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Cobb Site Development0 r�� ►��-1 � CITY OF OKEECHOBEE INVITATION TO BID CITY OF OKEECHOBEE TAYLOR CREEK SE 8t" AVENUE STORMWATER CONVEYANCE No. PW 02-00-1 Z-20 FDEP AGREEMENT No. LP47020 OPENING DATE AND TIME: JANUARY 14, 2021 at 3:00 P.M. Prepared by: David Allen, Public Works Director Dated: December 9, 2020 City of Okeechobee Project No. PW 02-00-12-20 Public Works Department CITY OF OKEECHOBEE CITY COUNCIL Bid No. PW 02-00-12-ZO FDEP AGREEMENT No. LP47020 CITY OF OKEECHOBEE TAYLOR CREEK SE 8t" AVENUE STORMWATER CONVEYANCE DOWLING R. WATFORD, JR., MAYOR WES ABNEY MONICA CLARK BOB JARRIEL BOBBY KEEFE City of Okeechobee Project No. PW 02-00-12-20 Pubfic Works Department MARCOS MONTES DE OCA, CITY ADMINISTRATOR TABLE OF CONTENTS PW 02-00-12-20 Invitation to Bid Advertisement Form Section I General Information Section II Submission Requirements Section III Bid Documentation Section IV Minimum Qualifications for Bidders Section V Bonding and Insurance Requirements Section VI Rejection of Bid Section VII Agreement for Services Section VIII Miscellaneous Attachments: A No Lobbying Affidavit B Anti-Collusion Statement and No Gift Statement C Proposer's Certification D Sworn Statement Pursuant to Section 287.133(3)(a), FL § on Public Entity Crimes E Conflict of Interest Disclosure Form F Immigration Law Certification G Drug-Free Workplace Certification H Reference Form I Florida Department of Environmental Protection, City of Okeechobee Taylor Creek SE 8t" Stormwater Conveyance Agreement 1 2 3 4-5 6-7 8-24 25 26 - 44 45 - 46 47 48 49 50-51 52 53 54 55 56-89 City of Okeechobee Project No. PW 02-00-12-20 Public Works Department INVITATION TO BID N0. PW 02-00-12-20 CITY OF OKEECHOBEE TAYLOR CREEK SE 8t" AVENUE STORMWATER CONVEYANCE Mandatory Pre•Bid: January 7, 2021, 3:00 PM Opening Date and Time: January 14, 2021, 3:00 PM The City of Okeechobee, Florida is currently soliciting bids to provide construction services needed to construct water quality and baffle box drainage improvements and perform roadway restoration on SE 8T" Avenue, Okeechobee, Florida 34974. Sealed bids must be received within the General Services Department at City Hall, 55 SE 3�d Avenue, Rm 101, Okeechobee, FL 34974, no later than 3:00 PM EST on or before Thursdav, January 14, 2021. All responses receivetl 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. A MANDATORY Pre-Bid Meetinq will be held on Thursdav, January 7, 2021 3:00 P.M. in the Council Chambers, Rm 200, at the address listed above. Bidders MUST attend this meeting in order to submit for this bid. Product specifications are available in the Bid Packets that may be obtained on the City's website: www.citvofokeechobee.com/contractinq-opportunities.html, 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(�a,citvofokeechobee.com. Questions concerning the scope of work are to be directed to Public Works Director David Allen, dallen(a�citvofokeechobee.com. NOTE: Bonding Requirements Apply to this Bid Opportunity. Bid submittals must be within a sealed envelope and contain two (2) clearly identified oriqinals and one (1) copy of the bid, with the outside of the envelope clearly labeled "BID N0. PW 02-00-12•20 CITY OF OKEECHOBEE TAYLOR CREEK SE 8th AVENUE STORMWATER CONVEYANCE, 01-14-21, 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 submif 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 bitls 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 02-00-12-20 Public Works Department 1 SECTION I PW 02-00-12-20 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 underwhich 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 clearlv identified oriqinals and one copv of your bid submittal are required. Bid submittals will be received by the General Services Department until 3:00 p.m. on January 14, 2021. Bid submittals are to be mailed, hand-delivered, and/or Express Mail to: City of Okeechobee General Services Department 55 S.E. 3�d Avenue, Room 101 Okeechobee, FL 34974 The submitting offeror is required to have printed on the sealed envelope or wrapping containing their submission their Companv name and return address, the Bid Number, Title, Openinq 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 02-00-12-20 Public Works Department 2 SECTION il PW 02-00-12-20 SUBMISSION REQUIREMENTS The bidder shall submit two (2) oriqinal clearlv identified oriqinals and one copv of the followinq: 1. Bid Documentation Form (Section III) 2. Minimum Qualifications for Bidder: references (Attachment H) 3. Bid Bond 4. Bid Unit Price Schedule (Section VII, Form (Section IV) and three (3) 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 Gift 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 Attachment H — Reference Form City of OI<eechobee Project No. PW 02-00-12-20 Public Works Department 3 SECTION III PW 02-00-12-20 BID DOCUMENTATION Clty COUIIC11 City of Okeechobee 55 S.E. 3rd Avenue Okeechobee, FL 34974 CC�hh ��- ��o��-��,� (BIDD�E Z`�COMPANV NAME) I have received the documents titled CITY OFOKEECHOBEE TAYLOR CREEK SE gt" AVENUE STORMWATER CONVEYANCE, Proiect No. PW 02-00-12-20. I have also received addendum number 1 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 untii ninety (90) days after Bids are opened, whichever is longer. 2. 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 within 15 calendar days from the Notice to Proceed and there after completing the work within 60 calendar days of commencement of work. 5. Regarding Compensation for the proposed work: if this Bid is accepted, I will construct this project on a unit price basis as reflected in the Bid Unit Price Schedule, Exhibit B of this agreement. Payment will be made upon invoice after completion of all work. 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 02-00-12-20 Public Works Department 4 Bidder: Cobb Site Development Inc. (Com ,any Name) -,�-.� .,.� By: ,._ ��. (Signature) Clay Cobb (Printed Name) Date: 1 / 12 / 21. Title: cEo Emall: operations@lcobbconstruction.com Mailing Address: 40l S 6th Ave Wauchula FL 33873 OfflCe NUI71b21': 863-773-3839 Fax Number: 863-773-2006 City of OI<eechobee Public Works Department Project No. PW 02-00-12-20 SECTION IV PW 02-00-12-20 MINIMUM QUALIFICATIONS FOR BIDDERS Minimum Qualifications: 1.0 Experience 1.1 Bidder must have at least 3 years of experience in providing commercial storm water improvement services including pipe, and structure installation and roadway restoration, 1.2 Bidder has successfully completed at teast 6 asphalt storm water improvement projects in the last three years. 2.0 References 2.1 Bidder must provide at least 3 verifiable references of similar work as referenced in section 1.0 above. 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 Discriminatory Vendor List 3.1 In accordance with Section 287.134, Florida Statutes, an entity or affiliate who has been placed on the Discriminatory Vendor List, kept by the Florida Department of Management Services, may not submit a bid on a contract to provide goods or services to a public entity; may not submit a bid on a contract with a public entity for the construction or repair of a public building or 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. 