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HomeMy Public PortalAboutExecuted Exhibits C through G.pdfExhibit C STATE OF: GEORGIA COUNTY OF: CHATHAM CONTRACTOR'S INTERIM LIEN WAIVER AND RELEASE UPON PAYMENT CONTRACTOR: West Construction Company GA, LLC OWNER: PROJECT TITLE: PROJECT LOCATION: CONTRACT: Agreement Between Owner and Contractor dated , for the construction of: 1. The undersigned CONTRACTOR contracted with OWNER to furnish labor, materials, equipment, rentals and/or services to the PROJECT in accordance with the CONTRACT referenced above. 2. CONTRACTOR herewith subunits its Application for Payment dated (the "CLOSING DATE") in the amount of $ for labor, materials, equipment, rentals and/or services supplied to the PROJECT pursuant to the CONTRACT. 3. Upon receipt from OWNER of $ , CONTRACTOR does hereby waive and release any and all liens and claims of lien against the PROJECT, and does waive and release the OWNER and the OWNER's successors and assigns from any and all claims, demands, actions, suits, causes of action, liability, or debt by reason of any labor, materials, equipment, rentals and/or services furnished by the CONTRACTOR either pursuant to the Contract and/or to or for the PROJECT through the CLOSING DATE to the extent of payment received from OWNER, EXCEPT THAT UNDERSIGNED DOES NOT WAIVE AND EXPRESSLY RESERVES THE FOLLOWING CLAIMS PENDING AS OF THE CLOSING DATE: 4. Contractor further represents and certifies that: (i) to its knowledge no liens have been filed against the PROPERTY by CONTRACTOR or any of its subcontractors, suppliers, laborers, or materialmen who furnished labor, materials, equipment, rentals and/or services to or for the PROJECT under or by virtue of the CONTRACT. 5. CONTRACTOR shall indemnify and hold Owner completely harmless from any claims, demands, liens, claims of lien, actions, suits by any of CONTRACTOR'S subcontractors, suppliers, laborers or materialmen. 6. THE UNDERSIGNED CONTRACTOR AGREES THAT THIS WAIVER AND RELEASE FORM COMPLIES WITH O.C.G.A. SECTION 44-14-366(C). DESCRIPTION OF CLAIM AMOUNT OF CLAIM Un Billed Change orders and Additional Work TBD 4. Contractor further represents and certifies that: (i) to its knowledge no liens have been filed against the PROPERTY by CONTRACTOR or any of its subcontractors, suppliers, laborers, or materialmen who furnished labor, materials, equipment, rentals and/or services to or for the PROJECT under or by virtue of the CONTRACT. 5. CONTRACTOR shall indemnify and hold Owner completely harmless from any claims, demands, liens, claims of lien, actions, suits by any of CONTRACTOR'S subcontractors, suppliers, laborers or materialmen. 6. THE UNDERSIGNED CONTRACTOR AGREES THAT THIS WAIVER AND RELEASE FORM COMPLIES WITH O.C.G.A. SECTION 44-14-366(C). IN WITNESS WHEREOF, CONTRACTOR has by its duly authorized representative set his hand and seal hereto this day of , 201 West Construction Company GA, LLC (Name of Contractor) By: Title: President Witness (Address) Sworn to and subscribed before me this _ day of , 201 . Notary Public My Commission Expires: (NOTARY SEAL) NOTICE• WHEN YOU execute and submit this document, you shall be conclusively deemed to have been paid in full the amount stated above, even if you have not actually received such payment, 60 days after the date stated above unless you file either an affidavit of nonpayment or a claim of lien prior to the expiration of such 60 day period. the failure to include this notice language on the face of the form shall render the form unenforceable and invalid as a waiver and release under o.c.g.a. section 44-14-366. Exhibit D March 1, 2018 Mr. Craig Clements Sottile & Sottile erns Se crest PARTNERS Re: West Construction Company GA, LLC Job: Tybee Island Marine Science Center, est $2.5 mill Dear Mr. Clements, We are pleased to inform you that Travelers Casualty and Surety Company of America is the surety for West Construction Company GA, LLC (West). Travelers is rated A++, class XV, by AM Best. I consider West to be well managed & financed. I can fully recommend them to you. 1 would estimate that West's bonding capacity to be in excess of $5 million single, $10 million aggregate. Please note that the decision to issue performance and payment bonds is a matter between West and Travelers, and will be subject to our standard underwriting at the time of the final bond request, which will include but not be limited to the acceptability of the contract documents, bond forms and financing. We assume no liability to third parties or to you for any reason we do not execute said bonds. Please feel free to call me at the telephone number shown below if you should have any questions or need any additional information. Sine ef e Chars 4V, Seiler, A ; AFSB C Account Executive — Bonds Sterling Seacrest Partners (912) 544-1909 Attorney-in-fact Travelers Casualty and Surety Company of America /cws 1001 Whitaker Street • Savannah, GA 31401 • Post Office Box 8004 Savannah, GA 31412-8004 912-544-1900 • fax 912-544-1901 • ATLANTA * SAVANNAH • COLUMBUS • LITTLE ROCK • HILTON HEAD ISLAND erlingsoacrest.com DAT313S, H March 1, 2018 Mr. Craig Clements Sottile & Soltile 10 West Taylor Street Savannah, Georgia 31401 Re: West Construction Company GA, LLC Mr. Clements: AN,HIT L r CANNON, LLP In accordance with the information listed in the request for proposal relative to Tybee Island Marine Science Center (RFP), we are submitting the following information on behalfofWest Construction Company GA, LLC (WCC). We performed a financial statement audit of WCC's financial statements as of December 31, 2016 and issued a report dated June 23, 2017. The audit was performed in accordance with auditing standards generally accepted in the United States of America. Those standards required that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement. Based on our audit, we determined that the financial statements referred to above present fairly, in all material respects, the financial position of WCC as of December 31, 2016, and the results of its operations and its cash flows for the year then ended in accordance with accounting principles generally accepted in the United States of America. Based on the financial statements as ofDecember 31, 2016, WCC's current ratio was 1.56 We anticipate performing a review of the financial statements as of December 31, 2017 -in the near term and will be able to provide the current ratio as of December 31, 2017 once our review is completed. Please do not hesitate to contact me should you have any questions. Sincerely, Talmadge R. Johnson, CPA 319 S. Main Soret .0. Bos 727 Statesboro, GA 30459 • Tel: 912-764-6951 Fax: 912-764-8795 • www.dhhccl;>a.com Ster9UngSeacrest PARTNERS March 1, 2018 RE• West Construction Company GA LLC Workers' Compensation Experience Modification Dear Sirs: Please be advised that the Experience Modification Factor promulgated by the National Council on Compensation Insurance for West Construction Company GA LLC is as follows: Effective 5-1-2017 1.00 Effective 5-1-2016 1.00 Should you have any questions or concerns about West Construction Company GA LLC and their safety performance, please do not hesitate to contact me. Sincerely, Susan White Partner 1001 Whitaker Street • Savannah, GA 31401 • Post Office Box 0004 Savannah, GA 31412-0004 • 912-544-1900 Fax 912-S44-1901 • sterlingseacrestcam ATLANTA • SAVANNAH • COLUMBUS LITTLE ROCK• HILTON HEAD ISLAND ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDWYYY) 3/1/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policyhes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Sterling Seacrest Partners, Inc. 1001 Whitaker Street Savannah GA 31401 INSURED West Construction Company GA LLC P.O. Box 61388 Savannah COVERAGES GA 31420 CONTACT Susan NAME: hite PHONE (912)544-1900 (A/C No Fxtl: AoORIESS. swhite@sspins.com AX (912)544-190 A/C, NO INSURERIS) AFFORDING COVERAGE NAIC q INsuRERA:Travelers Property Casualty Company INsuRERB:Travelere Casualty Ins Co of 25674 19046 INSURER C: INSURER D : INSURER E : INSURER F : CERTIFICATE NUMBER:17-18 COI REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTRINSD TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF M/ (MDDNYYY) POLICY EXP (MMIDDNYYYI LIMITS X COMMERCIAL GENERAL CLAIMS -MADE LIABILITY OCCUR C07277R120 5/1/2017 EACH OCCURRENCE $ 1,000,000 X 5/1/2018 AMAGEA PREMSESO(Ea occu ence) $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL 8,ADV INJURY $ 1,000,000 GE 'L AGGREGATE POLICY OTHER. LIMIT APPLIES JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 X ( PRODUCTS - COMP/OPAGG $ 2,000,000 $ A AUTOMOBILE LIABILITY AUTO OWNED AUTOS SCHEDULED AUTOS AUTOSWNED BA7277R120 5/1/2017 5/1/2018 (E a acBcliaeDt) OSINGLE LIMIT n $ 1,000,000 X ANY BODILY INJURY (Per person) $ ALL AUTOS BODILY INJURY (Per accident) $ X HIRED X PROPnt�AMAGE A X UMBRELLALIAB OCCUR -MADE CUP7277R120 5/1/2017 5/1/2018 EACH OCCURRENCE $ 5,000,000 EXCESSLIAB CLAIMS AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE (Mandatory In n NH)BER EXCLUDED? OFFICaRJMEMNH) If yes, describe under DESCRIPTION OF OPERATIONS below Y(N N/A DB7277R120 5/1/2017 5/1/2018 X STATUTE OTH- ER E.L EACH ACCIDENT $ 1,000,000 y E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Leased/Rented Equipment C07277R120 5/1/2017 5/1/2018 LIMIT: $100,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mo e space Is requl ed) RFQ/RFP #2018-709 The Tybee /eland Marine Science Center, North Beach Facility, Tybee Island, GA. Certificate holder is named as additional insured with respect to general liability as required by written contract. CERTIFICATE HOLDER CANCELLATION City of Tybee PO Box 2749 Tybee Island, Island GA 31328 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - David Paddison/BLALOC ACORD 25 (2014101) INS025 (201401) ©1988.