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10-10524
CITY OF. ZEPHYRHILLS 5335 - 8TH STREET • (813)780 -0020 10524 BUILDING PERMIT :ems o- ° • •' «, t v 6 � % T �:,? a- r ` .. ° "`.. R. as„ t . gf ? 7, -, .:£ � , : i.: , Permit Number: 10524 Address: 7209 GREEN SLOPE DR Permit Type: COMMERCIAL ZEPHYRHILLS, FL. Class of Work: ADD /ALT COMMERCIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 34- 25 -21- 0000 - 00300 -0091 Improv. Cost: 269,000.00 �` "s Date Issued: 6/02/2010 Name: CASELNOVA, MICHAEL & ANGELA Total Fees: 1,476.00 Address: 11335 FORT KING RD Amount Paid: 1,275.00 DADE CITY FL 33525 Date Paid: 6/02/2010 Phone: (813)788 -0411 Work Desc: INTERIOR REMODEL 3,100 SQ FT =•9 •- -U •N B ILDIN FE 1,170.00 EL - I AL FEE 35.00 SEALANDER CONTRACTOR SERVICES ft PLUMB 35.00 MECHANICAL FEE 35.00 WARD'S HTG. & AIR FIR LAN REVIEW FEES 18. 00 "`FIRE INSPECTION FEES 15.00 STRICKLAND POWER INC �- -_ _____ .__. � S P d�r� 4 ( ' I ' 6 ' iel NVC/11aVvLe I I — 'VIC- (A) a.s 'I .1 ''\ f t)/(frrlf C&r pRec)(6\43N ( n 1 [l( 11° s,e ste or • et O � fi I• F•• ER 2N• R I •U H P LU B IS IN LATN LIN G FOOTER BOND DUCTS INSULATED SEWER MISC. ROUGH ELECTRIC LINTEL MISC MISC. 1ST ROUGH PLUMB PRE -METER INSULATION WALL MISC. DUCTS INSTALLED WATER MISC DRIVEWAY PRE -SLAB SHEATHING MISC. MISC. CONSTRUCTION POLE FRAME MISC. MISC. REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection trips are necessary due to any one of the following reasons: a) wrong address b) condemned work resulting from faulty construction c) repairs or corrections not made when inspections called d) work not ready for inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. The payment of inspection fees shall be made before any further permits will be issued to the person owning same "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing, consult with your lender or an attorney befo - - cording your notice of commencement." / 6eig.— riF �• CONTRACTOR SIGNATURE PERMIT OFFI FR PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER O6/11/2O1O 8�2D A� �eceipt No. 0188711 CR 201.00 _________ Total: 201.00 O.0u Check/ 201.0O c4112519 prtm#1O524 Other: 201.00 Change: O.00 ck#1l2519 prtm#10524 OOOOOO Cashier: bobble Station� CASH1 RODDA CONSTRUCTION, INC. 112517 Invoice # Date Description Amount Discount Net Due 6 -1 /FLA.HOSP 05/31/10 FLA.HOSP -SLEEP LAB /PERMIT 1,275.00 1,275.00 05/31/10 Ck #: 112517 CITY OF ZEPHYRHILLS Page 1 of 1 1,275.00 813- 780 -0020 City of Zephyrhills Permit Application G/ � F aX- elsaed -ooze (` 62 f/ Lc'/7 /0 Building Department ' ' 6 if v ,,l /) 7 Date Received =;_ _ �� - = G.1 Phone Contact f • r Permitting li ' -- Owner's Name Eito, . I �/ f _Owner Phone Number F�lig 1 f Owner's Address i � Cr d LIf k\b ,)E0Nr I Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address n JOB ADDRESS • j�� ,� �i LOT # SUBDIVISION PARCEL ID#34 ''''p25 3 . 2 1- Q 100 -Go Soo - WO) (OBTAINED FROM P OPERTY TAX NOTICE) �V/`�� WORK PROPOSED NEW CONSTR ADD /ALT n SIGN n MOVE n DEMOLISH INSTALL REPAIR PROPOSED USE n SFR 1 1 COMM n OTHER TYPE OF CONSTRUCTION 1 A BLOCK FRAME n STEEL n OTHER I DESCRIPTION OF WORK 'M M 4 Q. ) BUILDING SIZE SQ FOOTAGE 3tO d S • f I :HEIGHT 110, BUILDING saw 60 0 VALUATION OF TOTAL CONSTRUCTION rr�i•• ELECTRICAL $ SO 0 0 U AMP SERVICE 1 I PROGRESS ENERGY n W.R.E.C. lingEMII I� MECHANICAL Mb 0 dr VALUATION OF MECHANICAL INSTALLATION n , { GAS (- n ROOFING n k 1 1 SPECIALTY [ / (��'6T FINISHED FLOOR ELEVATIONS FLO• t ONE AREA nYES ETNO .:::::: ...::::::...- ::::::::::::..:a ::::::::: -..::::::::::::: :::- :::::::::::::- .::r: :::::::::::::.................................... ... ...... ..... .... ............. . UILDER \ l� A s � l� COMPANY r�l �� ;��,,� UR i B SIGNATURE REGISTERED ? IMF N F URRENT n Erg Address Pill U, 1 MR, �' 1 _ � .�lq t 35i . ,.Li - - e# M. • • _ n % E I ELECTRICIAN , � .-. �eif j� COMPANY+ ' /� SIGNATURE l � k X 79`' n /{ RE�G IS � TERED • ©� FEE CURRENT /� MEW / Address �h! 1 I )42I, -lli l, rat ■ ° L icense# E C I • • r 1 3_ / i.• v. 1/1(1 PLUMBER * � � �,$ rvirr _ANY �� A I1 � 1 � � . W '� • SIGNATURE !�. • • , �r ��� 1t � FFEECURREN Address Ma�� �� UI� ► I • • \ilr"1t berTS2 # - MECHANICAL i,. Bilarri *MPANY t'�+�.M LI .j ( Q. SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT I Y/ N I Addre Eel ='I• . ,A 1 0 11'1 '� �',/� 1 =� 3* 3 L VT.,' . 1 OTHER f � A- COMPANY SIGNATURE ' `t REGISTERED I Y/ N 1 FEE CURRENT I Y/ N 1 Address License # I RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -O -W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R -O -W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. ****PROPERTY SURVEY required for all NEW construction. - -- WW..,.... ....wW.... ..w.... .. ...,w.......,w......W..w..... , W... w ... ..........�................�W.. Ww-----......,..-.---- W...............— ...,...... ...........� ..4 D Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A/C upgrades over $5000) '• Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades A/C Fences (Plot/Survey /Footage) Driveways -Not over Counter if on public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the Pasco County Building Inspection Division — Licensing Section at 727 -847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACT /UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89 -07 and 90 -07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water /Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law — Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to commencement. CONTRACTOR'S /OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: - Department of Environmental Protection- Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers - Seawalls, Docks, Navigable Waterways. - Department of Health & Rehabilitative Services/Environmental Health Unit - Wells, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency- Asbestos abatement. - Federal Aviation Authority- Runways. I understand that the following restrictions apply to the use of fill: Use of fill is not allowed in Flood Zone "V" unless expressly permitted. - If the fill material is to be used in Flood Zone "A ", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. - If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. - If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OE LAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU E OF; MENCEMENT. FLORIDA JURAT (F.S. 117.03) ,i// / /�� OWNER OR AGENT CONTRACTOR Subscribed and sworn to (or affirmed) before me this ..crib d and swor o (. mid) b:a' tit eh... by / . ...1i 3 • Who is/are personally known to me or has /have produced ho i /ar- personally known to me has/have produced as identification. / .s identification. 'L. Notary Public �. at.. ' d. 1(_ ali..