4.0 Bidder certifies that 4.1 Bidder meets the qualifications listed in Section IV, 1.0 above. 4.2 Bidder has never failed to complete work awarded under a contract due to circumstances that were under Bidder's control. 4.3 The Bidder has not been placed on the Discriminatory Vender List kept by the Florida Department of Management Services as listed in section 3.0 above. City of OI<eechobee Project No. PW 02-00-12-20 Public Works Department 6 � s.�,,..,_-_ � ' � SITE D�VCLOPM�(\IT IIVC 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 BIMINI BAY UTIITIES IMPROVEMENTS Pollc Count BOCC Davenport, FL Ryan Bengsch P) 863.298.4193 E) Rvanbengsch polk-countv.net $1,361, 571.7500. Contract Completion: April 2017 — February 2018 FLORIDA HOSPITAL SITE WORK Brasfield & Gorrie Wauchula, FL J.C. Peterson P) 407.304.7268 E) I�eterson@brasfield�orrie.com $1,765,720.00 Contract Completion: December 2018 BARTOW AIRPORT DRAlNAGE IMPROVEMENTS Bartow Aiport Authority Bartow, Florida Terry Beacham (863) 533-1195 tbeacham@bartow-airport. com Fax: 863-533-5968 $561,327.67 Scope of Work: Drainage improvements r `�_- _-� p' � SlT� DEVE�OPMENT INC 401 South Sixth Avenue, Wauchula, Flo►•ida 33873 Tel: 863-773-3839 or 863-385-2622/Fax: 863-773-3214 List of Maj or Proj ects Com�leted Istokpoga Marsh Ground Impoundment (Completing next month) Istokpoga, FL $6,960,211.00 - Prime Suzanne Hunnicutt: 863.402.6932 Bartow Airport Runway D Bartow Municipal Airport $2,093,920.72 Terry Beacham 863.533.1195 Bartow Airport Drainage Improvements Bartow Municipal Airport $561,327.67 Doug Wilcoxon 321.214.9309 Wauchula Airport Road & Pond Wauchula, FL $591,413.00 Russ Holiday 407.599.1122. ext.255 Wauchula Orange Street Drainage Wauchula, FL $1,267,772.78 Andy Maddox 863.773.3131 DMA Arcadia Nat'1 Guard Arcadia, FL $708,803.00 Crystal Scheeley 904.823.0287 Bimini Bay Utilities Improvements Davenport, FL $1,361,571.75 Ryan Bengsch 863.298.4193 FFWC Tenoroc Drainage Repairs Lakeland, FL $117,829.46 Dean Stoddart 850.413.7988 REA Rd Utilities Extension Wauchula, FL $434,730.63 Greg Witt 941.374.1056 Will Duke Site Work Wauchula, FL $766,164.53 Greg Witt 941.374.1056 Half Acre Hidden Creek Site Work Wauchula, FL $311,193.00 Greg Witt 941.374.1056 MOV Parking Avon Park Streetscape Improvements Avon Park, FL $984,374.54 Carl Cool 863.657.2323 DMA Bradenton Parking Stabilization Bradenton, FL $147,466.00 Crystal Scheeley 904.823.0287 Hardee Stadium and Track Renovation Wauchula, FL $309,758.87 Rob Krahl 863.735.2055 Autumnwood Grove Pond Remediation Lakeland, FL $205,944.90 John Delashaw 863.533.9007 Gilchrist Park Harbor Walk Restroom Port Charlotte, FL $ 147,355.64 Luis Silva 941.759.3818 Forrest Nelson Blvd. Force Main Replacement Punta Gorda, FL $562,410.25 Basia Baster 941.764.4586 Arcadia Sidewalk Improvements Arcadia, FL $150,004.82 Beth Carsten 863.494.4114 Winter Haven Streetscape Improvements Winter Haven, FL $4,444,444.44 joey Murphy 863.Z87.5455 Sunbelt Rentals Site Work Lakeland, FL $255,229.71 Laureen Pollock 941.979.8490 Jahna Concrete Site Modifications Zolfo Springs, FL $288,431.0 Freddy Jahna 863.453.4353 Bartow Airport Drainage Phase 2 Bartow, FL $379,647.26 Doug Wilcoxon 321.214.9309 Lake Wales Airport Bravo IVorth Lalce Wales, FL $1,558,740.18 Wilbur Mathurin 407.380.1919 Florida Hospital Site Work Wauchula, FL $1,765,720.00 J.C. Peterson 407.304.7268 Halfacre Construction Pond 100 Reconstruction Bowling Green, FL $582,036.18 Greg Witt 941-907-9099 DMA Orlando Fence Protection Orlando, FL $934,836.85 - Prime Fred Levinson 904.823.0255 Linder Airport Taxiway H Lalceland, FL $2,574,569.69 - Prime Todd Zimmerman 407.790.7397 Linder Airport Terminal&Customs Apron Lakeland, FL $3,074,216.58 -Prime Todd Zimmerman 407.790.7397 Tampa International Airport Taxiway G Ext. Tampa, FL $1,399,860.12 Chris Wilson 813-267-7538 Manatee CR 675 Canal Piping Parrish, FL $767,197.11- Prime Daniel Garner 941.708.7450, Ext.7236 Manatee Country Club Heights Waterline Bradenton, FL $1,169,944.37 - Prime Eric Schroyer 941.708.7450, Ext 7344 Bidder: cobb Site Development Inc. any Name) By: �'"� (Signature) Clay Cobb (Printed Name) Date: 1 / 12 /21 Title: CEo Email:operations@lcobbconstruction.com Mailing Address: 40l S 6th Ave Wauchula FL 33873 OfFice Number: 863-773-3839 Fax Number: 863-773-2006 City of Okeechobee Public Worl<s Department Project No. PW 02-00-12-20 SECTION V PW 02-00-12-20 BONDING AND INSURANCE REQUIREMENTS 5.01 Bid Guaranty A. Bid Bond Form. Each Bid must be accompanied by the CITY's Bid Bond form meeting the standards specified in this Article 5, including those applicable to the sureties for the Statutory Payment Bond and Common Law Performance Bond specified in the General Terms & Conditions. The bond shall be on the Bid Guaranty form provided by the CITY, with Power of Attorney Affidavit attached, in an amount not less than five percent (5°/o) of the amount of the bid. The Bid Bond shall be in the Prime Contractor's name. The Bidder is required to use the CITY forms provided in this RFB. Alternate bond forms will not be accepted. Failure to provide the CITY's bond forms will deem the Bid non-responsive. B. Alternate Security. In lieu of the Bid Bond, the Bid may be accompanied by an alternate form of security in the form of cash, a money order, certified check of any national or state bank made payable to the CITY, or an irrevocable letter of credit, in an amount not less than five percent (5%) of the amount of the Bid. Any such alternative form of security shall be for the same purpose and be subject to the same conditions as those applicable to the bond for which the alternative form of security is being substituted. The d�termination of the value of an alternative form of security shall be made by the CITY. C. Conditions. The Bid Bond or alternate security shall be conditioned upon the Bidder's: 1. Not withdrawing said bid within one hundred twenty (120) days after date of opening of the same, and 2. Within seven (7) business days after of the Notice of Apparent Low Bidder Letter: a. executing a written CONTRACT with the CITY, in accordance with the bid as accepted; b. providing evidence of insurance in the manner specified by the CITY; and c. if the Bid exceeds $200,000.00, providing 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, having provided an alternate form of security as specified in the General Terms & Conditions); d. or in the event to fully comply with all of the foregoing, if the Bidder shall have paid the CITY the difference between the amount specified in said bid and the amount for which the CITY may procure the required work and/or supplies, if the latter amount be in excess of the former. City of OI<eechobee Project No. PW 02-00-12-20 Publfc Works Department 8 D. Return of Bid Guaranty. Funds of any money order or check that may be received will be returned to all Bidders, with the exception of the two (2) apparent low Bidders, within thirty (30) days after the opening of the Bids. Bid bonds will not be returned to the bidders, unless specifically requested by a Bidder. The Bid Security of the apparent and second apparent low bidder shall be retained until such Bidder has executed the CONTRACT, furnished the Insurance Certificate and endorsements, complied with the CITY's SBE requirements, and furnished a valid and acceptable 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, having provided an alternate form of security as specified in the General Terms & Conditions) as required under the provisions of the CONTRACT. Any money order or check from the apparent low bidder shall be deposited upon receipt. Any money order or certified check from the second apparent low bidder may be deposited. Failure of the CITY to execute the CONTRACT within one hundred twenty (120) days after the date of the bid opening shall initiate release of the Bid Bond, certified check or cash of the lowest and second lowest bidders unless mutually agreed otherwise or specified in the Supplemental Conditions. 