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Cobb Site Development Inc.� V1 i Y) �l CITY OF OKEECHOBEE INVITATION TO BID OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS No. PW 03-11-08-20 OPENING DATE AND TIME: September 1, 2020 at 3:00 PM Prepared by David Allen, Public Works Director Dated: Aug 12, 2020 CITY OF OKEECHOBEE CITY COUNCIL Bid No. PW 03-11-08-20 OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS DOWLING R. WATFORD, JR., MAYOR WES ABNEY MONICA CLARK BOB JARRIEL BOBBY KEEFE MARCOS MONTES DE OCA, CITY ADMINISTRATOR TABLE OF CONTENTS PW 03-11-08-20 Invitation to Bid Advertisement Form 1 Section I General Information 2 Section II Submission Requirements 3 Section III Bid Documentation 4-5 Section IV Minimum Qualification for Bidders 6 Section V Bonding and Insurance Requirements 7 - 23 Section VI Rejection of Bid 24 Section VI Agreement for Services 25 - 56 Section VIII Miscellaneous 57 - 58 A No Lobbying Affidavit 59 B Anti -Collusion Statement and No Gift Statement 60 C Proposer's Certification 61 D Sworn Statement Pursuant to Section 287.133(3)(a), FL § on Public Entity Crimes 62 - 63 E Conflict of Interest Disclosure Form 64 F Immigration Law Certification 65 G Drug -Free Workplace Certification 66 H Reference Form 67 INVITATION TO BID NO. PW 03-11-08-20 OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS Opening Date and Time: September 1, 2020, 3:00 PM The City of Okeechobee, Florida is currently soliciting bids to provide construction services needed to install various concrete projects located within the City including: • 8-inch-thick roadway slab work. • Removal of existing sidewalk and installation of new ADA ramps. • Removal and replacement of existing sidewalk and/or curb and gutter. • Installation of new sidewalk and/or curb and gutter. Sealed bids must be received within the General Services Department at City Hall, 55 SE 3rd Avenue, Rm 101, Okeechobee, FL 34974, no later than 3:00 PM EST on or before Tuesday, September 1, 2020. All responses received by the deadline will be opened and recorded in the presence of one or more witnesses within the Council Chambers, Rm 200, at the address listed above. Any bids received after the above noted date and time will not be opened or considered. Facsimile or emailed bids will not be accepted. Product specifications are available in the Bid Packets that may be obtained on the City's website: www.cityofokeechobee.com/contracting-opportunities.htm], or from the General Services Department at City Hall during normal office hours, Mon -Fri, 8 AM-4:30 PM, except holidays, or by contacting Patty Burnette, 863- 763-3372 x 9820, or via email at pburnette@cityofokeechobee.com. Questions concerning the scope of work are to be directed to Public Works Director David Allen, 863-763-9790, or dallen(a.cityofokeechobee.com NOTE: Bonding Requirements Apply to this Bid Opportunity. Bid submittals must be within a sealed envelope and contain two (2) clearly identified originals and one (1) copy of the bid, with the outside of the envelope clearly labeled "BID NO. PW 03-11-08-20 OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS, 9-1-20, 3:00 PM" with the submitting Company Name, and Return Address. Bids may be mailed, hand delivered and/or express mailed to the address listed above. Firms properly registered in the State of Florida are encouraged to submit their bid for consideration. It is the sole responsibility of the Bidder to deliver personally or by mail, their bid to the General Services Department on or before the closing hour and date for the receipt of bids as noted above. This solicitation does not commit the City of Okeechobee to award any contracts, to pay any costs incurred in the preparation of a response to this bid, or to contract for any services. The City Council reserves the right to reject any or all bids, to waive informalities and to accept or reject all or part of any bid, as they may deem to be in the best interests of the City of Okeechobee. Responses to this bid, upon receipt by the General Services Department, will become public records subject to provisions of Florida Statute Chapter 119 Florida Public Records Law. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 1 SECTION I PW 03-11-08-20 GENERAL INFORMATION All responses which comply with the requirements of this Bid will be considered. Submittals must be made in the official name of the Firm or Individual under which business is conducted (showing official business address) and must be signed in ink by a person duly authorized to legally bind the person, Partnership, Company, or Corporation submitting the response to this Bid. Two clearly identified originals and one copy of your bid submittal are required. Bid submittals will be received by the General Services Department until 3:00 p.m. on September 1, 2020. Bid submittals are to be mailed, hand -delivered, and/or Express Mail to: City of Okeechobee General Services Department 55 S.E. 3rd Avenue, Room 101 Okeechobee, FL 34974 The submitting offeror is required to have printed on the sealed envelope or wrapping containing their submission their Company name and return address, the Bid Number, Title, Opening Date and Time. Bids received after the date and time specified above shall be returned to the sender unopened. Facsimile or emailed bids will not be accepted. All bids shall remain in effect for a period of ninety (90) days after the last day on which bids must be submitted. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 2 SECTION II PW 03-11-08-20 SUBMISSION REQUIREMENTS The bidder shall submit two (2) original clearly identified originals and one copy of the following: 1. Bid Documentation Form (Section III) 2. Minimum Qualifications for Bidders Form (Section IV) and three (3) references (Attachment H) 3. Bid Bond 4. Bid Unit Price Schedule (Section VII, Exhibit B) In addition to the above, please complete the following forms that must be returned with your bid: Attachment A — No Lobbying Affidavit Attachment B — Anti Collusion Statement and No Gifts Statement Attachment C — Proposer's Certification Attachment D — Sworn Statement Pursuant to Section 287.133(3)(a), FL Statutes on Public Entity Crimes Attachment E — Conflict of Interest Disclosure Attachment F — Immigration Law Certification Attachment G — Drug Free Workplace Certification City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 3 SECTION III PW 03-11-08-20 BID DOCUMENTATION City Council City of Okeechobee 55 S.E. 3rd Avenue Okeechobee, FL 34974 (BIDDER'S COMPANY NAME) I have received the documents titled OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS, Project No. PW 03-11-08-20. 