-J7--/ Notary Public Commission No. Cp missio t o , t ^ /Li� � e HLEEN I S. y..... �I(,� /i_ /71��. McCALLIJM Name of Notary typed, printed or stamped ame of Notary typed, printed or s "m pe d "�� Comm# 000728233 a "� ;`` Expires 1/16/2012 �� ` Florida Notary Assn., Inc Pasco County Parcel: 34-23-21-0000-00300-0091 001 Page 1 OT 1 Data Current as Of: II Weekly Archive - Saturday, April 03, 2010 Parcel ID II 34- 25 -21- 0000 - 00300 -0091 (Card: 001 of 001) I Classification 1 19 - Professional Service Building Mailing Address Final 2009 Value CASELNOVA MICHAEL L & ANGELA M Ag Land $0 11335 FORT KING RD Land $64,427 DADE CITY FL 33525 -8513 Building $294,957 Physical Address Extra Features $3,455 7209 GREEN SLOPE DR ZEPHYRHILLS FL 33541 -1306 Market Value $362,839 Legal Description (First 4 Lines) Assessed (Non - School Amendment 1) $362,839 COM AT NE COR OF SE1 /4 OF SEC 34 TH ALG NORTH LINE THEREOF Taxable Value $362,839 N89DEG 58'35 "W 1345.17 FT TO NLY EXTENSION OF WLY RIGHT-OF- Land Detail (Card: 001 of 001) Line II Use IID Zoning Units I Type II Price II Condition II Value 1 Q 1900 II PROF.BLDG 11 00C2 I 5,000.00 1 II $8.00 II 1.00 II $40,000 2 II 1900 II PROF.BLDG II 00C2 II 7,000.00 II SF I $2.15 1 1.00 11 $15,050 3 II 1900 II PROF.BLDG II 00C2 11 9,871 00 II 51 I $0.95 1 1.00 I� $9,377 Additional Land Information Acres 11 0.50 11 Tax Area II 30ZH II FEMA Code II -- 0 Code PTVM2AA Building Information - Use 19 - Offices Professional or Medical (Card: 001 of 001) Year Built 2002 Stories 1.0 Exterior Wall 1 Concrete Block Stucco Exterior Wall 2 Common Brick Roof Structure Gable or Hip Roof Cover Metal Interior Wall 1 Drywall Interior Wall 2 None Flooring 1 Cork or Vinyl Tile Flooring 2 Ceramic Clay Tile Fuel Electric Heat Forced Air - Ducted A/C Central Baths 4.0 I Line 1 Description Sq. Feet Repl. Cost New 1 1 1 BAS 1 3,200 I $327,616 I 2 11 CAN I 64 $1,945 Extra Features (Card: 001 of 001) Line 0 Description II Year 1I Units 11 Value 1 II PAV ASP 11 2002 1I 4,594 Il $2,636 2 II PAV CON II 2002 11 452 (1 $819 Sales History Previous Owner N/A Year 11 1 Month 1 1 1 1 Book /Page II Type 11 Amount 2002 1 01 5102 / 1679 11 WD 11 $0 http: / /appraiser.pascogov.com/ search /parcel.aspx ?sec= 34 &twn= 25 &rng =21 &sbb= 0000 &bl... 4/7/2010 Zephyrhills Fire Rescue 6907 Dairy Road, Zephyrhills, FL 33542 Fire Marshal Bus (813) 780 -0041 Kerry Barnett Fax (813) 780 -0044 E -mail: kbarnett @fire.zephyrhills.fl.us Plan Review #: 10 -060 Project: Interior Renovation Number of Pages: 18 May 27, 2010 I have received and reviewed the plans for the interior renovation located at 7209 Green Slope Dr and will allow the project to move forward. Please note that this review does not eliminate any further requirements as the project continues moving forward. By receiving permit, contractor acknowledges to comply with the items listed below. Should anyone have any questions, please do not hesitate to contact the Fire Marshal's office. 1. Renovation was reviewed using the Florida Fire Prevention Code and it was determined by Chapter 43 to classify this as new construction. Therefore it was reviewed as new business occupancy. 2. Building shall be placard due to light weight truss construction per Florida Administrative Rule. 3. Secondary egress doors shall have either panic hardware or a hotel style latch permitting only a single motion. 4. If the A/C unit produces 2000 cfm's or more a duct detector is required with a key reset switch. 5. Ensure interior finish in the exit corridors is Class A or B on the walls and ceilings. 6. Ensure the address is on the front of the building in 6" numerical. 7. Ensure the fire wall remains intact, is sealed and labeled as such. Any penetrations shall be of a listed method with method shown to the office at the time of the final. 2 Inspections Required: 1. Fire wall inspection 2. Acceptance Test /74 KERRY BA ' P FIRE MARSHAL ** *Please be advised this review of plans submitted is a cursory review to assist the contractor in compliance with applicable fire safety codes. This review is not intended to be a final approval of the submitted plans. It is the contractor's sole responsibility to ensure that the plans are in complete compliance with all applicable NFPA codes and local ordinances. In the event that further examination or site inspection reveals areas of non - compliance, it shall be the contractor's sole responsibility, at their sole expense to bring those areas in compliance. The City assumes no responsibility for the contractor's failure to be in compliance with all applicable NFPA codes and local ordinances. i I ZEPHYRHILLS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhills, FL 33542 Fire Chief Keith Williams Bus (813)780 -0041 Fax (813)780 -0044 FIRE SERVICE USER FEES 1 Occupancy No.: Plan No.: 4 / 7—c /1 I/ trt i Q n � � Contractor: ■ �/ a_ i , Business Name: S /'�' C am. 4 Billing Address: Ste) 0 IMMIIVITO Business Address: 7a 9 a --t7 gjG o ♦ � c e ._ Business Phone No.: Billing Phone No.: 1 Business Fax No.: Billing Fax No.: Contact: Contact: 1 PLAN REVIEW FEES INSPECTION FEES _ PERMIT FEE ; — FALSE ALARM FEE II Site Plan N/C — Annual N/C _ Sprinkler $50� - 1st Alarm N/C I .2 Multi - Family /Commercial .06 sf 1st Re- inspection N/C — Standpipes $50,. — 2nd Alarm N/C . 11' (Minimum Charge 525.00 _ 2nd Re- inspection $100 ^ Fire Pump $50 — .3rd Alarm N/C 0 Plan Revisions DBL — 3rd Re- inspection $250 — Hoods $50 — nspe Alarm 4th Alarm 5100 _ 4th Re-Inspection 5500 _ Fire Al $501 _ 5th Alarm 5150 SPRINKLER SYSTEMS (Business closed until __ LP Gas $50 — 6th Alarm 5200 0 - 25 Heads $50 violations corrected) — Natural Gas $501 _ NON COMPLIANCE $150 26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- per tank $50 1 STANDPIPE SYSTEM Hydro Undergrounds $45 _ Sparklers 5109 0 Per Riser $50 Hydrostatic Test 565 per system _ Fire Works $500 FIRE PUMP Acceptance Test $45 per system _ Camp Fire $251 0 Per Pump $100 Hydrant Flow $75 _ Controlled Burn 5100 _ FIRE ALARM SYSTEM — Hood/Duct $501 — 0 - 25 Devices 550 — FIRE ALARM SYSTEM _ Place of Assembly $501 Annual _ 26 plus Devices $100 . , System Acceptance $50 _ Fire Protection $251 _ SUPPRESSION SYSTEMS _ Recall Acceptance 550 — Flammable Application 5501 Annual — Wet 550 — OTHER — Waste Tire Storage $501 Annual — Dry $50 — Fire Wall/Smoke Wall $1 per wan _ Generator < KW 5100 — CO2 550 — LP Gas $25 per tank — Generator >30 KW 150 Other 550 Natural Gas $25 per system — Bio-Hazard Waste $100; Annual KITCHEN EXHAUST _ — Fumigation Tenting $50 0 Hood/Ducts $50 — Tent 10x10' or greater $15 p er tent _ Torch Pot/Applied 5501 OTHER Fire Pump $45 Haz. Materials 5100; Annual LP Installation per tank 550 _ Fire Suppression $30 _ Fuel Tank Installation 550 System. Acceptance ❑ (Per Tank) $50 Exhaust Hood/Duct 530 ; Natural Gas Installation $50 Re- inspection DBL (Per System) (other than annual) _ Spray Booth $50 ❑ Inspection scheduled DBL and cancelled Tess than _ _ 24 hours — Construction Insp. N/C Emergency Vehicle Ac $ FALSE ALARM "`777 ---- "`` PLANS TOTAL rile INSPECTION TOTAL PERMIT TOTAL I ! TOTAL GRAND TOTAL I ..QC, (— I Comments: Date: .. 2'7 (d / / City of.Zephyrhills BUILDINGPLAN REV.IEW.COMIvIENTS Contra omeowner: 0/5, Date Received: J /7 Site: 7 d O 1 t744 - Permit Type: Approved w /no comments Approved w /the below comments:.❑ Denied w /the below comments: 0 This comment she shall • - . - . ., 'th the permit and/or plans. Bill z urgess — Buil • • . g • is cial Date Contractor and/or Homeowner (Required when comments are present) 06/01/2010 09:23 FAX 863 701 9025 WARDS AIR 2001/004 WARDS 865 CREATIVE DRIVE LAKELAND, FLORIDA .33813 Cunt/4P( 6iY swian AIR CONDITIONING PHONE 1863) 6460020 v 1i,, ( 96 FAX /863/ 70 f -9025 CAC 05763 ��� i tei .../ d s..,„.....x. ,- ,e,,,,--.4i -7"10-Pief-`) ... 