5.02 Performance and Payment Bond: Bonds must be in compliance with Florida Law. If the CONTRACT price is in excess of $200,000.00, the [CONTRACTOR] shall, within seven (7) business days of date of the Notice of Apparent Low Bidder from CITY, provide CITY with a Common Law PerFormance Bond and a Statutory Payment Bond meeting the standards specified herein, on the forms provided by the CITY with Power of Attorney Affidavit attached, each in an amount not less than the CONTRACT Price. The bonds shall also be accompanied by the CITY's Affidavit for Surety Form. The Performance and Payment Bonds shall be in the Prime Contractor's name. Failure to provide the bond(s) within the seven (7) business day period shall be sufficient cause for the CITY to deem the Bidder non-responsive and nullify the CONTRACT award. The [Contractor] shall provide a Performance Bond which guarantees the performance of the Work as well as any applicable extended warranty. 5.03 Al1 Bonds Sureties Qualifications: All bonds required under this CONTRACT, including, but not by way of limitation, any Bid Bond, Common Law Performance Bond or Statutory Payment Bond shall be written through a reputab�e and responsible surety bond agency licensed to do business in the State of Florida and with a surety which holds a certificate of authority authorizing it to write surety bonds in Florida meeting the following requirements: City of Okeechobee Project No. PW 02-00-12-20 Public Works Department 9 BOND ANDINSURANCE REQUIREMENTS FOR CONSTRUCTION CONTRACTS CONTRACT SUM BEST'S RATING CLASSIFICATION FOR BEST'S FINANCIAL SURETY AND INSURANCE FIRMS, & SIZE CATEGORY OTHER REQUIREMENTS FOR SURETY AND INSURANCE FIRMS From: $0.00 Bid Bond and Insurance Required. No Minimum To: $200,000.00 Required. Performance and Payment Bond Not Required (unless specified in Contract Not Applicable. Documents From: $200,000.01 All Bonds and Insurance Required: No Minimum To: $500,000.00 See re uirements under ara ra h 3 below Re uired. From: $500,000.01 All Bonds and Insurance Required: IV or larger. To: $2,500,000.00 A- or better Circular 570 requirements (paragraph 2 below From: $2,500,000.01and All Bonds and Insurance Reauired: V or larger. more A- or better Circular 570 requirements ara ra h 2 below [CONTRACTOR] must use the CITY bond forms enclosed herein. Failure to use the CITY forms shall deem the bidder as non-responsive. 1. Ratings by A.M. Best: The surety and insurance company or corporation shall have a minimum A.M. Best Company rating as indicated above in addition to the surety qualifying pursuant to paragraph (3) below: 2. Circular 570, CONTRACT Price of $500,000.01 or More: If the CONTRACT Price is $500,000.01 or greater, the surety shall also comply with the Circular 570 requirements as set forth in this paragraph 2. The surety shall maintain a current certi�cate of authority as an acceptable surety on Federal Bonds in accordance with U.S. Department of Treasury Circular 570, current revision. If the amount of the bond exceeds the underwriting limitations set forth in the Circufar, in order to qualify, the net retention of the surety company shall not exceed the underwriting limitation in the Circular and the excess risk must be protected by co- insurance, reinsurance, or other methods in accordance with Treasury Circular 297, revised September 1, 1978 CFR Section 223.10 - Section 223.111. Further the surety company shall provide the CITY with evidence satisfactory to the CITY, that such excess risk has been protected in an acceptable manner. City of Okeechobee Project No. PW 02-00-12-20 Public Works Department 10 3. CONTRACT Price of $500,000 or Less: Notwithstanding the foregoing paragraphs 1. and 2., in the event the CONTRACT price is $500,000.00 or less, in accordance with Section 287.0935, Florida Statutes, bonds with a surety company in compliance with the following requirements shall be acceptable: a. The surety company is licensed to do business in the State of Florida; and b. The surety company holds a certificate of authority authorizing it to write surety bonds in Florida; and c. The surety company has twice the minimum surplus and capital required by the Florida Insurance code at the time this Request for Bids is issued; and d. The surety company is otherwise in compliance with the provisions of the Florida Insurance Code; and e. The surety company holds a currently valid certificate of authority issued by the United States Department of the Treasury under 31 U.S.C. ss.9304 to 9308. In order to qualify as an acceptable surety company under this paragraph 3, an Affidavit for the Surety Company shall be executed by an Officer of the surety bond insurer as evidence that a surety company is in compliance with the foregoing requirements. A. Additional or replacement bond: It is further mutually agreed between the parties hereto that if, at any time, the CITY shall deem the surety or sureties upon any bond to be unsatisfactory, or if, for any reason, such bond ceases to be adequate, the [CONTRACTOR] shall, at its expense within seven (7) business days after the receipt of notice from the CITY to do so, furnish an additional or replacement bond or bonds on the CITY'S standard form, with the same amount, and with such surety or sureties as shall be satisfactory to the CITY. In such event, no further payments to the [CONTRACTOR] shall be deemed to be due under this CONTRACT until such new or additional security for the faithful performance of the work shall be furnished in the manner and form satisfactory to the CITY. In addition, the [CONTRACTOR] shall for any increases in the CONTRACT amount automatically increase the amount of the performance and payment bonds to equal the revised amount of the contract and shall provide the CITY with evidence of same. B. The surety company shall provide a Florida address for service of process in the prescribed space on the forms provided by the CITY for all bonds required by the CITY. City of Okeechobee Project No. PW 02-00-12-20 Public Works Department 11 C. Alternate form of security: In lieu of the Common Law PerFormance Bond or Statutory Payment Bond, [CONTRACTOR] may, pursuant to Section 255.051, Florida Statutes, provide an alternate form of security in the form of cash, a money order, a certified check, or an irrevocable letter of credit. Any such alternative form of security shall be for the same purpose and be subject to the same conditions as those applicable to the bond for which the alternative form of security is being substituted. The