1 have also received addendum number_ through and have included these provisions in my Bid. I have examined both the Bid documents and the construction site and submit the following Bid in which I agree: To hold my Bid open until an agreement has been executed between the City of Okeechobee and accepted Bidder, or until ninety (90) days after Bids are opened, whichever is longer. Regarding the Disposition of Bid Security: to accept the provisions of the Instructions to the Bidders. 3. To accomplish the work included in, and in accordance with the Contract Documents, if this Bid is accepted. 4. To start work on the first day of the month following the date of the Notice to Proceed. This contract will be in force for a period of one (1) year. This contract may be extended beyond the initial one (1) year. Each extension period will be for an additional one (1) year and may be renewed thereafter on an annual basis. It may be under the same or superior terms and conditions as this bid. This shall be accomplished by mutual written agreement/acceptance between the vendor and the City. 5. Payment will be made on a monthly cycle after work has been completed. A monthly invoice will be submitted on or before the 9th day of each month for payment. The invoice will be processed through our regular cycle with payment usually made by the end of the following month. Example: Work performed from September 11t through September 30th. The bill is to be received by the City no later than October 91h, and payment should be made by October 30th. NOTE: The City shall not be liable to pay interest on any unpaid balance. Vendor is solely responsible for all taxes, withholding, or social security obligations. 6. Regarding the Award of the Contract: if I am awarded a contract for this project, I understand that the award may be for all or any portion thereof, of the items listed under the Bid Unit Price Schedule. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 4 Bidder: Cobb Site Development Inc. (Company Name) By: (Signature) Clay Cobb (Printed Name) Mailing Address: 401 S 6th Ave Office Number: 863-773-3839 Date: 9/1/20 Title: CEO Email:operations@lcobbconstruction.com Fax Number: 863-773-2006 City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 5 SECTION IV PW 03-11-08-20 MINIMUM QUALIFICATIONS FOR BIDDERS Minimum Qualifications: 1.0 Experience 1.1 Bidder must have at least 3 years of experience in providing commercial concrete services including sidewalks and other flat work, roadway curbing, and roadway concrete pavement. 1.2 Bidder has successfully completed at least 12 concrete projects including at least one project in each of the following categories: 1.2.1 Sidewalk installation 1.2.2 Roadway curbing 1.2.3 Roadway concrete pavement 2.0 References 2.1 Bidder must provide at least 3 verifiable references of similar prior concrete services including sidewalks and other flat work, roadway curbing, and roadway concrete pavement 2.2 For each reference, Bidder shall submit a completed Reference Form provided in Attachment H. provide the client name, client phone number, and client e- mail address. 2.3 Bidder shall provide a written description of the services performed in sufficient detail as they directly relate to the work of this Request for Bid. The description shall include the dates of the period that the Bidder provided the services as well as the contractual amount of the services provided. 2.4 The City, in its sole discretion, may reject any and all bids if the City is not able to verify the references provided. 3.0 Bidder certifies that 3.1 Bidder meets the qualifications listed in Section IV, 1.0 above. 3.2 Bidder has never failed to complete work awarded under a contract due to circumstances that were under Bidder's control. Bidder: Cobb Site Development Inc. Date: 9/1/20 (Com Name) By: Title: CEO (Signature) Clay Cobb Email: operations@lcobbconstruct ion. com (Printed Name) Mailing Address: 401 S 6th Ave Wauchula FL 33873 Office Number: 863-773-3839 City of Okeechobee Public Works Department Fax Number: 863-773-2006 Project No. PW 03-11-08-20 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we,COBB SITE DEVELOPMENT, INC. as Principal and WESTERN SURETY COMPANY _, as Surety, are held and firmly bound unto the City of Okeechobee (the "City"), in the penal sum of (�; )lawful money of the United States, for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. THE CONDITION OF THE OBLIGATION IS SUCH, that whereas the Principal has submitted the accompanying bid, dated _ September 1 _ _ _ 20 20 , for the Contract Documents: Contract Title: OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS Contract Number: PW 03-11-08-20 NOW, THEREFORE, 1. If the Principal, a. Within seven (7) business days after the date of the Notice of Apparent Low Bidder; provides a Statutory Payment Bond and a Common Law Performance Bond as specified in the General Terms & Conditions or, in lieu of the Statutory Payment Bond or Common Law Performance Bond, provides an alternate form of security as specified in the Contract Documents; and provides the insurance certificate required under the Contract Documents, completed by a lawfully authorized insurance agent; and b. Within seven (7) business days of receipt of the Contract Documents, enters into a written contract with the City, in accordance with the Bid, as accepted, then the above obligations of the Principal and Surety shall be null and void. 2. However, should the Principal fail to fully comply with the conditions of paragraph 1 above, then the Principal and Surety, jointly and severally, shall be liable to the City for the full penal sum of this Bond which shall be forfeited to the City as liquidated damage, but not a penalty, as a result of the Principal's failure to comply with the bid instructions and conditions, regardless of whether the City ultimately decides to change the project requirements or resolicit bids. 3. The remedies provided herein are not to be construed as the City's exclusive remedies for the Principal's failure to enter into a contract with the City but shall be deemed supplemental to all remedies available to the City at law or otherwise. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 15 DATED ON September 1 , 2Q 20 . FOR NON -CORPORATE BIDDERS: By: (Witness) (Signature of Principal) (Print Name) (Print Name and Title) (Witness) (Print Name) Business Address FOR CORPORATE BIDDERS: COBB SITE DEVELOPMENT, INC. ATTEST:'',/ (Signat of Corporate Principal) SecretrinVlName and Title) 4016utik (it" AvL- Wowc uiVL-, rL , 53873 Business Address SURETY: ATTEST: WESTERN SURETY COMPANY (Corporate Seal) , (Corporate Surety) << �`` a .� ��=-�"� Tom S Lobrano.Ill Attorney -in -Fact & Florida Resident Agent Secretary Catherine Bennett (Print Name and Title) 151 N. Franklin Street, Chicago, Illinois 60606 Business Address 500 Colonial Center Parkway, Suite 400, Lake Mary, FL 32746 Florida Address for Service of Process 407-804-5929 Telephone Number (Surety shall provide evidence of signature authority such as a certified copy of Power of Attorney. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 16 Western Surety Company POWER OF ATTORNEY APPOINTING INDIVIDUAL. ATTORNEY -IN -FACT Know All Men By These Presents, That WESTERN SURETY COMPANY; a South Dakota corporation, is a duly organized and existing corporation having its principal office in the City of Sioux Falls, and State of South Dakota. and that it does by virtue of the signature and seal herein affixed hereby make, constitute and appoint Tom S Lobrano III, Tom S Lobrano IV, Mark C Fore, Geoffrey M Munn, Individually of Jacksonville, FL. its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bonds, undertakings and other obligatory instruments of similar nature - In Unlimited Amounts - and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney. pursuant to the authority hereby given, are hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof duly adopted; as indicated, by the shareholders of the corporation. In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be hereto affixed on this 9th day of February, 2018. 4 WESTERN SURETY COMPANY aul T. Bruflat; Vice President State of South Dakota ss County ofMinnehaha On this 9th day of February; 2018, before me personally came Paul T. Bruflat; to me known, who; being by me duly sworn; did depose and say: that he resides in the City of Sioux Falls, State of South Dakota that he is the Vice President of WESTERN SURETY COMPANY described in and which executed the above instrument that he knows the seal of said corporation: that the seal affixed to the said instrument is such corporate seal; that it was se affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporation. My commission expires J. MOHRJim q SOUTH AKCTA June 23: 2021 x soun+oa"cry �t►��/ C., MMo'hr. Notan Public CERTIFICATE L L Nelson. Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabeve set forth is still in force. and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporation this 1st day of September 2020 `FESTER' SURETY COMPANY W 0* c c)Y &,,e, /SO ♦Q' L Nelson. Assistant Seeretar\ Fonn F4280-7-2012 Go to www.cn_asurety.corn > Owner / Obligee Services > Validate Bond Coverage, if you want to verify bond authenticity. Authorizing By -Law ADOPTED BY THE SHAREHOLDERS OF WF.STFRN Si TRFTY COMPANY This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the shareholders of the Company. Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the corporate name of the Company by the President Secretary, and Assistant Secretary, Treasurer, or any Vice President or by such ocher officers as the Board of Directors may authorize. The President, any Vice President Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile. C D 6rj EXHIBIT B BID UNIT PRICE SCHEDULE PW 03-11-08-20 OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS EST. ITEM UNIT UNIT DESCRIPTION QTY AMOUNT NO. MEASURE PRICE POUR EIGHT (8) INCH CONCRETE ROADWAY SLAB TWENTY-FOUR (24) FEET XONE HUNDRED -FIFTY (150) FEET, 3,000 PSI MINIMUM W/6 INCHES X6 INCHES —1.4 X 1.4 WWF REINFORCEMENT ON NW 10TH STREET. CITY 5q G 1 TO REMOVE EXISTING ASPHALT AND EXCAVATE EACH 1 I0 , EXISTING ROAD BASE AND PROVIDE NEW SUBBASE. WORK TO BE PERFORMED IN TWO SEGMENTS TO MAINTAIN ACCESS TO APARTMENT COMPLEX ON NORTH SIDE OF 10TH STREET. POUR EIGHT (8) INCH CONCRETE ROADWAY SLAB TWENTY-FOUR (24) FEETX ONE HUNDRED -FIFTY (150) FEET, 3,000 PSI MINIMUM W/6INCHES X6INCHES —1.4 X 1.4 WWF REINFORCEMENT ON NW 10TH STREET. CITY 2 TO REMOVE EXISTING ASPHALT AND EXCAVATE EACH 1Iq�O"� EXISTING ROAD BASE AND PROVIDE NEW SUBBASE. WORK TO BE PERFORMED IN TWO SEGMENTS TO MAINTAIN ACCESS TO DIAMOND R FERTILIZER. REMOVE EXISTING SIDEWALK AND INSTALL NEW ADA CURB RAMP CR-B PER FDOT INDEXES 300 CURB & CURB AND GUTTER, AND 304 DETECTABLE WARNINGS AND 1 3 SIDEWALK CURB RAMPS. CONCRETE SHALL BE 3,000 EACH 1 �rOh 1 PSI WITH FIBER OF OTHER APPROPRIATE REINFORCEMENT MATERIAL. DETECTABLE WARNING MAT COLOR SHALL BE BRICK RED. REMOVE EXISTING SIDEWALK AND INSTALL NEW ADA CURB RAMP CR-C PER FDOT INDEXES 300 CURB & CURB AND GUTTER, AND 304 DETECTABLE WARNINGS AND `� SIDEWALK CURB RAMPS. CONCRETE SHALL BE 3,000 I 100� ✓� PSI WITH FIBER OF OTHER APPROPRIATE 4 EACH 7 REINFORCEMENT MATERIAL. DETECTABLE WARNING MAT COLOR SHALL BE BRICK RED. WIDTH TO VARY FROM 6 FEET TO 8 FEET DEPENDING ON LOCATION. RAMP WIDTH TO MATCH WIDTH OF EXISTING PAVER SIDEWALK. City of Okeechobee Public Works Department Project No. PW 03-11-08-20 54 REMOVE EXISTING SIDEWALK AND INSTALL NEW ADA CURB RAMP CR-L PER FDOT INDEXES 300 CURB & CURB 5 AND GUTTER, AND 304 DETECTABLE WARNINGS AND SIDEWALK CURB RAMPS. CONCRETE SHALL BE 3,000 EACH 2 PSI WITH FIBER OF OTHER APPROPRIATE REINFORCEMENT MATERIAL. DETECTABLE WARNING MAT COLOR SHALL BE BRICK RED. 6 REMOVE AND REPLACE EXISTING FIVE (5) FOOT WIDE LINEAR 100 L� �j.?Uq,q70-(b CONCRETE SIDEWALK. TEN (10) YARD TOTAL. FOOT 7 REMOVE AND REPLACE EXISTING FIVE -FOOT -WIDE LINEAR 50 I O� I)D l CONCRETE SIDEWALK. LESS THAN TEN (10) YARD TOTAL FOOT $ REMOVE AND REPLACE EXISTING CONCRETE "F" CURB. LINEAR 100 (�� 00 TEN (10) YARD TOTAL FOOT 9 REMOVE AND REPLACE EXISTING CONCRETE "F" CURB. LINEAR 100 LESS THAN TEN (10) YARD TOTAL FOOT J `1 10 INSTALL NEW FIVE (5) FOOT WIDE CONCRETE LINEAR 500 �� 100 06 SIDEWALK. TEN (10) YARD TOTAL FOOT W 11 INSTALL NEW FIVE (5) FOOT WIDE CONCRETE LINEAR 100 �1- a`� j (P' � SIDEWALK. LESS THAN TEN (10) YARD TOTAL FOOT 12 INSTALL NEW CONCRETE "D" CURB. TEN (10) YARD OR LINEAR 100 Q 00 GREATER TOTAL FOOT 13 INSTALL NEW CONCRETE "D" CURB. LESS THAN TEN LINEAR 50 lad-31 (10) YARD TOTAL FOOT 14 INSTALL NEW CONCRETE "F" CURB. TEN (10) YARD OR LINEAR 100 (�'� U7 (� GREATER TOTAL FOOT + 15 INSTALL NEW CONCRETE "F" CURB. LESS THAN TEN (10) LINEAR 50 123 A YARD TOTAL FOOT -37 Jo .56 16 INSTALL NEW 4-INCH-THICK CONCRETE SLAB SQUARE OOT 500 17 INSTALL NEW 6-INCH-THICK CONCRETE SLAB SQUARE FOOT 500 TOTAL BID AMOUNT n (Based on Bid Unit Prices & Estimated Quantities) City of Okeechobee Public Works Department Project No. PW 03-11-08-20 55 Bidders Company Name Cobb Site Development Inc. NOTE: This Bid is on a unit price basis. The total estimated amount is for Bid comparison purposes only. The Contractor should field verify the actual site conditions prior to time of bidding and before submitting the Bid proposal. The Contractor should read the special conditions and the requirements for insurance before submitting a Bid proposal. The Contractor should verify the quantities to be included in the construction contract. The Contractor shall furnish the City of Okeechobee with a Payment and Performance Bond in 100 percent (100%) of the total estimated amount of the contract. The Payment and Performance Bond shall continue in effect for one (1) year after completion and acceptance of the work as guarantee against construction defects. The Contractor in his Bid shall include the cost of said bond. I have attached the required 5 percent (5%) Bid Security to this Bid. Bidder: Cobb Site Development Inc. (Com any Name) By: Title ( ignature) Clay Cobb (Printed Name) Date: 9/1/20 CEO Email:operations@lcobbconstruction.com Mailing Address: 401 S 6th Ave Wauchula FL 33873 Office Number: 863-773-3839 Fax Number: 863-773-2006 City of Okeechobee Public Works Department Project No. PW 03-11-08-20 56 SECTION VIII PW 03-11-08-20 MISCELLANEOUS A. No Lobbying: All respondents are hereby placed on notice that any communication, whether written or oral, with City of Okeechobee elected officials or any City staff or outside Individuals working with the City in respect to this request (with the exception of the General Services personnel designated to receive requests for interpretation or corrections or technical questions), is prohibited. These persons shall not be lobbied, either individually or collectively, regarding any request for Bid, qualifications and/or any other solicitations released by the City. To do so is grounds for immediate disqualification from the selection process. All respondents must submit the attached No Lobbying Affidavit with their submittal stating that they and their Subcontractor, sub - consultants and agents agree to abide by the no lobbying restrictions in order to be considered for this request. Any respondent that does not submit the required No Lobbying Affidavit will be automatically disqualified from further consideration. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment A B. Collusion, Gratuities and Kickbacks: It shall be unethical for any respondent to collude with any other respondent or offer, give or agree to give any City Council member, City employee or City representative (including selection committee members) a gift, gratuity or an offer of employment in connection with any decision, approval, disapproval, recommendation or preparation of any part of the procurement process. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment B C. Modifications: The City reserves the right to modify, alter or change the scope or other aspects of this solicitation. D. Level Playing Field. The contents of this solicitation are intended to provide a level playing field on which Firms or Individuals may base their responses. E. Public Entity Crime Affidavit: As requested by Florida Statute 287.133(2)(a), a person or affiliate who has been placed on the convicted vendor list following a conviction for a Public Entity Crime may not submit a Bid on a contract with a Public Entity for the construction or repair of a public building or a public work, may not submit Bids on leases of real property to a Public Entity, may not be awarded or perform work as a Contractor, supplier, Subcontractor, or consultant under a contract with any Public Entity, and may not transact business with any Public Entity in excess of the threshold amount provided in F.S. 287.017 for Category Two for a period of thirty-six (36) months from the date of being placed on the convicted vendor list. Any person must notify the City within thirty (30) days after a conviction of a Public Entity crime applicable to that person or to an affiliate of that person. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment D City of Okeechobee Public Works Department Project No. P1N 03-11-08-20 57 F. Conflict of Interest: The award hereunder is subject to the provisions of Chapter 112, Florida Statutes. All respondents must disclose with their submission the name of any officer, director, employee or agent who is also a public officer, employee or an agent of the City of Okeechobee City Council, or any of its agencies. Furthermore, all respondents must disclose the name of any City officer, employee or agent who owns, directly or indirectly, an interest of five percent (5 %) or more in the Firm or any of its parent companies or subsidiaries. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment E G. Immigration Laws: Respondents must comply with all applicable immigration laws in their employment practices. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment F H. Tie Bids: Preference shall be given to businesses with drug -free workplace programs. Whenever two or more bids which are equal with respect to quality and service are received by the City for the procurement of commodities or contractual services, a bid received from a business that certifies that it has implemented a drug -free workplace program shall be given preference in the award process. Established procedures for processing tie bids will be followed if none of the tied vendors has a drug -free workplace program. City of Okeechobee Public Works Department Project No. PW 03-11-08-20 58 ATTACHMENT A PW 03-11-08-20 NO LOBBYING AFFIDAVIT STATE OF FLORIDA COUNTY OF Hardee This 1st day of September2020 Clay Cobb being first duly sworn, deposes and says that he/she is the authorized representative of Cobb Site Development Inc. (Name of Contractor, Firm or Individual) respondent to the attached request for Bid, or qualifications and/or any other solicitation released by City of Okeechobee, and that the Bidder and any of its agents agrees to abide by the City of Okeechobee no lobbying restrictions in regard to this solicitation. > Affiant The foregoing instrument was acknowledged before me by means of 99 physical presence or ❑ online notarization, this 1st day of September , 20 20 , by Clay Cobb , who is personally known to me or produced as identification. Notary Public State of Florida ,Q Diana Weems My Cbrnrnlss,on GG 232550 Expires 06126f2022 wa City of Okeechobee Public Works Department --. NotaryPu lic Signature Commission No. C.1 C1 �-S S o Project No. PW 03-11-08-20 59 ATTACHMENT B PW 03-11-08-20 ANTI -COLLUSION STATEMENT AND NO GIFTS STATEMENT Date: 9/1/20 Anti -collusion statement: The below -signed Bidder has not divulged to, discussed, or compared his/her Bid with other Bidders and has not colluded with any other Bidder or parties to a Bid whatsoever. No gifts statement: No premiums, rebates, gifts or gratuities are permitted with, prior to, or after submission of the Bid. Any such violation will result in rejection of the Bid and removal from the Bid list(s). Firm Name: By (printed/typed): By (signature): Title: Mailing Address: City, State, Zip: Telephone No.: City of Okeechobee Public Works Department Cobb Site Development Inc. CEO 401 S 6th Ave Wauchula FL 33873 Wauchula FL 33873 863-773-3839 Project No. PW 03-11-08-20 M ATTACHMENT C PW 03-11-08-20 PROPOSER'S CERTIFICATION I have carefully examined this Request for Bid (BID)/Request for Proposals (RFP)/ Request for Qualifications (RFQ), which includes scope, requirements for submission, general information and the evaluation and award process. I acknowledge receipt of the following addenda. Addendum # Date: Addendum # Date: Addendum # Date: Addendum # Date: Addendum # Date: Addendum # Date: I hereby propose to provide the services requested in the City's BID/RFP/RFQ and, if awarded, to enter into the attached draft contract. I agree that the terms and conditions of the City's BID/RFP/RFQ shall take precedence over any conflicting terms and conditions submitted with my proposal and agree to abide by all conditions of the BID/RFP/RFQ, unless a properly completed Exceptions to BID/RFP/RFQ form is submitted. I acknowledge that the City may not accept the proposal due to any exceptions. I certify that all information contained in my proposal is truthful to the best of my knowledge and belief. I further certify that I am duly authorized to submit this proposal on behalf of the Company as its agent and that the Company is ready, willing and able to perform if awarded a contract. further certify, under oath, that this proposal is made without prior understanding, agreement, connection, discussion or collusion with any other person, Company or Corporation submitting a proposal for the same product or service; no gratuities, gifts or kick -backs were offered or given by the Bidder or anyone on its behalf to gain favorable treatment concerning this procurement; no City Council member, employee or agent of City of Okeechobee or of any other Company is interested in said Bid; and that the undersigned executed this Proposer's Certification with full knowledge and understanding of the matters therein contained and was duly authorized to do so. Cobb Site Development Inc. 401 S 6th Ave Name of Business Authorized ignature Clay Cobb / CEO Name & Title, Typed STATE OF FLORIDA COUNTY OF Hardee Mailing Address Wauchula FL 33873 City, State & Zip Code 863-773-3839 / 863-773-2006 Telephone Number/Fax Number operations@lcobbconstruction.com Email Address The foregoing instrument was acknowledged before me by means of X physical presence or ❑ online notarization, this 1st day of Sept . 202 0 by Clay Cobb , who is personally known to me or produced as identification. Nchiv=I/Voems a Notary-�Public Signatu DianaCommission No. 1 C1YA5uMy C<ir ofFxp+r ; City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 61 ATTACHMENT D PW 03-11-08-20 SWORN STATEMENT PURSUANT TO SECTION 287.133 (3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement is submitted to CITY OF OKEECHOBEE, FLORIDA by: Clay Cobb / CEO (print Individual's name and title) for: Cobb Site Development Inc. (print name of entity submitting sworn statement) whose business address is 401 S 6th Ave Wauchula FL 33873 and (if applicable) its Federal Employer Identification Number (FEIN) is: 13-4205756 (If the entity has no FEIN, include the Social Security Number of the Individual signing this sworn statement: 2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including but not limited to, any Bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentations. 3. 1 understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non -jury trial, or entry of a plea of guilty or nolo contendere. 4. 1 understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes, means: a. A predecessor or successor of a person convicted of a public entity crime; or b. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. City of Okeechobee Public Works Department Project No. PW 03-11-08-20 62 5. 1 understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which Bids or applies to Bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. 