4 ,, _. 06/01/2010 09:23 FAX 863 701 9025 WARDS AIR 12 003/004 • IMPORTANT If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) 2 of 2 #S144935/M144885 06/01/2010 09:23 FAX 863 701 9025 WARDS AIR Z 002/004 Client#: 20630 WARDHEA — ACORD,M CERTIFICATE OF LIABILITY INSURANCE D ATE( o D'T""I PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lanier Upshaw, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1115 US Hwy 98 South ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. P.O. Box 468 Lakeland, FL 33802 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A; Westfield Insurance Company 24112 Ward's Resting & Air Conditioning, Inc, INSURER E: Brldgefield Employers Insurance 10701 865 Creative Drive INSURER C: Lakeland, FL 33813 INSURER D; INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDIT)ONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRC, TYPE OF INSURANCE POLICY NUMBER DATE (MMID DATE MM10D T/YYY/L LIMITS A OENRRAL LIABILITY TRA5280807 06/03/2010 06/03/2011 EACH OCCURRENCE 11,000,000 X COMMERCIAL GENERAL LIABILITY ; SY SFr T. /Fe nra+ 5500 000 RENTED CLAIMS MADE in OCCUR 54 P0 EXP (Any one person) 510,000 PERSONAL IL ADV INJURY 51,000,000 GENERAL AGGREGATE s2,000,000 GEN 'L AGGREGATE LIMIT APPLIES PER; PRODUCTS - COMP /OP AGG 12.000.000 7 POLICY f JECT r7 LOC _ A AUTOMOBILE LABILITY TRA5280807 06/03/2010 06/03/2011 COMBINED SINGLE LIMIT X ANY AuTO (Ea accident) 51,000,000 ALL OWNED AUTOS BODILY INJURY `^ SCHEDULED AUTOS (Per wean) 5 X MIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per modem) 1 PROPERTY DAMAGE 1 (Perecddenq GARAGE LIABILITY AUTO ONLY • EA ACCIDENT $ H ANY AUTO OTHER THAN EA ACC 1 AUTO ONLY: AGO 1 A EXCESS / UMBRELLA LIABILITY TRA5280807 06/03/2010 06/03/2011 EACH OCCURRENCE 52.000.000 OCCUR E CLAIMS MADE AGGREGATE X 12 000,_000 1 DEDUCTIBLE 1 )C I RETENTION 1 0 � OGA. $ WORKERS COMPENSATION AND 083041305 - B 5 04101/2010 04/01/2011 X) TOY Wdr EMPLOYERS' LIABILITY ANY C PR Ep O � PRIETOR/ PARTNERJEXECUTIVE E.L. EACH ACCIDENT s500,000 anlde�drYFrnMI� EXCLUDED? N E,L, DISEASE - EA EMPLOYEE 1500,000 :n e ar yePECIe. d.e Pcdb. un ONS below E.L. DISEASE - POLICY LIMIT s500,000 AL ROVISI A OTHER Rented or TRA5280807 06/0312010 06/03/2011 550,000 Limit Leased Equipment 51,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 10 Days for Non - Payment sHOULD ANY of THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE EXPIRATION City of Zephyrhllls DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 4n DAYS WW1 - TEN 5335 8th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT PAILURE TO 00 30 SHALL Zephyrhllls, FL 33540 -4312 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS CR REPREBENTA1WEB, AuTTotoruZEO REPR ENTATIVE - ` / 4 1 Z Gamz - ACORD 25 (2009/01) 1 of 2 #S144935/M144885 0 1988 -2009 ACORD CORPORATION. All rights reserved. TM ACORD name and logo are registered marks of ACORD ALM 06/01/2010 09:23 FAX 863 701 9025 WARDS AIR al PQLK couNTY LOCAL BUSINESS TAX RECEIPT . ACCOUNT NO. 27969 CLASS: B EXPIRES: •913O/201 • OWNER NAME LOCATION • RICE, J' TIMOTHY - CERT 865 CREATIVE DR LAKELAND - IN BUSINESS NAME AND MAILING ADDRESS CODE ACTIVITY TYPE ,c ,i rs� f, 239915 CONTRACTOR AIR CONDITIONING 4 • . • " • WARDS I EATINO 8 Ant CONDITIONING • J TIMOTF111'f'RICE -•CERT � (a 995 CRFATNE'DN. LAKELAND; FL33813 • ^ '� _r.• aT i Id1111 � OFFICE OF JOE G. TEODER; C F•C"TAX COLLECTOR CO'NBPICU08L CI3PLA EDAT ITON • PAID - 1203236.0001 -0001 12 08/13/2009 55.00 • AC# 3945321 .. : STATE ; ~•O'F FLORIDA DEPARTMENT OF:ggaZUEde5AND PROFESSIONAL REGULATION • CONS3?RU T STRY'• LICENSING HOARD ' SEQ #L0908201190 • DATE HATCH NUMBER - LICENSE ' '1 R: t A8',.26..12OO8 b'7'a5' CAC ,mile' dIrAS a ' , I -, I . • IT r e sr> Q- CON h-�,CTOR �NDMec ;'he3,Eiw•,, 5 ". t4RTIFfErk ': • 'tT 'der tIe pi►'cviei`one of Chapter i499..F'9. , Expiration date: AUG 31, 2010 t., • RICE, 7OHN TIMQTH : `:i: r t '` . , • WARD:' S; HEATSNG & AS4 " C ; i, NI G T,NC 9651 DR. i'' • ":,tr r :LAIKELAND FL 33 813 • • F . 'CHAtRLI bb7 F r I 4 ?• /� � ., te r' •, � i R'. CRX " 11111���� ; �: �1�:; " / +• � '' � ' CHARLES W . DRAQO VERNOR., :� ;• `P:LA . SECRETARY . • D'ISPl;,4 UIRED BY LAW ` J • • AHS Owner- Contractor Lump Sum Agreement for limited scope projects AGREEMENT BETWEEN OWNER AND CONTRACTOR (For Construction Projects of Limited Scope Where the Basis of Payment is a STIPULATED SUM) This Agreement made as of this 7th day of May, in the year of Two Thousand Ten, between the Owner: Florida Hospital Zephyrhills 7050 Gall Blvd. Zephyrhills, FL 33541 -1399 and the Contractor: Rodda Construction, Inc. 250 E. Highland Drive Lakeland, FL 33813 for the Project: Sleep Lab 7209 Green Slope Drive Zephyrhills, FL 33541 -1306 The Architect is: Burt Hill/Pollock Krieg Architects, Inc. 8250 College Parkway, Suite 203 Fort Myers, FL 33919 Where no Architect is employed for a Project, all references to Architect in this Agreement shall mean Owner. The Owner and the Contractor agree as set forth below: ARTICLE 1 - THE WORK OF THIS CONTRACT 1.1 The Contractor shall execute the entire Work described in the Contract Documents (as defined in Article 6), except to the extent specifically indicated in the Contract Documents to be the responsibility of others. 1 ARTICLE 2 - DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION 2.1 Contract Time. Time being of the essence in the performance of this Agreement, the Work to be performed shall be commenced on or before May 17, 2010, and, subject to authorized adjustments by Change Order, Substantial Completion shall be achieved not later than 60 calendar days from the date of commencement. 2.2 Liquidated Damages. If the Contractor fails to substantially complete the work within 30 calendar days after the above agreed upon Date of Substantial Completion set forth in this Agreement (including any extension granted by the Owner in writing), then the Contractor agrees to pay the Owner, as liquidated damages, the sum of $0.00 per calendar day until Substantial Completion of the Work is actually achieved. Such amount is agreed upon as a reasonable measure of the damages that the Owner will sustain from the Contractor's failure to timely complete the Work. Owner and Contractor recognize the delays, expense and difficulties involved in providing in an arbitration or judicial proceeding the actual loss suffered by the Owner if the Work is not completed on time and accordingly, instead of requiring such proofs, they agree upon the above - stated amount as liquidated damages for delay (but not as a penalty). The foregoing liquidated damages shall be in lieu of all other monetary remedies that the Owner shall have in the event of the Contractor's delay in completing the Project. ARTICLE 3 - CONTRACT SUM 3.1 The Owner shall pay the Contractor in current funds for the Contractor's performance of the Contract the Contract Sum of Two Hundred Twenty Three Thousand One Hundred Twelve Dollars ($223,112.00), subject to additions and deductions as provided in the Contract Documents. 