determination of the value of an alternative form of security shall be made by the CITY. 5.04 Insurance A. Certificate of Insurance. The [CONTRACTOR] shall deliver to CITY and maintain insurance coverage reflecting, at a minimum, the amounts and conditions as specified within the CITY'S Insurance Requirements Checklist, attached herein. All insurance required under this CONTRACT shall meet the requirements listed in the Table found in 5.03 above. In addition, at the direction of the CITY, the [CONTRACTOR] shall for any increases in the CONTRACT amount automatically increase the amount of the insurance to equal the revised amount of the contract and shall provide the CITY with evidence of same. The [CONTRACTOR] shall provide the certificate within seven (7) business days from the date of the Notice of Apparent Low Bidder. The [CONTRACTOR] shall have thirty (30) business days after CONTRACT execution, to produce the required Insurance Declaration Page of Policy, additional insured endorsement forms, and a waiver of subrogation endorsement as set forth in the General Terms & Conditions, and the Insurance Requirements Checklist included herein. [CONTRACTOR] shall provide an insurance policy that provides the City of Okeechobee, and the Florida Department of Environmental Protection, as additional insured, a separate defense in the event of a claim filed by a third party against the City, regardless of whether an allegation of negligence is alleged against the CONTRACTOR. B. Qualifications to Do Business in Florida. All insurers must be qualified to lawfully conduct business in the State of Florida. Failure of the CITY to notify the CONTRACTOR that the Certificate of Insurance provided does not meet the CONTRACT requirements, shall not constitute a waiver of the [CONTRACTOR'S] responsibility to meet the stated requirements. In addition, receipt and acceptance of the certificate of insurance by the CITY shall not constitute approval of the amounts, conditions or types of coverage listed on the certificate. Misrepresentation of any material fact, whether intentional or not, regarding the [CONTRACTOR'S] insurance coverage, policies or capabilities, may be grounds for rejection of the response and rescission of any ensuing contract. City of Okeechobee Project No. PW 02-00-12-20 Public Works Department 12 C. Self-insured Provisions. If the [CONTRACTOR] is a self-insured entity, the [CONTRACTOR] may contact the CITY'S CONTRACT Administrator, identified on the cover page, and request the CITY'S self-insurance package. It shall be the responsibility of the [CONTRACTOR] to ensure that all Subcontractors are adequately insured or covered under their policies. The CITY may at its discretion, require the [CONTRACTOR] to provide a complete certified copy of its insurance policy(s). D. Workers' Compensation: 1. Workers' Compensation insurance shall comply with Chapter 440, Florida Statute, including Employer's Liability. If work is performed in/over navigable waters, an endorsement covering the U.S. Longshore and Harbor Workers' Compensation Act (LHWCA) 33 U.S.C. Section 901, et seq. and Jones Act, 46 App U.S.C. Section 861, et seq. shall be included. 2. If [CONTRACTOR] claims an exemption from coverage, it must attach proof of same for consideration in the form of a certified copy of your state exemption form. The CITY reserves the right to require said coverage regardless of the state exemption. E. Commercial Liability Insurance 1. Coverage shall be no more restrictive than that identified by the Insurance Services Office, Inc. (ISO). 2. Coverage shall be written on an Occurrence Basis Form. 3. Coverage shall provide as a minimum those limits identified within the CITY's Insurance Requirements Checklist. Coverage shall be "first dollar" coverage. If [CONTRACTOR'S] policy includes a Self-Insured Retention (SIR) [CONTRACTOR] may, at the CITY's option, be required to meet established financial security requirements. 4. Coverage shall include as a minimum, the following coverage endorsements: Premises / Operations, Products/Completed Operations, Contractual Liability, Independent CONTRACTORS, Broad Form Property Damage, Underground Explosion/Collapse (XCU) and Personal Injury. Additional endorsements may be required as the CONTRACT dictates. Refer to the CITY's Insurance Requirements Checklist attached herein. 5. The CITY and FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION shall be added by endorsement as an Additional Insured. An endorsement shall also be included which specifies that the inclusion of an additional insured does not exclude any pollution liability coverage otherwise afforded by said policy. City of Okeechobee Project No. PW 02-00-12-20 Public Works Department 13 F. Business Auto Liabilify Insurance 1. Coverage shall be no more restrictive than that identified by the Insurance Services Office, Inc. (ISO). 2. Coverage shall provide as a minimum those limits identified within the CITY's Insurance Requirements Checklist. Coverage shall be "first dollar" coverage. If [CONTRACTOR'S] policy includes a Self-Insured Retention (SIR) [CONTRACTOR] may, at the CITY's option, be required to meet established financial security requirements. 3. Coverage shall be "Any Auto" - Symbol 1. G. Builders Risk Insurance/Installation Floater 1. The insurance policy shall be "broad form," "all risk" covering all equipment and machinery; or a special Installation Floater may be included to ensure the required coverage for this exposure. The policy form shall be no more restrictive than the "inland marine type form." The CITY shall be allowed to occupy the property in question without voiding any of the provided coverages. 2. The policy(s) shall state, "on behalf of all parties to the contract." The [CONTRACTOR], the CITY and all other applicable subcontractors are to be included as "insureds" on the policy(s). 3. At a minimum, the "covered property" will include the building or structure being constructed, including all fixtures, materials, supplies, machinery and equipment to be used in, or incidental to the construction. This will extend coverage to underground works. Coverage shall also be afforded to the property of others through a"care, custody or control" endorsement, as well as property off-site or in transit. The following coverages shall also be included by endorsement, unless excluded by the CITY: Boiler & Machinery, Testing, Mechanical Breakdown, Earthquake, and Flood. 4. Coverage shall be valued on a Replacement Cost (100%) basis. A maximum (SIR) of $5,000 is allowed. If multiple limits of liability are proposed for the construction site, property in transit, off-site storage, etc., the same value requirement shall be used for each. 5. All coverages afforded under this policy(s) shall remain in effect and not be excluded by a"Force Majeure Clause" found elsewhere in these Bidding Documents. 