6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Indicate which statement applies). X Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. ❑ The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. ❑ The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list (attach a copy of the final order). I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. Signature STATE OF FLORIDA COUNTY OF Hardee The foregoing instrument was acknowledged before me by means of a physical presence or ❑ online notarization, this 1stday of Sept . 20 20 , by Clay Cobb , who is personally known to me or produced as identification. �Ow Notary Public State o! Florida Diana Weems My Commission GG 232550 'tOf Expires 06/26/2022 City of Okeechobee Public Works Department ' '-hA04 Notary Pu Signature Commission No. ,�1 L, ()-3 � 5.5 0 Project No. PW 03-11-08-20 63 ATTACHMENT E PW 03-11-08-20 CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all Bidders must disclose if any City of Okeechobee employee(s), elected official(s), or any of its agents is also an owner, corporate officer, director, agent, employee, etc., of their business. Indicate either "yes" (a City employee, elected official or agent is associated with your business), or "no". If yes, give person(s) name(s) and position(s) with your business. YES NO X Name(s) Position(s) Firm Name: Cobb Site Development Inc. By (Printed): Clay Cobb By (Signature): Title: CEO Address: 401 S 6th Ave Wauchula FL 33873 Phone Number: 863-773-3839 City of Okeechobee Public Works Department Project No. PW 03-11-08-20 64 ATTACHMENT F PW 03-11-08-20 IMMIGRATION LAW CERTIFICATION City of Okeechobee will not intentionally award City contracts to any Contractor who knowingly employs unauthorized alien workers, constituting a violation of the employment provisions contained in 8 U.S.C. Section 1324 a(e) (Section 274a(e) of the immigration and nationality act ("INA")). City of Okeechobee may consider the employment by any Contractor of unauthorized aliens a violation of Section 274A(e) of the INA. Such violation by the recipient of the employment provisions contained in Section 274A(e) of the INA shall be grounds for unilateral cancellation of the contract by City of Okeechobee. Respondent attests that it is fully compliant with all applicable immigration laws, specifically relating to the 1986 immigration act and subsequent amendments. Cobb Site Development Inc. A e nature CEO Title 9/1/20 Date STATE OF FLORIDA COUNTY OF Hardee The foregoing instrument was acknowledged before me by means of N physical presence or ❑ online notarization, this 1st day of Sept . 2020 by Clay Cobb _,who is personally known to me or produced as identification. Notary Public State of Florida :f ,p Diana Weems Nota ublic Signature My Commission GG 232550 R, xp;r:° 06/26/2022 CW VPCommission No. J �� City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 65 ATTACHMENT G PW 03-11-08-20 DRUG -FREE WORKPLACE CERTIFICATION THE BELOW SIGNED Bidder/proposer CERTIFIES that it has implemented a drug -free workplace program. In order to have a drug -free workplace program, a business shall: Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violation of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are under quote a copy of the statement specified in subsection 1. 4. In the statement specified in subsection 1, notify the employees that, as a condition of working on the commodities or contractual services that are under quote, the employee will abide by the terms of the statement and will notify the employer of any conviction or plea of guilty or nolo contendere to any violation occurring in the workplace no later than five (5) days after such conviction. 5. Impose a sanction on, or require the satisfactory participation in, drug abuse assistance or rehabilitation program if such is available in the employee's community, by an employee who is convicted. 6. Make a good faith effort to continue to maintain a drug -free workplace through implementation of this section. As the person authorized to sign this statement, I certify that this Firm complies fully with the above requirements. Signature: Date: 9/1/20 Company: Cobb Site Development Inc. Address: 401 S 6th Ave Wauchula FL 33873 City of Okeechobee Public Works Department Name: Clay Cobb Title: CEO Phone Number: 863-773-3839 Project No. PW 03-11-08-20 66 ATTACHMENT H CITY OF OKEECHOBEE OKEECHOBEE 2020 SIDEWALK AND ROADWAY CONCRETE IMPROVEMENTS PW 03-11-08-20 REFERENCE Client Name: City Of Avon park Client Phone Number: 863-657-2323 Client E-mail: carl@coolandcobb . com Service Dates: Beginning July 2016 End September 2017 Estimated Annual Contract Amount: $984 , 374.54 Description of the services performed as they directly relate to the work of this Request for Bid: CDBG streetscape improvements, which included new drainage, road reconstruction, sidewalk and curb, pavilion, site lighting and site furnishings. City of Okeechobee Project No. PW 03-11-08-20 Public Works Department 67 P' iTE DEVELOPMENT iNC 401 South Sixth Avenue, Wauchula, Florida 33873 Tel: 863-773-3839 or 863-385-2622/Fax: 863-773-3214 LIST OF PREVIOUS PROJECTS AND REFERENCES WAUCHULA ORANGE STREET DRAINAGE City of Wauchula Wauchula, FL Andy Maddox P) 863.773.3131 E) and y0citvofwauchula.com $1,267,843.00 Contract Completion: June 2016 —July 2017 FLORIDA HOSPITAL SITE WORK Brasfield & Gorrie Wauchula, FL J.C. Peterson P) 407.304.7268 E) 1peterson@brasfleldgorrie.com $1,765,720.00 Contract Completion: December 2018 Contract Completion: August 2015 —July 2016 AVON PART{ STREETSCAPE INFRASTRUCTURE IMPROVEMENTS City pf Avon Park Avon Park, FL Carl Cool P) 863.657.2323 E) corl@coolandcobb.com $984,374.54 Contract Completion: September 2017 CONSTRUCT TAXIWAY D AT BARTOW MUNICIPAL .AIRPORT Bartow Municipal Airport Bartow, FL Terry Beacham P) 863.370.1996 E) tbeacham@bartow-airport.com $2,098,450.79 Contract Completion: August 2015 —July 2016 Form W"9 Request for Taxpayer Give Form to the (Rev. January 2011) Certification bo not l)eparlrnentofthe Treasury Identification Number and Certification send to the IRS. Internal Revenue Service Name (as shown on your Income tax return) Cobb Site Development, Inc. N Buslness name/disregarded entity na " differeni from above m rn m a Check appropriate box for federal tax 0 d c classification (required): ❑ Individual/sole proprietor ❑ C