3.2 The Contract Sum is based upon the alternates attached as Exhibit "A ", if any, which are described in the Contract Documents and are hereby accepted by the Owner: ARTICLE 4 - PROGRESS PAYMENTS 4.1 Based upon Applications for Payment submitted to the Architect by the Contractor and Certificates for Payment issued by the Architect, the Owner shall make progress payments on account of the Contract Sum to the Contractor as provided below and elsewhere in the Contract Documents. The period covered by each Application for Payment shall be one calendar month ending on the last day of the month. 4.2 Each Application for Payment shall be based upon the Schedule of Values submitted by the Contractor in accordance with the Contract Documents. The Schedule of Values shall allocate the entire Contract Sum among the various portions of the Work and be prepared in such form and supported by such data to substantiate its accuracy as the Architect may require. This Schedule, unless objected to by the Architect, shall be used as a basis for reviewing the Contractor's Applications for Payment. 4.3 Applications for Payment shall indicate the percentage of completion of each portion of the Work as of the end of the period covered by the Application for Payment. 2 4.4 The amount of each progress payment shall be as follows: Ninety percent (90 %) of the portion of the Contract Sum properly allocable to labor, materials and equipment incorporated in the Work and Ninety percent (90 %) of the portion of the Contract Sum properly allocable to materials and equipment suitably stored at the site or at some other location agreed upon in writing, for the period covered by the Application for Payment, less the aggregate of previous payments made by the Owner. 4.5 The Owner shall make payment to the Contractor on or before the 20th of the month for work performed the previous month. 4.6 Upon Substantial Completion of the entire Work, the Owner shall make payment of a sum sufficient to increase the total payments to Ninety -Five percent (95 %) of the Contract Sum, less such amounts as the Architect shall determine for all incomplete Work and unsettled claims as provided in the Contract Documents. 4.7 Each Application for Payment shall be accompanied by an acknowledgement of progress payment and release of liens, signed by Contractor, in a form approved by the Architect/Owner, and, beginning with the second Application for Payment and thereafter, shall also be accompanied by such acknowledgements signed by all major subcontractors and materiahen to whom payments are intended to be made, in order to assure an effective release of mechanics' and materialmens' liens in compliance with the laws of the State in which the Project is located. ARTICLE 5 - FINAL PAYMENT 5.1 Final payment shall be made by the Owner to the Contractor when (1) the Contract has been fully performed by the Contractor and accepted by the Architect except for the Contractor's responsibility to correct defective or nonconforming Work, and to satisfy other requirements, if any, which necessarily survive final payment; (2) a final Application for Payment has been submitted by the Contractor; and (3) a final Certificate for Payment has then been issued by the Architect; such final payment shall be made by the Owner not more than 30 days after the issuance of the Architect's final Certificate for Payment. Owner may withhold 150% of the value of any remaining unfinished or punchlist Work. 5.2 The final Application for Payment shall not be submitted until the Contractor delivers to the Architect (1) a complete release of all liens and/or a waiver of all lien rights arising out of this Agreement; (2) an affidavit that the release and/or waivers of lien includes and covers all materials and services for which a lien could be filed, but Contractor may, if any Subcontractor or supplier refuses to furnish a release in full, furnish a bond satisfactory to Owner and to indemnify Owner against any lien; (3) all warranties, guarantees, maintenance manuals and record drawings required by the Contract Documents, and (4) such other documents and information as Architect or Owner may reasonably request. ARTICLE 6 - ENUMERATION OF CONTRACT DOCUMENTS 6.1 The Contract Documents are as listed in this Article 6 and, except for Modifications issued after execution of this Agreement, are enumerated as follows: 6.1.1 The Agreement is this executed Form of Agreement Between Owner and Contractor. 3 6.1.2 The Specifications dated: N /A. 6.1.3 The Drawings are as follows: Refer to Exhibit B Contract Document List 6.1.4 The Addenda, if any, are as follows: N/A 6.1.5 Other Documents, if any, forming part of the Contract Documents are as follows: Exhibit A Bid Proposal dated May 7, 2010 Exhibit B Contract Document List GENERAL CONDITIONS ARTICLE 7 - CONTRACT DOCUMENTS 7.1 The Contract Documents consist of this Agreement with Conditions of the Contract, Drawings, Specifications, addenda issued prior to the execution of this Agreement, other documents listed in this Agreement and Modifications issued after execution of this Agreement. The intent of the Contract Documents is to include all items necessary for the proper execution and completion of the Work by the Contractor. The Contract Documents are complementary, and what is required by one shall be as binding as if required by all; performance by the Contractor shall be required only to the extent consistent with the Contract Documents and reasonably inferable from them as being necessary to produce the intended results. 7.2 The Contract Documents shall not be construed to create a contractual relationship of any kind (1) between the Architect and Contractor, (2) between the Owner and a Subcontractor or Sub - subcontractor or (3) between any persons or entities other than the Owner and Contractor. 7.3 Execution of the Contract by the Contractor is a representation that the Contractor has visited the site and become familiar with the local conditions under which the Work is to be performed. 7.4 The term "Work" means the construction and services required by the Contract Documents, whether completed or partially completed, and includes all other labor, materials, equipment and services provided or to be provided by the Contractor to fulfill the Contractor's obligations. The Work may constitute the whole or a part of the Project. If modifications to existing construction are required, the Work shall also include all labor and equipment necessary to remove existing construction to be removed and to protect existing construction to remain. ARTICLE 8 - OWNER 4 8.1 Except for permits and fees which are the responsibility of the Contractor under the Contract Documents, the Owner shall secure and pay for necessary approvals, easements, assessments and charges required for the construction, use or occupancy of permanent structures or permanent changes in existing facilities. 