6. Coverage shall cease when the entire project covered by said policy is accepted by the CITY. In the event testing by the CONTRACTOR is conducted after acceptance by the CITY, coverage shall remain in full force and effect until all testing is complete and accepted by the CITY, and final payment is made. City of OI<eechobee Project No. PW 02-00-12-20 Public Worl<s Department 14 INSURANCE [CONTRACTOR] shall, at its sole cost and expense, procure and maintain throughout the term of this contract, Comprehensive General Liability, Worker's Compensation, and Commercial Automobile Liability insurance, including Employer Liability insurance, with minimum policy limits specified below Combined Single Limits,. or to the extent and in such amounts as required and authorized by Florida Law, and will provide endorsed certificates of insurance generated and executed by a licensed insurance broker, brokerage or similar licensed insurance professional evidencing such coverage, and naming the City of Okeechobee and the Florida Department of Environmental Protection as a named additional insured, as well as furnishing the City of Okeechobee with a certified copy, or copies, of said insurance policies. Certificates of insurance and certified copies of these insurance policies must accompany this signed contract. Said insurance coverages procured by [CONTRACTOR] as required herein shall be considered, and [CONTRACTOR] agrees that said insurance coverages it procures as required herein shall be considered, as primary insurance over and above any other insurance, or self- insurance, available to the City of Okeechobee, and that any other insurance, or self-insurance available to the City of Okeechobee shall be considered secondary to, or in excess of, the insurance coverage(s) procured by [CONTRACTOR] Worker's' Compensation - Coverage is to apply for all employees for statutory limits in compliance with the applicable state and federal laws. The policy must include Employers' Liability with a limit of $500,000.00 each accident, $500,000.00 each employee, $500,000.00 policy limit for disease. Commercial General Liability (Occurrence Form Required) (ContractorNendor) shall maintain commercial general liability (CGL) insurance with a limit of not less than $1,000,000.00 each occurrence. If such CGL insurance contains a general aggregate limit, it shall apply separately to this location/project in the amount of $1,000,000.00. Products and completed operations aggregate shall be $5,000,000.00. CGL insurance shall be written on an occurrence form and shall include bodily injury and property damage liability for premises, operations, independent Contractors, products and completed operations, contractual liability, broad form property damage and property damage resulting from explosion, collapse or underground (x, c, u) exposures, personal injury and advertising injury. Damage to rented premises shall be included at $100,000.00. Commercial Automobile Liability Insurance (ContractorNendor) shall maintain automobile liability insurance with a limit of not less than $1,000,000.00 each accident for bodily injury and property damage liability. Such insurance shall cover liability arising out of any auto (including owned, hired and non-owned autos). The policy shall be endorsed to provide contractual liability coverage. Nothing herein shall be construed to extend the City of Okeechobee's liability beyond that provided in F.S. 768.28, Florida Statutes. Will need to be completed. City of Okeechobee Project No. PW 02-00-12-20 Public Works Department 15 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we,. COBB SITE DEVELOPMENT, INC. as Principal and WESTERN SURETYCOMPANY ,, as Surety, are held and firmly bound unto the City of Okeechobee (the "City"), in the penal sum of $ F��P��►B�� lawful money of the Uniied States, forthe 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 submitied the accompanying bid, dated January 14 , 20 21, for the Contract Documents: Contract Nurnber: PW 02-00-12-20 Contract Title: CITY OF OKEECHOBEE 7AYLOR CREEK SE gtn AVENUE STORMWATER CONVEYANCE 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 shafl 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 02-00-12-20 Public Works Department 16 DATED ON January 14, , 20 21 , FOR NON-CORPORATE BIDDERS: (Witness) (Print Name) (Witness) (Print Name) FOR CORPORATE BIDDERS: ATTEST: Secret �l1RETY: !�TTEST: ;�,orporate Seal) ��`��.. SeC►'etary Catherine Bennett �y: (Signature of Principal} (Print Name and Title) Business Address COBB SITE DEVELOPMENT, INC. J (Signatur of Corporate Principal� �1°� �_`�� (Print N me and Title) 401 Sout� Sixfh Avenue Wauchula, Florida 33873 Business Address WESTERN S Tl' OMPANY ( orporate Surety) Tom S. Lobrano, IV, Aftomey-in-Fact 8 Florida Resident Agent (Print Name and Title) 151 N. Frank�in Street, Chicago, Illinois 60606 Business Address 500 Colonial Center Parkway, Suite 400, Lake Mary.; FL 32746 Florida Address for Service of Process 407-8045929 Telephone Number (Surety shall provide evidence of signature authority such as a certified copy of Power of Attorney.) City of Okeechobee Project No. PW OZ-00-12-20 Public Works Department 17 ster� Sur�� .n� P05�i'E� ��'.��'�i'�R.��' �PP��(T[�t� (!(��iID�iAi. A�fTmIZNEY-I.Y-F:�CT C�nr�w Alt d1e�� By rhese Presents, i'hai b� E5 rE2�i S_.`ItETY CG:Lf?�� Y, a ioueh Dako�a :orporation, �s s dufv ,�r�2ntz�d and �xi>r�� p�prat�on haviR� its principa! o�ce in rhe Ciry or Siouz F311>, and Scate of $ou[h D�kota, �nd tha[ it does by vtrbl� u[ tha �ignature aad ;eal herain afiixed her�� mak�, �onstrtui� and appoint T'om 5 I.obrana III, �'oan S$..o'bt-�na IV, Nl�rk C Fore, Geoffa-�y !�I biunn, In�livi�ivally� of Jackaonville, FL, i� h-ue and lawfu! Atiorney(s)-in-Fact with fufl power and 3uthvriry hereby coaferr�d to sign, seaf and ex�cute for and on its beha(f b�nds, undertakittgs and ather obligatory instruments of �imtfar nature - In Unlimited Amounts - aad to biad it thenby as fufly 3nd to the same �xte�t � if>uch instru�ttents were sign�d by a du[y 3uthorized afficer of the corporation and afi the acG af said Attorney, pursuant to the a¢thority 6ereby giv�n, ar� hereby ratified and confirmed. This Power of AEtomey is made �nd ex�cuted pursuattt to and 6y authority of the By-Law printed on the rev�rse hereof, duly adopted, as indicat:.d, by ehe shareho[ders ofdte corporation_ in Witness �Vfiereof, FF✓ESTERN SURETY COIvtPANY h3, caused thes� preseats to be si�ct�d by its Vice Pr�sident aad its corporate �raf to be hereto at�Cxed on this 4±h day ofF�braary, 20(B. ;Q �'"��o. :�: ,�asa,q :_t. =NiVO l��_y_ �Y: �=c ��'. S �.:'C� '.s�y-=.�. ea •_ .�P`�� '3„'?� N�,c` �tate of 5oath Dakota � ss County af Minnehaha �rESTERN SUREI'Y COMPA.NY aui F. Bruiiat, Vice Prasident On this 9th day of February, 2o18, before �ne personally came Paut T. Bnitlat, to me known, who, being by me duty sworn, did depose and say: that he re>ides in the Ctry of Sioax Falls, State of South Dakota; tftat he is the Vice President of WES"I'ERN SURETY COMPANY described in and which executed the above inslrument; ihat he [cnows the saa! of said corporation; that the seaI affixzd to the said iastnimeat is such corporate seal; that it was ;o affixed puruant to authority �iven by the Board of Directors oi said corporaiion and that he signed his name ther:.to pursuant to lik� authority, and acknowledges same to be the act and deed of said corporarion. My comcnission expires June Z3. 202 ,.,.w..�:.�..