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Exhibit E Proposer Affidavit By executing this affidavit, the undersigned proposer/contractor verifies its compliance with O.C.G.A. § 13-10-91, as it may be engaged in the physical performance of services under a contract with the City of Tybee Island, Georgia, it has registered with, is authorized to use and uses the federal work authorization program commonly known as E -Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91. Furthermore, in the event proposer contracts with the City after receiving the award, the contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will contract for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the information required by O.C.G.A. § 13-10-91(b). Additionally, the undersigned contractor will forward notice of the receipt of an affidavit from a subcontractor to the City of Tybee Island within five business days of receipt. If the undersigned contractor receives notice of receipt of an affidavit from any sub -subcontractor that has contracted with a subcontractor to forward, within five business days of receipt, a copy of such notice to the City of Tybee Island. Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows: a In \c\U b%1 ' /'to\\ Date of Authorization `�j /',, \'U'c CbNa S sIZA) �`� \b• r\ C�C' o\,�, i (2 ' Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Execon �_'' ',►. ioj .. - ! 1 in SPh4(> y), 61\ (state). Signature of ut horized ffi 'r or A exit Printed Name and Title of Authorized Officer or Agent SUBSCBED ANp SW N BEFORE ME THEV(' _ D 1 OF \.,\`\3. C\\ NOTA 1 BLIC My Comm��.i8t'IQ o s: Notary Public rarn County, Georgia commission Expires :..t u ly 19th, 2019 Exhibit F 18 O.C.G.A. § 50-36-1(e)(2) SAVE Affidavit By executing this affidavit under oath, as an applicant for a(n) construction contract for a public benefit as referenced in O.C.G.A. § 50-36-1, from the CITY OF TYBEE ISLAND, Georgia, the undersigned applicant verifies one of the following with respect to my application for a public benefit: X I am a United States citizen. I am a legal permanent resident of the United States. 1 am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1(e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: Drivers License In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed in Savannah (city), y), GA (state). i Signature of Applicant Matthew A. West, Sr. Printed Name of Applicant WORN BEFORE ME ON THER0tDAY OF My Commissi_ p i;'8. ; V ';7020 r•' ` •/f' • /* e ° 'Lf Waft, - e G„ I _ 0 20/� DRIVER'S LICENSE ocfNob051.0239601 oos,03/27/2885 :,, LASS 0 - Ekr 03127/2025 MAT WJVF?RV moopoptegoOtoR 'A MAr040148853288Er :R tJc Ions Bim`' y,—_., •�. Bs x8/0372 S Ni iyesa Win 03 Wge 1 8820081420048817 cr MANOR Exhibit G NON -INFLUENCE AFFIDAVIT — CONSTRUCTION O.C.G.A. § 36-91-21 Excerpt from Georgia Laws O.C.G.A. § 36-91-21 (d) Whenever a public works construction contract for any governmental entity subject to the requirements of this chapter is to be let out by competitive sealed bid or proposal, no person, by himself or herself or otherwise, shall prevent or attempt to prevent competition in such bidding or proposals by any means whatever. No person who desires to procure such work for himself or herself or for another shall prevent or endeavor to prevent anyone from making a bid or proposal therefore by any means whatever, nor shall such person so desiring the work cause or induce another to withdraw a bid or proposal for the work. (e) Before commencing the work, any person who procures such public work by bidding or proposal shall make an oath in writing that he or she has not directly or indirectly violated subsection (d) of this Code section. The oath shall be filed by the officer whose duty it is to make the payment. If the contractor is a partnership, all of the partners and any officer, agent, or other person who may have represented or acted for there in bidding for or procuring the contract shall also make the oath. If the contractor is a corporation, all officers, agents, or other persons who may have acted for or represented the corporation in bidding for or procuring the contract shall make the oath. If such oath is false, the contract shall be void, and all sums paid by the governmental entity on the contract may be recovered by appropriate action. STATE OF GEORGIA COUNTY OF CHATHAM I do solemnly swear on my oath that, as to the Contract dated July 12, 2018, between West Construction Company GA, LLC and the City of Tybee Island Georgia, I have not directly or indirectly influenced or the attempted exertion of any influence on behalf of the firm on behalf of which this affidavit is made, in any way, manner, or form in the purchase of materials, equipment, or other items involved in construction, manufacture, or employment of labor under the aforesaid Contract by or on any employee, officer, or agent of the Board, or any person connected with the City of Tybee in any way whatsoever and I have not directly or indirectly violated subsection (d) of OCGA 36-91-21. This day of -1--t � , 2018. Signature Matthew A. West, Sr. President West Construction Company GA, LLC Sworn to and subscribed before me this (4� day of , , 2018. (L.S.) ( Notary Publib My Commission expires This ' ° Comm. Exp, : `.a Y1102119 �. `'- 1 .t., T', I - '. F 1E1® e. day of , 20 / / .