8.2 If the Contractor fails to correct Work which is not in accordance with the requirements of the Contract Documents or persistently fails to carry out the Work in accordance with the Contract Documents, the Owner, by a written order, may order the Contractor to stop the Work, or any portion thereof, until the cause for such order has been eliminated; however, the right of the Owner to stop the Work shall not give rise to a duty on the part of the Owner to exercise this right for the benefit of the Contractor or any other person or entity. ARTICLE 9 - CONTRACTOR 9.1 The Contractor shall supervise and direct the Work, using the Contractor's best skill and attention. The Contractor shall be solely responsible for and have control over construction means, methods, techniques, sequences and procedures and for coordinating all portions of the Work under the Contract, unless Contract Documents give other specific instructions concerning these matters. 9.2 Unless otherwise provided in the Contract Documents, the Contractor shall provide and pay for labor, materials, equipment, tools, construction equipment and machinery, water, heat, utilities, transportation, and other facilities and services necessary for the proper execution and completion of the Work, whether temporary or permanent and whether or not incorporated or to be incorporated in the Work. 9.2.1 No Work shall be allowed on -site from sundown on Friday until sundown on Saturday. 9.2.2 No smoking or the use of alcoholic beverages or illegal substances shall be allowed on -site at any time. 9.3 The Contractor shall enforce strict discipline and good order among the Contractor's employees and other persons carrying out the Contract. The Contractor shall not permit employment of unfit persons or persons not skilled in tasks assigned to them. 9.4 The Contractor warrants to the Owner and Architect that materials and equipment furnished under the Contract will be of good quality and new unless otherwise required or permitted by the Contract Documents, that the Work will be free from defects not inherent in the quality required or permitted, and that the Work will conform with the requirements of the Contract Documents. Work not conforming to these requirements, including substitutions not properly approved and authorized, may be considered defective. The Contractor's warranty excludes remedy for damage or defect caused by abuse, modifications not executed by the Contractor, improper or insufficient maintenance, improper operation, or normal wear and tear under normal usage. If required by the Architect, the Contractor shall furnish satisfactory evidence as to the kind and quality of materials and equipment. 9.5 Unless otherwise provided in the Contract Documents, the Contractor shall pay sales, consumer, use, and other similar taxes which are legally enacted when bids are received or negotiations 5 concluded, whether or not yet effective or merely scheduled to go into effect, and shall secure and pay for the building permit and other permits and governmental fees, licenses and inspections necessary for proper execution and completion of the Work. 9.6 The Contractor shall comply with and give notices required by laws, ordinances, rules, regulations, and lawful orders of public authorities bearing on performance of the Work. The Contractor shall promptly notify the Architect and Owner if the Drawings and Specifications are observed by the Contractor to be at variance therewith. 9.7 The Contractor shall be responsible to the Owner for the acts and omissions of the Contractor's employees, Subcontractors and their agents and employees, and other persons performing portions of the Work under a contract with the Contractor. 9.8 The Contractor shall review, approve and submit to the Architect Shop Drawings, Product Data, Samples and similar submittals required by the Contract Documents with reasonable promptness. The Work shall be in accordance with approved submittals. When professional certification of performance criteria of materials, systems or equipment is required by the Contract Documents, the Architect shall be entitled to rely upon the accuracy and completeness of such certifications. 9.9 The Contractor shall keep the premises and surrounding area free from accumulation of waste materials or rubbish caused by operations under the Contract. At completion of the Work the Contractor shall remove from and about the Project waste materials, rubbish, the Contractor's tools, construction equipment, machinery, and surplus materials. 9.10 The Contractor shall provide the Owner and Architect access to the Work in preparation and progress wherever located. 9.11 The Contractor shall pay all royalties and licenses fees: shall defend suits or claims for infringement of patent rights and shall hold the Owner harmless from loss on account thereof, but shall not be responsible for such defense or loss when a particular design, process or product of a particular manufacturer or manufacturers is required by the Contract Documents unless the Contractor has reason to believe that there is an infringement of patent. 9.12 To the fullest extent permitted by law, the Contractor shall indemnify and hold harmless the Owner, Owner's Consultants, Architect, Architect's consultants, and agents and employees of any of them from and against claims, damages, losses and expenses, including but not limited to attorney's fees, arising out of or resulting from performance of the Work, provided that such claim, damage, loss or expense is attributable to bodily injury, sickness, disease or death, or to injury to or destruction of tangible property (other than the Work itself) including loss of use resulting therefrom, but only to the extent caused in whole or in part by negligent acts or omissions of the Contractor, a Subcontractor, anyone directly or indirectly employed by them or anyone for whose acts they may be liable, regardless of whether or not such claim, damage, loss or expense is caused in part by a party indemnified hereunder. Such obligation shall not be construed to negate, abridge, or reduce other rights or obligations of indemnity which would otherwise exist as to a party or person described in this Paragraph 9.12. 6 • 9.12.1 In claims against any person or entity indemnified under this Paragraph 9.12 by an employee of the Contractor, a Subcontractor, anyone directly or indirectly employed by them or anyone for whose acts they may be liable, the indemnification obligation under this Paragraph 9.12 shall not be limited by a limitation on amount or type of damages, compensation or benefits payable by or for the Contractor or a Subcontractor under workers' or workmen's compensation acts, disability benefit acts or other employee benefit acts. 9.12.2 The obligations of the Contractor under this Paragraph 9.12 shall not extend to the liability of the Architect, the Architect's consultants, and agents and employees of any of them arising out of (1) the preparation or approval of maps, drawings, opinions, reports, surveys, Change Orders, Construction Change Directives, designs or specifications, or (2) the giving of or the failure to give directions or instructions by the Architect, the Architect's consultants, and agents and employees of any of them provided such giving or failure to give is the primary cause of the injury or damage. ARTICLE 10 - ARCHITECT 10.1 The Architect will provide administration of the Contract and will be the Owner's representative (1) during construction, (2) until final payment is due and (3) with the Owner's concurrence, from time to time during the correction period described in Paragraph 18.1. 