+ d. kAOHR �raaraRrauauc SOIRN OAKQTA � CEItTIFICArE ��/��II ! J. Mo6t, 1Votary P¢blic I, L. Netson, Assistant Secretary of WESTERN SURETY CONtPANY do hereby ceRify that the Power of Attorney hereinabove set fQrth is s[il( in force, aad further certify that the By-Law af the eorporanoR priand on the ravers� hereof is stiIi in force. In iestimoay wfiereof I have heceunto subscribed my name and affixed the seal ofthe said corparation this 14th day of January 2�21 _- �S`N`e--�� : e,= �• o- =`3pRp�qQr'e3 s�.`�iic. e^aa� 'r= .� � SF /��!:; ��c ��^M��'"�r.ww•s��``• Form F4280-7-2012 �ESTERN SURETY COMPANY L. Nelsoa, Assistant 5ecretary Go to www.cnasuretv.corr� > Owner / Obligee Servic2s > Validate Bond Coverage, if you want to verify bonc! authenticity. EXHIBIT B BID UNIT PRICE SCHEDULE PW 02-00-12-20 CITY OF OKEECHOBEE TAYLOR CREEK SE 8t" AVENUE STORMWATER CONVEYANCE ITEM DESCRIPTION UNIT ESTIMATED UNIT AMOUNT NO. MEASURE QUANTITY PRICE MOBILIZATION / r.�' �� J �7� U(p��`� 1 DEMOBILIZATION, PRE- LUMP SUM 1 E°, � CONSTRUCTION VIDEO PER CONSTRUCTION 2 TURBIDITY CONTROLS LUMP SUM PLANSAND 7j��j�.�� '75f�vc%.G�'� SPECIFICATIONS PIPING MATERIALSAND PERCONSTRUCTION 3 INLETS (EXCLUDING LUMP SUM PLANSAND �, 5�5"y�� `1•�� SEPORATOR sPEciFicaTioNs y 4 DRAINAGESEPORATOR LUMPSUM 1 �� ,ij�f�,� 3��(D��-�� 5 MAINTENANCE OF TRAFFIC LUMP SUM 1 ��l�c,�t�5.jj ��Jc�s Ij CONCRETE SIDEWALKS, PERCONSTRUCTION 6 CURBING AND DRIVEWAYS LUMP SUM SPECIFICATIONS ��i� `��`�7�� 07"U� SUBBASE/BASE MATERIAL PER CONSTRUCTION , _ 7 PLACEMENTINCLUDING LUMPSUM PLANSAND (p,��F,j,s7 65^��°JS-S� COM PACTION SPECIFICATIONS PER CONSTRUCTION 8 ROADWAY PAVING LUMP SUM PLANSAND ��a�`.�� i��3t��,j� SPECIFICATIONS � ROADWAY MARKINGS, PERCONSTRUCTION 9 STRIPING AND SIGNAGE LUMP SUM SPECAFICATIONS �'��'�� 10 PROJECT STABILIZATION LUMP SUM 1 (,�f�7`� Qr7 � AND CLEANUP � �� '�� 11 CONSTRUCTION LUMP SUM 1 (p��yt3.3i �, i� j0,j� LAYOUT/RECORD DRAWINGS TOTAL BID AMOUNT ��r��a �G� Based on Bid Unit Prices & Estimated Quantities City of Okeechobee Project No. PW 02-00-12-20 Public Works Department 44 Bidders Company Name cobb site Development znc . 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. Date: 1/14/21 (Company Name) gy. �' Title: cEo (Signature) Clay Cobb (Printed Name) Email:operationsClcobbconstruction.com Mailing Address: 401 S 6th Ave Wauchula FL 33873 Office Number: 863-773-3839 FaX NUII'1b@I':863-773-2006 City of OI<eechobee Public Works Department Project No. PW 02-00-12-20 45 SECTION VIII PW 02-00-12-20 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 Entify Crime Affidavit: As required by Florida Statute 287.133(3)(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 Cateqory 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. PW 02-00-12-20 46 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 °/o) 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 02-00-12-20 47 ATTACHMENT A PW 02-00-12-20 NO LOBBYING AFFIDAVIT STATE OF FLORIDA COUNTY OF xardee This 14thday ofJanuary , 20 21_, clav cobb being first duly sworn, deposes and says that he/she is the authorized representative of Cobb site Development znc . (Name of Contractor, Firm or Individual) respondent to the attached request for Bid, or quafifications 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 �I physical presence or ❑ online notarization, this 14thclay of January , 2p2 i, py Clay cobb , who is personally known to me or produced � as identification. ��y p�� Notary public State of F�onda �� .b R`t Diana Weems � My Commiss�on GG 232550 Nota Public Signature =.�`� • ExP�res 0612612022 �°Kti� ��a�a��s� Commission No. City of Okeechobee Public Works Department Project No. PW 02-00-12-20 48 ATTACHMENT B PW 02-00-12-20 ANTI-COLLUSION STATEMENT AND NO GIFT STATEMENT Date: 1/14/21 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: Tefephone No.: City of Okeechobee Public Works Department Cobb Site Development Inc. Clay Cobb CEO 401 S 6th Ave Wauchula, FL, 33873 863-773-3839 Project No. PW 02-00-12-20 49 ATTACHMENT C PW 02-00-12-20 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 # 1 Date: 1 12 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. f 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. I 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. Name of Business .> ,- Authorize ignature 401 S 6th Ave Mailing Address Wauchula FL 33873 City, State & Zip Code Rti3-773-38�A / 86�-77�-2006 Telephone Number/Fax Number Clay Cobb / CEO Name & Title, Typed STATE OF FLORIDA COUNTY OF xardee operations�lcobbconstruction.com Email Address The foregoing instrument was acknowledged before me by means of �7 physical presence or ❑ online notarization, this 14 day of January , Zp ai, by Clay Cobb , who is personally known to me or produced as identification. �=o�,a`+pu�4� Notary Public State of Florida NO Public Signa i Diana Weems �r;,� aa My Commission GG 232550 Commission Na � *�.of�� Expves 06/26/2022 �. City of Okeechobee Project No. PW 02-00-12-20 Public Works Department 50 ATTACHMENT D PW 02-00-12-20 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. 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 sfafement) whose business address is 401 S 6th Ave Wauchula FL 33873 and (If applicable) its Federal Employer ldentification Number (FE�N) is:13-4205�56 (If the entity has no FEIN, include the Social Security Number of the Individual signing this sworn statement: - 2. I 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. I 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. I 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 02-00-12-20 51 5. I 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). � 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 CHA E IN THE INFORMATION CONTAINED IN THIS FORM. . 7 'p Signature STATE OF FLORIDA COUNTY OF xardee The foregoing instrument was acknowledged before me by means of � physical presence or ❑ online notarization, this 14 day of January , 20 ai by Clay Cobb / cEo , who is personally known to me or produced as identification. �.Y niy Notary Public State of Flonda Not ublic i nature a°r�,'�' � Diana Weems �, ,�` c My Commiss�on GG 232550 + Expires 06f26/2022 �os h� �� City of Okeechobee Public Works Department Commission No. ��'1�`��J� Project No. PW 02-00-12-20 52 ATTACHMENT E PW 02-00-12-20 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): clav Cobb By (Signature) Title: cEo Address: 4oi S 6th Ave Wauchula Fl 33873 Phone Number: 863-��3-3a39 City of Okeechobee Public Works Department Project No. PW 02-00-12-20 53 ATTACHMENT F PW 02-00-12-20 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 ("I NA")). 