price quote and the County’s Designated Agent’s approval authority.

IFCA: A Change Order price quote resulting in a Contract Modification that does not increase the monetary amount of the Contract. An IFCA shall only be initiated by the County Designated Agent set forth herein after completion of all steps in this Change Order Request Form.

Contract Amendment A Change Order price quote resulting in a Contract Modification that increases the Contract not-to-exceed amount.

A Contract Amendment requires approval by the appropriate delegated authority to authorize the expenditure of such Change Order. See Res. No. 2022-152 and the Procurement Manual, as amended, for further details. Change Order Requests requiring a Contract Amendment shall only be issued by the appropriate delegated authority. If funds have not been appropriated by the Board of County Commissioners, a Change Order Request shall only be issued by the Board.

Step 1: Request

The County Designated Agent requests a price quote to change the scope of the Project and directs the responsible engineer/architect to complete documentation supporting the request using Form for Step 1 of this form.

Step 2: Contractor Cost Proposal

Instructions (cont’d)

Upon receiving a County-issued Change Order Request Form for Step 1, the Contractor shall submit a written price quote on the Form for Step 2 to the County Designated Agent listed above and must be signed and dated by the Contractor’s authorized agent. Price quotes not in conformance with the above shall not meet the contract requirements for Change Orders.

Step 3: Approval or Denial to be filled out by County’s Designated Agent on the Form for Step 2 and returned to Contractor within 35 days of receipt of price quote

Upon the County Designated Agent’s receipt of Contractor’s price quote, County Designated Agent will review the price quote and, within 35 days after receipt of such quote, send written notice to Contractor of whether the County approves or denies the price quote. If the price quote is denied, the denial notice will specify the deficiency and actions necessary to remedy the deficiency.

A price quote shall be denied as deficient if the price quote is above the Contract amount, more than the remaining contingency, above the budgeted funds appropriated for the Project, or above the County Designated Agent’s approval authority. Additionally, the County Designated Agent shall have discretion to deny the price quote for other reasons that are in the interests of the Project and County.

Step 4. Processing of approved Change Agreement

If the price quote is approved by the County’s Designated Agent who is authorized to approve such expenditure, an Interim Field Change Agreement (IFCA) will be processed for the additional work reflected in the approved Change Order Request to begin. No work is to begin until the IFCA is completed.

Rights Reserved

If the price quote is denied, the County reserves the right to re-issue a change order request for a new price quote at a later date by written notification from the County representative who has the signature authority for the relevant monetary amounts.

Nothing herein shall change or waive the County’s rights set forth in the other provisions of the Contract.

In the event s. 218.755, F.S., is determined to be invalid by a court of competent jurisdiction, the statutory requirements as set forth above shall be null and void.

FORM STEP 1 - Request

CHANGE ORDER REQUEST NO.: COR- enter COR Number

PROJECT NAME: Click or tap here to enter text.

CIP PROJECT NO.: Click or tap here to enter text.

PO NO. Click or tap here to enter text.

CONTRACT NO.: Click or tap here to enter text.

DATE: Click or tap here to enter text.

AOR/EOR Firm Name

NAME: Representative Name

TITLE: Click or tap here to enter text.

EMAIL: Click or tap here to enter text.

PHONE: Click or tap here to enter text.

THIS IS NOT A CHANGE ORDER, INTERIM FIELD CHANGE AGREEMENT (IFCA) OR A

DIRECTION TO PROCEED WITH THE WORK DESCRIBED IN THE DESCRIPTION.

The Architect or Engineer of Record has provided the following to be used in the change order cost proposal.

<<Note to A/E: COR may include multiple items. Add to section below as needed.>>

COR Item No. Click or tap here to enter No. For: Click or tap here to enter COR Description.

REASON FOR REQUEST: Click or tap here to enter text.

PROPOSED CHANGES: Click or tap here to enter text.

<<Note to A/E: Reference specific edits to contract documents and attach all documents. Use DRAWING and/or SPECIFICATIONS sections as needed.>>

DRAWINGS:

1. Prof. Discipline Sheet Sheet Number Revision number dated Revision Date Brief description of changes included on sheet

2. Prof. Discipline Sheet Sheet Number Revision number dated Revision Date Brief description of changes to spec section

SPECIFICATIONS:

3. Specifications Section Section Number – Section Name dated Revision Date

ATTACHMENTS:

FORM STEP 1 – Request (cont’d)

1. Click or tap here to enter text.

2. Click or tap here to enter text.

3. Click or tap here to enter text.

Printed name of AOR/EOR: Click or tap here to enter text.

Signature: _____________________ Date: ________

Printed name of County Designated Agent: Click or tap here to enter text.

Signature: _____________________ Date: ________

[End of FORM - STEP 1]

Remainder of page intentionally left blank

FORM STEP 2 – Contractor’s Proposal

CHANGE ORDER REQUEST NO.: COR- enter COR Number

CONTRACTOR Firm Name

NAME: Contractor’s Authorized Agent Name

TITLE: Click or tap here to enter text.

EMAIL: Click or tap here to enter text.

PHONE: Click or tap here to enter text.

DESCRIPTION:

1. Contractor’s price quote total: Click or tap here to enter text.

2. Additional contract days requested: Click or tap here to enter text.

3. Additional information related to the price quote:

Click or tap here to enter text.

4. Attachments:

a. Click or tap here to enter text.

b. Click or tap here to enter text.

c. Click or tap here to enter text.

Submittal Date of Price Quote: Click to enter Date

Approval/Denial Date (35 calendar days from Submittal): Click to enter Date

Price Quote valid thru Date (Optional): Click to enter Date or N/A

Contractors Authorized Agent Signature:

[End of FORM - STEP 2]

FORM STEP 3 – Approval or Denial

CHANGE ORDER REQUEST NO.: COR- Click to enter COR Number

A. The Designated Agent recommends approval of the Contractor’s Proposal:

☐ Recommend Approval – IFCA will be initiated for approval and execution

B. Designated Agent denies the Contractor’s Proposal and specifies the following deficiencies:

☐ Denied – Requires a Contract Amendment and Board approval. Request requires a Contract Amendment or no other delegated authority exists. Item may be brought before Board to consider issuing a Change Order.

☐ Denied – Price quote is too expensive

☐ Denied – Other reason(s) for deficiency: Click or tap here to enter text.

C. If denied, the Designated Agent identifies the following possible actions to remedy deficiencies:

☐ Designated Agent will request preparation of a draft Contract Amendment incorporating the Contractor’s Proposal to be brought before the Board for consideration.

The anticipated Board date is before the Price Quote valid thru Date identified by the Contractor on the Step 2 Form.

☐ Contractor’s Proposal may be adjusted and resubmitted to reduce price.

☐ Other means to remedy: Click or tap here to enter text.

Printed name of County Designated Agent: Click or tap here to enter text.

Signature: _____________________

Notification Date of Approval or Denial: Click or tap here to enter text.

[End of FORM - STEP 3]