10.2 The Architect will visit the site at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the completed Work and to determine in general if the Work is being performed in a manner indicating that the Work, when completed, will be in accordance with the Contract Documents. However, the Architect will not be required to make exhaustive or continuous on -site inspections to check quality or quantity of the Work. On the basis of on -site observations as an architect, the Architect will keep the Owner informed of progress of the Work and will endeavor to guard the Owner against defects and deficiencies in the Work. 10.3 The Architect will not have control over or charge of and will not be responsible for construction means, methods, techniques, sequences or procedures, or for safety precautions and programs in connection with the Work, since these are solely the Contractor's responsibility as provided in Paragraphs 9.1 and 16.1. The Architect will not be responsible for the Contractor's failure to carry out the Work in accordance with the Contract Documents. 10.4 Based on the Architect's observations and evaluations of the Contractor's Applications for Payment, the Architect will review and certify the amounts due the Contractor and will issue Certificates for Payment in such amounts. 10.5 The Architect will interpret and decide matters concerning performance under and requirements of the Contract Documents on written request of the Owner or Contractor. The Architect will make initial decisions on all claims, disputes or other matters in question between the Owner and Contractor, but will not be liable for results of any interpretations or decisions rendered in good faith. The Architect's decisions in matters relating to aesthetic effect will be final if consistent with the intent expressed in the Contract Documents. All other decisions of the Architect, except those which have been waived by making or acceptance of final payment, shall be subject to arbitration. 7 • 10.6 The Architect will have authority to reject Work which does not conform to the Contract Documents. 10.7 The Architect will review and approve or take other appropriate action upon the Contractor's submittals such as Shop Drawings, Product Data and Samples, but only for the limited purpose of checking for conformance with information given and the design concept expressed in the Contract Documents. 10.8 Any approvals, certificates, or decisions of the Architect are subject to the approval of Owner, which approval shall not be unreasonably withheld. At Owner's discretion, the duties of the Architect described herein may be performed by the Owner or the Owner's representative. ARTICLE 11 - SUBCONTRACTS 11.1 A Subcontractor is a person or entity who has a direct contract with the Contractor to perform a portion of the Work at the site. 11.2 Unless otherwise stated in the Contract Documents or the bidding requirements, the Contractor shall, within 15 days after notice to proceed, furnish in writing to the Owner through the Architect the names of the manufacturers proposed to be used for each of the products identified in the Contract Documents and the name of the Subcontractor furnishing the product. The Contractor shall not contract with any Subcontractor to whom the Owner or Architect has made reasonable and timely objection. The Contractor shall not be required to contract with anyone to whom the Contractor has made reasonable objection in writing. Contracts between the Contractor and Subcontractors shall (1) require each Subcontractor, to the extent of the Work to be performed by the Subcontractor, to be bound to the Contractor by the terms of the Contract Documents, and to assume toward the Contractor all the obligations and responsibilities which the Contractor, by the Contract Documents, assumes toward the Owner and Architect, and (2) allow to the Subcontractor the benefit of all rights, remedies and redress afforded to the Contractor by these Contract Documents. ARTICLE 12 - CONSTRUCTION BY OWNER OR BY SEPARATE CONTRACTORS 12.1 The Owner reserves the right to perform construction or operations related to the Project with the Owner's own forces, and to award separate contracts in connection with other portions of the Project or other construction or operations on the site. 12.2 The Contractor shall afford the Owner and separate contractors reasonable opportunity for the introduction and storage of their materials and equipment and performance of their activities, and shall connect and coordinate the Contractor's construction and operations with theirs as required by the Contract Documents. 12.3 The Contractor shall be responsible for the installation of certain equipment furnished by the Owner as indicated in the Contract Documents. It shall be the Contractor's responsibility to receive, unload, store, protect, set in place and connect each piece of equipment. Any equipment damaged or lost 8 after receipt by the Contactor shall be replaced or repaired by the Contractor at no cost to the Owner. The Contractor shall forward a Receiving Notice to the Owner the same day such equipment is received. The Receiving Notice shall be in sufficient detail to allow the Owner to match the Receiving Notice to the Purchase Order and Vendor Invoice. ARTICLE 13 - CHANGES IN THE WORK 13.1 The Owner, without invalidating the Contract, may order changes in the Work consisting of additions, deletions or modifications, the Contract Sum and Contract Time being adjusted accordingly. Such changes in the Work shall be authorized by written Change Order signed by the Owner, Contractor and Architect, or by written Construction Change Directive signed by the Owner and Architect. 13.2 The Contract Sum and Contract Time shall be changed only by Change Order. 13.3 If the Change Order provides for an adjustment to the Contract Sum, the adjustment shall be based on the following method. The Contractor and Subcontractors shall submit an estimate of cost for the Change Order to the Owner and Architect. The estimate shall include a complete itemization of cost and shall be limited to the following: .1 costs of labor, including social security, old age and unemployment insurance, fringe benefits required by agreement or custom, and workers' or workmen's compensation insurance; .2 costs of materials, supplies and equipment, including cost of transportation, whether incorporated or consumed; .3 rental costs of machinery and equipment, exclusive of hand tools, whether rented from the Contractor or others; .4 costs of premiums for all insurance, permit fees, and sales, use or similar taxes related to the Work; .5 additional costs of supervision and field office personnel directly attributable to the change; and .6 allowance for overhead and profit in accordance with Paragraph 13.7. 