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. Comp N S gna re CEO Title 1/14/21 Date STATE OF FLORIDA COUNTY OF xardee The foregoing instrument was acknowledged before me by means of �7 physical presence or ❑ online notarization, this 14 day of January , 20 zi, by Clay Cobb , who is,�ersonally known to me or produced as identification. ��nn .J.n�aa Notary Public State of Ftoritla Notary I' lic Signature r° �; Diana Weems c My Commission GG 232550 ��.oFc�� Expires O6l26/2022 � City of Okeechobee Public Works Department Commission No. �G� �� Project No. PW 02-00-12-20 54 ATTACHMENT G PW 02-00-12-20 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 cantendere 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. ��' �f�! Signature: L%�v' � Date: 1/14/21 C01'T1p811y:Cobb Site Develo ment Inc. _ Address: 401 S 6th Ave City of Okeechobee Public Works Department Name: claY cobb Title: �Eo Phone Number: a63-��3-3a3a Project No. PW 02-00-12-20 55 ATTACHMENT H CITY OF OKEECHOBEE CITY OF OKEECHOBEE TAYLOR CREEK SE 8th AVENUE STORMWATER CONVEYANCE PW 02-00-12-20 REFERENCE FORM Client Name: AmaZon KLAL Gateway Client Phone Number: s13-833-69s1 Cllent E-mall: �effrey.clemens@aecom.com Service Dates: Beginning December 2019 End September aoao Estimated Annual Contract Amount: $13 , slo , sla . o0 Description of the services performed as they directly relate to the work of this Request for Bid: Provide and install earthwork, utilities, base, asphalt, storm water, aprons and taxi lanes. Project included off-site utility and road way work for the City of Lakeland on Kidron Road. City of Okeechobee Public Works Department Project No. PW 02-00-12-20 56 ATTACHMENT I CITY OF OKEECHOBEE CITY OF OKEECHOBEE TAYLOR CREEK SE 8t'' AVENUE STORMWATER CONVEYANCE PW 02-00-12-20 City of Okeechobee Public Works Department Project No. PW 02-00-12-20 57 � Form (Rev. January 2011) Deparlment of the Treasury Internai Revenue Servtce Name (as shown an your N N � N c 0 � d � �; c � a`� ;C U d a � �i � Reques� for Taxpayer Give Form to fhe requester. Do not id�c��ifi�a�ion f�umber and Ce�tiifica�@on send to the IRS. Cobb Site Development, In.c. above Buslness na Cheok appropriate box for faderel tax classiAcatlon (requlrsd); ❑ IndividuaVsote proprielor ❑ C Corporailon .�5 Cotpora�ian ❑ Parinership [] TrusVeslate � LlmOed Ilabilfly company. Enler the iax classification (C=C corporalion, S=S corporallon, P=parinershipj d _ ____________ Other Address (number, slreet, and apt, or sufts no. 4U1 S. 6th A�re. Cfty, staie, and ZIP code Wauc.�u 1a , FL 3 3 �i 7 3 Llst acccunt numbef(s) here (optional) name and ❑ Exempt payne Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" Iine t�oc�a� sec��r to avoid backup withholding. For Ind(vfduals, this is your socla! securiiy number (SSN). However, for a �_ resident alien, sole proprietor, or disragarded entiiy, see the Part I insiructions on page 3. For olher entities, it Is your empioyer identification number (EIN). li you do not have a number, see Now fo get a ilN on page 3. Employer idenf 11ote. If the account is in more than one name, see the ciiart on page �1 for guideiines on whose number to enter. m - � 0�� Under penalties of perjury, I certify ihat: 1. The number shown on thls form is my correct taxpayer idantiiicatlon number (or f am waiting for a number to be issued to ma), and 2. I am not subjact to backup withholding 6ecause: {a)1 am exempt from backup wiihholding, or (b) I have not Been notiffed by the Internai Revenue Service (IRS) that ( am subject to backup wilhholding as a result of a failure io report ali interest or dividends, or (c) tha IRS has notified me that I am no longer subject.to backup withhoiding, end 3. I am a U.S. citizen or other U.S. person (deffned below). Certification Instruct(ons, You must cross out item 2 above if you have been noti{ied by the IRS that you are currentiy subject to bacicup Withholding becausa you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not appfy. Far mortgaga interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRAj, and generally, paymenfs other than interest and dividends, you are not required to stgn the certification, but you must praviiie your correct TIN. See ihe instructions on page 4. _ , , ,, 5+gn Slgnature ofi Here U.s.person► Generai Instru�tions �' - -�.�� Seciifln referencas are to the inlernal Revenue Code unless otherwise noted. Purpose of Form A person wha Is reguired to file an information return with the IRS musf obtain your correct taxpayer identification number (TIN) to report, for examp�e, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cattceflation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U,S, person (includtng a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when appiioabte, to: 1. Certify that fhe TIN you are giving (s correct (or yuu are waiting for a number to be issued), 2, Certiiy that yau are not subject fo backup withholding, or 3. Clalm exemption from backup witl�holding 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 eNeciively connected income, Note. ii a requester gives you a form ofher than Form W-9 to request your 71N, you must use the reqvester's form if li is substantlaliy similar to ihis Form W-9. Detinition of a U.S, person. For federal #ax purposes, you are considered a U.S, person if you are: • An individUai who Is a U.S. citizen or U.S. resident alien, � A parinership, corporation, company, or assaciatlon created or organized tn the Uniied 5tates or under lhe laws of tha United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701-7). Special rules for partnersi�tps. Partnerships thaE 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 thai a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner fn a partnership conducting a trade or business in fhe Uniked States, provide Form W-9 to the partnershfp to establish your U.S. status and avoid withholding on your share of partnership income. number numbar Cat. No. 16231X Form W-9 (Rev. 1-2011) Ron DeSantis, Governor a �Qf'1�� '� STATE OF FLORIDA JEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE UNDERGROUND UTILITY & EXCAVATION CO HEREW IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES Halsey Beshears, Secretary , _ . , _. _ _- . . _ . a .__ „� -- -- : . _ . _.. , : . � __ — ,. :... . • �- � __ COBB, JAMES CLAY COBB SITE DEVELOPMENT, INC 401 SOUTH SIXTH AVE WAUCHULA FL 33873 ��,_-..�C� � . i;7� ��• .�.�,,��',,� I`�' �, ;�'•�,'Y' �' � � �'��.:-,� T _ _ -- — _ --- --- LICENSE NUMBER: CUC1224962 _ _ __ __ _— —_ __ EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at MyFloridaLicense.com 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. 1 CONSTRUCTION INDUSTRY LICENSING BOARD THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES Ron DeSantis, Governor �=0t}i'ICi� :�� STATE OF FLORIDA �EPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Halsey Beshears, Secretary �� .. , � _ , _ _ . COBB, JAMES CLAY COBB SITE DEVELOPMENT INC 401 5 6TH AVE WAUCHULA FL 33873 LICENSE NUMBER: CGC1516528 EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at MyFloridaLicense.com �,�� .e ��"�'��', "' Do not alter this document in any form. � ` �'�,,. �� `��'��"� � T This is your license. It is unlawful for anyone other than the licensee to use this document. o�� :��.:� �DOT Florida Department of Transportation RON DESANTIS 605 Suwannee Street KEVIN J. THIBAULT, P.E. GOV�RNOR Tallahassee, FL 32399-0450 SECRETARY August 25, 2020 COBB SITE DEVELOPMENT, INC 401 SOUTH SIXTH AVE WAUCHULA, FLORIDA 33873 *REVISED* 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 5.337.14 (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://fdot 1.dot.state.fl.us/ContractorPreQualification/ Once logged in, select "View" £or the most recently approved application, and then click the "Manage" and "Application Summary" tabs. FDOT APPROVED WORK CLASSES: DRAINAGE, FLEXIBLE PAVING, GRADING, HOT PLANT-MIXED BITUM. COURSES, PORTLAND CEMENT CONCRETE ROADWAY PAVING, 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(3j, 