Corporation ®iS Corporation ❑ Partnership ❑ Trust/estate 0 0 ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=parinershipl / El Exempt payee `a ---------------------- C y ❑ Other (see instructions)► Address (number, street, and apt, or suite no.) Requester's name and address (optional) a 401 S. 6th Ave. City, state, and ZIP code W Waucnula, FL 33873 List account number(s) here (optional) 9013 Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line Social security number avoid backup withholding. For individuals, this is your social security number However, for re page resident alien, sale proprietor, or disregarded entity, see the Part I instructions on page 3. For other _ m _ entities. it Is vour emolover identification number 1E1N1. If you do not have a number. see How to oat a TiN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. ©©M©©M©©©E Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. citizen or other U.S, person (defined below). Certification instructions, You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all Interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement ((RA), and generally, payments other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Her ► d / Signature of /✓ 1 �,� ` /� Here U.S, person/'�,� ��� Date%11 General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who Is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA, Use Form W-9 only if you are a U,S. person (including a resident alien), to provide your correct TiN to the person requesting it (the requester) and, when applicable, to: 1, Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701-7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, In certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner In a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income, Cat. No. 10231X Form W-9 (Rev. 1-2011) Ron DeSantis, Governor STATE OF FLORIDA Halsey Beshears, Secretary 'rKAEKI'r OF BUSINESS AND PROFESSIONAL REGULATION LJ Q 1— 1-% F% CONSTRUCTION INDUSTRY LICENSING BOARD THE UNDERGROUND UTILITY & EXCAVATION CO HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES COBB, JAMES CLAY COBB SITE DEVELOPMENT, INC 401 SOUTH SIXTH AVE WAUCHULA FL 33873 LICENSE NUMBER: CUC1224962 EXPIRATION DATE: AUGUST 31,2022 Always verify licenses online at MyFloridal-icense.corn rwDo not alter this document in any form. % :r This is your license. It is unlawful for anyone other than the licensee to use this document. Ron DeSantis, Governor Halsey Beshears, Secretary "a S STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES off COBB, JAM ES CLAY COBB SITE DEVELOPMENT INC 401 S 6TH AVE WAUCHULA FL 33873 LICENSE NUMBER: CGC1516528 EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at MyFloridaLicense.com r Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. '""" mal Florida Department of Transportation RON DESANTIS 605 Suwannee Street KEVIN J. TIIIBAUI. P, P.E. GOVERNOR Tallahassee, FL 32399-0450 SECRETARY March 31, 2020 COBB SITE DEVELOPMENT, INC 401 SOUTH SIXTH AVE WAUCHULA, FLORIDA 33873 RE: CERTIFICATE OF QUALIFICATION Dear Sir/Madam: The Department of Transportation has qualified your company for the type of work indicated below. Unless your company is notified otherwise, this Certificate of Qualification will expire 4/30/2021. However, the new application is due 2/28/2021. In accordance with S.337.14 (1) F.S. your next application must be filed within (4) months of the ending date of the applicant's audited annual financial statements. If your company's maximum capacity has been revised, you can access it by logging into the Contractor Prequalification Application System via the following link: HTTPS://fdotwpl.dot.state.fl.us/ContractorPreQualification/ Once logged in, select "View" for the most recently approved application, and then click the "Manage" and "Application Summary" tabs. FDOT APPROVED WORK CLASSES: DRAINAGE, FLEXIBLE PAVING, GRADING, SIDEWALK, Underground Utilities (Water & Sewer) You may apply for a Revised Certificate of Qualification at any time prior to the expiration date of this certificate according to Section 14-22.0041(3), Florida Administrative Code (F.A.C.), by accessing your most recently approved application as shown above and choosing "Update" instead of "View." If certification in additional classes of work is desired, documentation is needed to show that your company has done such work with your own forces and equipment or that experience was gained with another contractor and that you have the necessary equipment for each additional class of work requested. All prequalified contractors are required by Section 14-22.006(3), F.A.C., to certify their work underway monthly in order to adjust maximum bidding capacity to available bidding capacity. You can find the link to this report at the website shown above. AA:cg p, Sincerely, Alan Autry, M ager Contracts A inistration Office www.fdot.gov Cobb Site Development, Inc. Equipment List 03i29/19 DJW GLlf nn Ins_ Yr Purch Value CSE01 Gator Gator Utility HP46X010125 MOHP4GX010125 Yes 2003 3000 CSE02 New Holland Tractor NH TS110 Cab 4WD 159361E Yes 2008 12000 CSE03 MMD Mud Pump N300-H 607503 Yes 2010 3000 CSE04 Caterpillar Leeboy Grader 685CAB AC 49215 Yes 2011 65000 CSE05 John Deere 700J Bulldozer 2005 700J T0700JX110283 Yes 2012 35000 CSE07 Gehl Crawler Paver 1996 1448 IM0317047 Yes 2014 2000 CSE08 Bobcat Compact Track Loader T780 ANBL12628 Yes 2014 50000 CSE09 Hypac Hypac Roller Used1999 C330B 90IB15803824 Yes 2014 5000 CSE10 Bobcat Mini Excavator E85T4 B34T11694 22455 Yes 2014 70000 CSE11 Rex Rex Mixer 2009 HK631 Yes 2014 10000 CSE12 Bomag Reversible Compactor Plate BPR35/60 101690451279 Yes 2014 5000 CSE13 Ingersoll-Rand Wheel Roller (2000) PT125R 9 166154 Yes 2016 15000 CSE14 Lee -Boy Crawler Asphalt Paver 2005 8500T 44623 Yes 2016 25000 CSE15 John Deere Grader 672 DW672BX548045 Yes 2016 45000 CSE16 Caterpillar Loader Bucket, Forks, Rake 928 G 1T28GV8CR03414 Yes 2016 55000 CSE17 Caterpillar Trachoe aka Excavator 322CL 0322CEBKJO0661 Yes 2016 55000 CSE20 Caterpillar Off Road Dump Truck D25 11HK0490 Yes 2016 25000 CSE21 Caterpillar 2008 Excavator f/M&E Precision 304CR 0304CVENW00916 Yes 2016 30000 CSE22 John Deere 24" High Flow Cold Planer