13.4 If the method set forth in Paragraph 13.3 is not agreed upon, the adjustment shall be based on one of the following methods: .1 unit prices stated in the Contract Documents or subsequently agreed upon; .2 cost to be determined in a manner agreed upon by the parties and a mutually acceptable fixed or percentage fee; or 9 .3 as provided in Paragraph 13.5. 13.5 If the Contractor disagrees with the method for adjustment in the Contract Sum, the method and the adjustment shall be determined by the Architect on the basis of reasonable expenditures and savings of those performing the Work attributable to the change, including, in case of an increase in the Contract Sum, an allowance for overhead and profit as set forth in Paragraph 13.7. In such case, the Contractor shall keep and present, in such form as the Architect may prescribe, an itemized accounting together with appropriate supporting data. Unless otherwise provided in the Contract Documents, costs for the purposes of this Paragraph 13.5 shall be limited to the costs itemized in Paragraph 13.3. 13.6 Pending final determination of cost to the Owner, amounts not in dispute may be included in Applications for Payment. The amount of credit to be allowed by the Contractor to the Owner for a deletion or change which results in a net decrease in the Contract Sum shall be actual net cost as confirmed by the Architect. When both additions and credits covering related Work or substitutions are involved in a change, the allowance for overhead and profit shall be figured on the basis of net increase, if any, with respect to that change. 13.7 In Paragraphs 13.3, 13.4 and 13.5 the allowance for overhead and profit combined, included in the total cost to the Owner, shall be based on the following schedule: .1 For the Contractor, for any Work performed by the Contractor's own forces, 10% of the cost. .2 For the Contractor, for Work performed by his Sub - contractor, 10% of the amount due to the Subcontractor. .3 For each Subcontractor or Sub - subcontractor involved, for any Work performed by that Subcontractor or Sub - subcontractor's own forces, 15% of that cost. .4 For each Subcontractor, for Work performed by his Sub- subcontractors, 5% of the amount due the Sub - subcontractors. .5 Cost to which overhead and profit is to be applied shall be determined in accordance with Paragraph 13.3. ARTICLE 14 - TIME 14.1 Time limits stated in the Contract Documents are of the essence of the Contract. By executing the Agreement the Contractor confirms that the Contract Time is a reasonable period for performing the Work. 14.2 The date of Substantial Completion is that date certified by the Architect. 14.3 If the Contractor is delayed at any time in progress of the Work by changes ordered in the Work, by labor disputes, fire, abnormal adverse weather conditions not reasonably anticipated, 10 • unavoidable casualties or any causes beyond the Contractor's control, or by other causes which the Architect determines may justify delay, then the Contract Time shall be extended by Change Order for such reasonable time as the Architect may determine. ARTICLE 15 - PAYMENTS AND COMPLETION 15.1 Payments may be withheld on account of (1) defective Work not remedied, (2) claims filed by third parties, (3) failure of the Contractor to make payments properly to Subcontractors or for labor, materials or equipment, (4) reasonable evidence that the Work cannot be completed for the unpaid balance of the Contract Sum, (5) damage to the Owner or another contractor, (6) reasonable evidence that the Work will not be completed within the Contract Time and that the unpaid balance would not be adequate to cover actual or liquidated damages for the anticipated delay, or (7) persistent failure to carry out the Work in accordance with the Contract Documents. 15.2 When the Architect agrees that the Work is substantially complete, the Architect will issue a Certificate of Substantial Completion. 15.3 Final payment shall not become due until the Contractor has delivered to the Architect and Owner a complete release of all liens arising out of this Contract or receipts in full covering all labor, materials and equipment for which a lien could be filed, or a bond satisfactory to the Owner to indemnify the Owner against such lien. If such lien remains unsatisfied after payments are made, the Contractor shall refund to the Owner all money that the Owner may be compelled to pay in discharging such lien, including all costs and reasonable attorney's fees. 15.4 The making of final payment shall constitute a waiver of claims by the Owner except those arising from: .1 liens, claims, security interests or encumbrances arising out of the Contract and unsettled; 2 failure of the Work to comply with the requirements of the Contract Documents; or .3 terms of special warranties required by the Contract Documents. Acceptance of final payment by the Contractor, a Subcontractor or Material Supplier shall constitute a waiver of claims by that payee except those previously made in writing and identified by that payee as unsettled at the time of final Application for Payment. ARTICLE 16 - PROTECTION OF PERSONS AND PROPERTY 16.1 The Contractor shall be responsible for initiating, maintaining, and supervising all safety precautions and programs in connection with the performance of the Contract. The Contractor shall take reasonable precautions for safety of, and shall provide reasonable protection to prevent damage, injury or loss to: .1 employees on the Work and other persons who may be affected thereby; 11 • .2 the Work and materials and equipment to be incorporated therein; and .3 other property at the site or adjacent thereto. The Contractor shall give notices and comply with applicable laws, ordinances, rules, regulations and lawful orders of public authorities bearing on safety of persons and property and their protection from damage, injury or loss. The Contractor shall promptly remedy damage and loss to property at the site caused in whole or in part by the Contractor, a Subcontractor, a Sub - subcontractor, or anyone directly or indirectly employed by any one of them, or by anyone for whose acts they may be liable and for which the Contractor is responsible under Subparagraphs 16.1.2 and 16.1.3, except for damage or loss attributable to acts or omissions of the Owner or Architect or by anyone for whose acts either of them may be liable, and not attributable to the fault or negligence of the Contractor. The foregoing obligations of the Contractor are in addition to the Contractor's obligations under Paragraph 9.12. 16.2 The Contractor shall not be required to perform without consent any Work relating to asbestos or polychlorinated biphenyl (PCB). ARTICLE 17 - INSURANCE 17.1 The Contractor shall purchase from and maintain in a company or companies lawfully authorized to do business in the jurisdiction in which the Project is located insurance for protection from claims under workers' or workmen's compensation acts and other employee benefit acts which are applicable, claims for damages because of bodily injury, including death, and from claims for damages, other than to the Work itself, to property which may arise out of or result from the Contractor's operations under the Contract, whether such operations be by the Contractor or by a Subcontractor or anyone directly or indirectly employed by any of them. This insurance shall be written for not less than limits of liability specified in Sup - paragraph 17.1.1 or required by law, whichever coverage is greater, and shall include contractual liability insurance applicable to the Contractor's obligations under Paragraph 9.12. Certificates of such insurance shall be filed with the Owner prior to the commencement of the Work. 17.1.1 The insurance requirements of Paragraph 17.1 shall be written in amounts not less than the following, but in greater amounts if required under applicable Federal, State or local laws and regulations. 