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. Sincerely, D�� .Ah:��, for A1an Autry, Manager Contracts Administration Office AA:cg bf�prove Safety, Enlzance Mobility, Inspire Innovation www.fdot.gov . . s..,_. _ _ ,.: -._- i, . > _ - _._ , : E-Verify_ Employer Wizard - Company Information �:'=�� 1/�rlFy. Welcome Diana Weems ; Company Information ; � � Company Name ' ' Cobb Site Develapment, Inc. ' ` Company ID Number ; � 774044 � Doing Business As (DBA) Name f ; ; DUNS Number ', Physical Location ; ; Address 1 � 401 S. 6th Ave i : Address 2 : City � Wauchula ; State FL �; Zip Code 33873 county : HARDEE https://e-verify.uscis.gov/web/EmployerW izard.aspx = MENU ._. __. —i � i s �. i I 1/3 E-Verify: Empioyer Wizard - Company Information Mailing Address � Address 1 ; ' Address 2 ; City I '" i ' State � ! Zip Code � � __ � i Additionallnformation i ; ; Employer ldenti�cation Number � 'i 34205756 � � i Total Number of Employees ; � 5to9 ' � Parent Organization � � ? Administrator � ` Organization Designatiore � ; Employer Category ;; Federal Contractor with FAR E-Verify Clause ' ' Federal Contractor Category � ; i None of these categories apply : Employees Being Verified � 7 All new hires and all existing employees assigned to a Federal contract � ' 10iew ! Edit , , ; � ;.._�.__._..._._.___...__.._....._.. i...................�......---_�_._,._._......._.._..._........______-----------...._...__------_.. _ i : NAICS Code � 238 - SPECIALTY TRADE CONTRACTORS https://e-verify.uscis.gov/web/EmployerW izard.aspx i i i� � � ; I ; 2/3 - ,. _., . i, _ . , . _. _ . . _. - --_ _ __� _ -- _ __ . .. _ _ _ _ _ _--- — - -- .. _ � _—:. E-Verify: Employer Wizard - Company Information VIBW I �C�If Toial Hiring Sites 1 � : View / Edit � i ( 7otal Points of Contact 3 ; ; View / Edit i � � ! '----._.____------------- View Original MOU Template �;;s.�,,.� �5,��;ni a �,, rY ..t � ;.r,�.>, � st:ctr `�--r,r�`�t r��\1�1 i�r? �� iJSA. '�!-�" �4e ��f�� ` 0 iG,��j.+ ll,.yfS,i,¢�S U.S. Department of Homeland Security U.S. Citizenship and Immigration Services Enable Permanent Tooltips Accessibility https://e-verify. uscis_gov/weblEmployerW izard. aspx Download Viewers I i` i Last Login: 08/18/2020 09:46 AM 3/3 12/17l2020 Detail by Entity Name L�ivi�io�� or Cnr;r...,., � ��..� � , . � .7. ;'�?�;f+�)^ i r��. �' ' � 'A�� f � t �� "� ��" i i � ,`� `��' ( �. I� � '�; _;/: "/ ��; . ,_�: - �- -, . ._ . , _ )_. _ . . � ' . _ . ;,,.�:; ;; - �,_ - _._ , , ,, . , - � f� :;j_�r ' �_.' S9a3e / O�ir<;ii�� r,f C� _ __� � c�....� � '' -- � c , - -, _-_U;?! �! ;r'_ / �� k�y ��9 i�9��G� Florida Profit Corporation COBB SITE DEVELOPMENT, INC. Filing Information Document Number FEI/EIN IVumber Date Filed State Status LastEvent Event Date Filed Event Effective Date P02000043597 13-4205756 04/15/2002 FL ACTNE NAME CHANGE AMENDMENT 10111 /2007 'i 1/05/2007 Principal Address 401 SOUTH SIXTH AVENUE WAUCHULA, FL 33873 Mailing Address 401 SOUTH SIXTH AVENUE WAUCHULA, FL 33873 Registered Agent Name & Address COBB, LAVON 401 SOUTH SIXTH AVENUE WAUCHULA, FL 33873 OfficerlDirector Detail Name & Address l'itle D, T, P COBB, LAVON 401 50UTH SIXTH AVENUE WAUCHULA, FL 33873 Titie D, V COBB, LINDA 401 SOUTH S1XTH AVENUE WAUCHULA, FL 33873 Title D, S, CEO search.sunbiz.org/lnquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=lnitial&searchNameOrder=COBBS ITEDEV... 1/2 12l17/2020 COBB, JAMES C 401 S. 6TH AVE WAUCHULA, FL 33873 Title COO Cobb, Justin K 401 SOUTH SIXTH AVENUE WAUCHULA, FL 33873 Annual Reports ReporE Year Filed Date 2018 04/10/2018 2019 04/23/2019 2020 03/31 /2020 Document Images , ._.,.-._ , _ �.. 1 , d �I�';��.''—Ai�iiV��L -urtl _u .v�i��!�y, .: .�. _ .__.""___'____"_._.._"_"__.,_ ...__..__ 0412�l201� - ANNIlAL REPORT View image in PDF format � 9�! � 012D98 -- ANNUAL REPORT View image in PDF fDrmai I �141061�p17 - ANNUAt REPORT __ _ Uew image in PDF.form3l_ __. 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Detail by Entity Name search.sunbiz.orgll nquirylCorporationSearchlSearchResultDetail?inquirytype=EntityName&directionType=lnitial&searchNameOrder=COBBS ITEDEV... 2/2 (363) 773-3131 (SG3) 773-0773 TAX 126 S 7`h Ave WAUCHULA, PL 33873 Business No.- 0062 BUSINESS TAX October 1, 2020 — September 30, 2021 This authorizes COBB SITE DEVELOPMENT, INC to conduct business as a GENERAL CONTRACTOR at the follovving location: within the city limits of Wauchula, Florida , � �--�--� Signed ��i ✓C��t�l�e�'�� % Date 9/15/2020 (863) 773-3131 (863) 773-0773 FAX 126 S 7`�' Ave WAUCFiiJLA, I'L 33873 Client#: 298 ��,M �o�� 4��I�O�� G�9e��9'�� 12l04l2020 rn PRO�UCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Construction Underwriters, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAMEND, EXTEND OR 4168 Southpoint Pkwy - Ste 305 ALTER THE COVERAGE AFFORDED BY THE POLICIES SELOW. Jacksonvilfe, FL 32216 INSUREftS AFFORDING COVERAGE NAIC # lNSURED �NsuReRa: Amerisure Mutual Ins. Co. 23396 Cobb Site Development� �f]C. INSURER6: 401 6th Ave. iNsuReR c: Wauchula, FL 33873 INSURER�: 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 OTHEft DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRfBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE �IMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR OD' POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE MM/D�/YY /., GENERALLIA8ILITY CPP21106100001 12%D�J%ZQ �Z��J�21 EACHOCCURRENCE S�� 00� 0�0 OAMAGETORENTED g$� OOOOOD }( COMIdERCIAL GENERAL LIABILITY Contractual Liab PR ISES 2 o c rrence CLAIMS MADE � OCCUR XCU Included MED EXP (Any one person) 5$� � �� X Blnkt Addl Insd Design Services PERSONAL&ADVfNJURY s$1 OOD 000 X Blnkt WOS Broad Form PD GENERALAGGREGATE 5$2 ��0 �Q� PRODUCTS-COMP/OPAGG S$2 OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X EC�T LOC f� AIJTOMOBILE LIABILITY CA21'106090001 12/05/20 12/65/29 COMBINED SINGLE LIMIT $�,� QOO 000 (Ea accident) X ANYAUTO BlnktAddllnsd ALLOWNE�AUTOS B1nktWOS BOD�LYINJURY $ (Per person) SCHEDULED AIfTOS �� O�OOO PIP X HIRED AUTOS BODILY INJURY c� (Per accident) X NON-OWNEDAU70S X Comp Ded 1,�� PROPERTYDAMAGE $ (Per accidont) X Coll Ded 1,000 AUTO ONLY - EA ACCIDENT S GARAGE LIA8ILITY ANY AUTO OTHER THAN EA ACC 5 AUTO DNLY: qGG S i� EXCESSIUMBRELLA LIABILITY CU21106090001 12l05120 12/05/21 EACH OCCURRENCE �� 0 0�� Q0� X OCCUR � CIAIMS MADE Follow Form & AGGREGATE S� O OOO OOO XS of GL & Auto � � DEDUCTIBLE S RETENTION S WC STATU- 07H- A WORKERSCOMPENSATIONAN� WC 2��638��0� 12/31120 12/31/29 i� EMPLOYER5' LIABILITY B�n�t WOS E.L. EACH ACCIDENT $� �OOO,OOO ANYPROPRIETOR/PARTNER/EXECUT�VE E.L.DISEASE-EAEMPLOYEE Si�OOO�OOO OFFICER/McMBER EXCLUDE�9 . Ifyes,describeunder E.L.DISEASE-AOLICYLIMIT 5�,��,�0� SPECIAL PROVISIONS below A OTHER Rental Equip CPP21906100009 92/05/20 12/05/21 $500,000/�1,000,000 Special Form/�v1,000 Ded includin Theft OESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS AD�ED BY ENDORSEMENT / SPECIAL PROVISIONS 1 ATfIIAI \' SHOULO ANY OF THE ABOVE PESCRIBEO POLICIES BE CANCELlEO BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL EN�EAVOR TO MAIL �p_ OAYS WRITTEN NOTiCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OSLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZE� RE�PQRESENTATIVE I �J� �"°^" d1 • �� ACORD 25 (20o�/OS) � of 1 #S325499/M325498 KLC o ACORD CORPORATION 1988