CP24 1TOCP24CHC0000049 Yes 2016 10000 CSE23 Caterpillar Wheel Loader 2014 924K PWR03272 22456 Yes 2016 140000 CSE24 Caterpillar Track Type Tractor D3K2LGP KLL00373 22461 Yes 2016 70000 CSE25 Caterpillar LGP Tractor D6K2LGPT4 ORST01594 22460 Yes 2016 160000 CSE26 Caterpillar 930K Wheel Loader 930K 930K-RHN03296 22506 Yes 2016 180000 CSE27 John Deere Loader w/Rake, Bucket, Forks 2004 DW 644-JX 595669 Yes 2017 92000 CSE28 John Deere 6" Well Point Pump 3281 PE404DI O7839 Yes 2015 8500 CSE29 Bad Boy Recoil Buggy 2016 A8B70bvg 8015670 Yes 2016 15000 CSE30 Trimble Rover Receiver S s985 0635JO07SW 22459 Yes 2015 80000 CSE31 La or Rotary Broom Sweeper SM300 36617SM Yes 2018 CSE32 Caterpillar Vibratory Soil Compactor CS54BCAB L4HOO638 Yes 2018 CSE33 Bad Boy Stampede Buggy 9000172 Yes 2017 CSE34 Bad Boy HD Electric Buggy HD 3246666 Yes 2017 CSE35 Caterpillar 345 Excavator 1443 AGS1010 18300 Yes 2018 CSE36 Caterpillar D6N Track Type Tractor D6N PBA02525 22508 Yes 2018 CSE37 Bobcat Compact Track Loader T870 B47C12092 No 2018 CSE38 Bobcat Compact Track Loader T870 ASWT11690 No 2016 CSE39 Caterpillar Hydraulic Excavator 313 HDK10228 22509 Yes 2018 CSE40 Caterpillar 740 Dump truck 2007 740 B1 PO3005 Yes 2018 64000 CSE41 Caterpillar 740 Dump truck 2007 740 B1 PO3003 Yes 1 2018 64000 CSE42 Caterpillar 740 Dump truck 2007 740 BlPO3000 Yes 2018 64000 CSE43 Caterpillar 120M Motor Grader 120M B9CO0535 22470 Yes 2019 95,000.00 CSE44 Caterpillar Off Road Water Truck 613C 90Z34837 Yes CSE45 Rotary Lobe Wellpoint Diesel Pump TCAE-55 Yes 50,000.00 CSE46 Dri-Prime Diesel Pump 3TNV88F Yes 25,000.00 CSE47 Trimble Earthworks GPS System Yes 56,520.00 Caterpillar Loader Bucket 2Yard 117261op—pWeSN&L04L-tft) No 2003 Spectra Precision Laser Level Kit w/ Tri od&Rod LL500 62714/M300208 No 2008 Wylie 2011 Water Trailer Tank(Water Wagon) EXP-1025-5 41064 No 2015 CST/Berger 26 X Auto Level Kit 811869 M300208 No 2008 DeSite Screener SLG-60 No 2015 Chainsaw 1 20" JSCS2255 No 2016 Sthil Concrete Saw 450 No 2016 Pasload Cordless Angled Finish Funs 18 Guage No 2016 Pasload Cordless Staple Gun No 2016 Cate illar 613E Water Wagon 613B Trailer.38W5377 Tank28671-C No 2019 Bomag Compactor Plate- Non Reversible BP18/45-2 Total: $ 1,684,020.00 E-Verify: Employer Wizard -Company! nfurnation E Verify Welcome Diana Weems Company Information Company Name Cobb Site Development, Inc. Company ID Number 774044 Doing Business As (DBA) Name DUNS Number Physical Location Address 1 401 S. 6th Ave Address 2 City Wauchula State FL Zip Code 33873 County HARDEE https: e-veFify.uscis.gov/web/EmployerWizard.aspx MENU i e r 1/3 E-Verify: Employer Wizard - Company Information Mailing Address Address 1 Address 2 City State Zip Code Additional Information Employer Identification Number 134205756 Total Number of Employees 5to9 Parent Organization Administrator Organization Designation Employer Category Federal Contractor with FAR E-Verify Clause Federal Contractor Category None of these categories apply Employees Being Verified All new hires and all existing employees assigned to a Federal contract View / Edit NAICS Code 238 - SPECIALTY TRADE CONTRACTORS https://e-verify.uscis.gov/web/EmployerVVizard.aspx 2/3 E-Verify: Employer Wizard - Company Information View / Edit Total Hiring Sites 1 View I Edit Total Points of Contact 3 View I Edit View Original MOU Template View 560 w fS-TV� ` t. SIC, '� IIIIiII •vlST0.F U.S. Department of Homeland Security U.S. Citizenship and Immigration Services Enable Permanent Tooltips Accessibility Download Viewers Last Login: 08/18/2020 09:46 AM https://e-verify.uscis.gov/web/EmployerWizard.aspx 3/3 (863)773-3131 (863) 773-0773 FAX Business No.- 0062 BUSINESS TAX October 1, 2019 — September 30, 2020 This authorizes COBB SITE DEVELOPMENT, INC to conduct business as a GENERAL CONTRACTOR at the following location: within the city limits of Wauchula, Florida Signed � �!`' �_ � ' t'r=Y;'�'r�' Date 9/30/20I9 126 S 7'n Ave WAUCHULA; FL 33873 Client#: 298 LCOBg ACORU., CERTIFICATE OF LIABILITY INSURANCE DATE MMIDDIY 2019YYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Construction Underwriters, Inc 4168 Southpoint Pkwy -Ste 305 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Jacksonville, FL 32216 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Amerisure Mutual Ins. Co. 23396 Cobb Site Development, Inc. 401 6th Ave. Wauchula, FL 33873 INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES 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. SR LTR DD INSRE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD POLICY EXPIRATION DATE (MMIDDIYYI LIMITS A GENERAL LIABILITY CPP21106100001 12/05/19 12/05/20 EACH OCCURRENCE $ 1 000 000 X COMMERCIAL GENERAL LIABILITY Contractual Liab DAMAGE TO RENTED S 1 000 000 CLAIMS MADE a OCCUR XCU Included MED EXP (Any one person) $$10 000 PERSONAL &ADV INJURY $$1000000 X Blnkt Addl Insd Design Services X Blnkt WOS GENERAL AGGREGATE $$2 000 000 Broad Form PD GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG $$2 000 000 POLICY-X] jE LOC A. AUTOMOBILE LIABILITY X ANY AUTO CA21106090001 Blnkt Addl Insd 12/05/19 12/05/20 COMBINED SINGLE LIMIT (Ea accident) $$ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEOULEDAUTOS Blnkt WOS $10,000 PIP BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE (Peraccidenq $ X Comp Ded 1,000 X Coll Ded 1,000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S ANY AUTO S AUTO ONLY: AGG A EXCESSIUMBRELLA LIABILITY CU21106090001 12105/19 12/05/20 EACH OCCURRENCE S10 000 000 X OCCUR CLAIMS MADE Follow Form & AGGREGATE $10 000 000 S XS of GL & Auto S DEDUCTIBLE $ REl'ENTION $ATU A WORKERS COMPENSATION AND WC 21106380001 12/31/19 12/31/20 TH- X WC STIMIT FR EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Blnkt WOS E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE- POLICY LIMIT S1,000,000 A OTHER Rental Equip CPP21106100001 12/05/19 12/05/20 $50,000/$250,000 Special Form/$1,000 Ded Including Theft DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30_ DAYS WRITTEN NICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL LOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ZED REPRESENTATIVE ;III,A.' ACORD 25 (2001/08) 1 of 1 #S276082/M276032 RLG 0 ACORD CORPORATION 1988