1. Workers' Compensation a. State: Statutory b. Applicable Federal (e.g. Longshoremen's): Statutory c. Employer's Liability: $1,000,000 2. Commercial General Liability and Contractor's Liability Insurance conditions which shall also include completed operations and product liability 12 coverages and eliminate the exclusion with respect to property under the care, custody and control of Contractor: a. General Aggregate: (Except Products- - Completed Operations) $2,000,000 b. Products -- Completed Operations Aggregate $2,000,000 c. Personal and Advertising Injury (Per Person/ Organization) $1,000,000 d. Each Occurrence (Bodily Injury and Property Damage) $1,000,000 e. Property Damage Liability Insurance will provide Explosion, Collapse and Underground coverages where applicable. 3. Umbrella (Excess) Liability: a. General Aggregate $5,000,000 b. Each Occurrence $5,000,000 4. Automobile Liability: a. Bodily Injury: $1,000,000 Each Person $1,000,000 Each Accident Property Damage: $1,000,000 Each Accident or b. Combined Single Limit (Bodily Injury and Property Damage): $1,000,000 Each Accident 13 17.1.2 On all insurance coverage that the Contractor is required to obtain and maintain under this Agreement the Owner shall be named as additional insured. Copies of the Certificates of Insurance for each type of coverage and amounts shall be sent to the Owner. 17.2 The Owner shall be responsible for purchasing and maintaining the Owner's usual liability insurance. Optionally, the Owner may purchase and maintain other insurance for self protection against claims which may arise from operations under the Contract. The Contractor shall not be responsible for purchasing and maintaining this optional Owner's liability insurance unless specifically required by the Contract Documents. 17.3 The Owner shall purchase and maintain, in a company or companies lawfully authorized to do business in the jurisdiction in which the Project is located, property insurance upon the entire Work at the site to the full insurable value thereof. This insurance shall be on an all -risk policy form and shall include interests of the Owner, the Contractor, Subcontractors and Sub - subcontractors in the Work and shall insure against the perils of fire and extended coverage and physical loss or damage including, without duplication of coverage, theft, vandalism and malicious mischief. 17.4 A loss insured under Owner's property insurance shall be adjusted with the Owner and made payable to the Owner as fiduciary for the insureds, as their interests may appear, subject to the requirements of any applicable mortgagee clause. The Owner shall be responsible for any deductible related to the property insurance. 17.5 The Owner shall file a copy of each policy with the Contractor before an exposure to loss may occur. Each policy shall contain a provision that the policy will not be canceled or allowed to expire until at least 30 days' prior written notice has been given to the Contractor. 17.6 The Owner and Contractor waive all rights against each other and the Architect, Architect's consultants, separate contractors described in Article 12, if any, and any of their subcontractors, sub - subcontractors, agents and employees, for damages caused by fire or other perils to the extent covered by property insurance obtained pursuant to this Article 17 or any other property insurance applicable to the Work, except such rights as they may have to the proceeds of such insurance held by the Owner as fiduciary. The Contractor shall require similar waivers in favor of the Owner and the Contractor by Subcontractors and Sub - subcontractors, agents and employees of any of them. 17.7 Bond. At Owner's cost, Owner shall have the right to require Contractor to furnish bonds in an amount equal to 100% of the Contract Sum covering faithful performance of the Contract and payment of obligations arising thereunder. The bonds shall comply with the requirements of the state where the Project is located. "Conditional" Payment Bonds shall not be acceptable. Proper Power of Attorney shall accompany said bonds. Said bonds shall be delivered to the Owner for recording with the Notice of Commencement. No Work shall commence on the Project until the Notice of Commencement and copies of the Payment Bonds are recorded and certified copies thereof are posted at the Project site ARTICLE 18 - CORRECTION OF WORK 14 18.1 The Contractor shall promptly correct Work rejected by the Architect or failing to conform to the requirements of the Contract Documents, whether observed before or after Substantial Completion and whether or not fabricated, installed or completed, and shall correct any Work found to be not in accordance with the requirements of the Contract Documents within a period of one year from the date of Substantial Completion of the Contract or by terms of an applicable special warranty required by the Contract Documents. The provisions of this Article 18 apply to Work done by Subcontractors as well as to Work done by direct employees of the Contractor. 18.2 Nothing contained in this Article 18 shall be construed to establish a period of limitation with respect to other obligations which the Contractor might have under the Contract Documents. Establishment of the time period of one year as described in Paragraph 18.1 relates only to the specific obligation of the Contractor to correct the Work, and has no relationship to the time within which the obligation to comply with the Contract Documents may be sought to be enforced, nor to the time within which proceedings may be commenced to establish the Contractor's liability with respect to the Contractor's obligations other than specifically to correct the Work. ARTICLE 19 - MISCELLANEOUS PROVISIONS 19.1 The Contract shall be governed by the law of the place where the Project is located. 19.2 All claims or disputes between the Contractor and the Owner arising out or relating to this Contract, or the breach thereof, shall be first submitted to non - binding mediation as a condition precedent to arbitration. Mediation shall be in accordance with the rules or law of the State where the Project is located. Any and all claims shall then be subject to binding arbitration pursuant to the construction rules of the American Arbitration Association. Venue for all mediation and arbitration shall be in the County where the Project is located. 19.3 Where reference is made in this Agreement to a provision of another Contract Document, the reference refers to that provision as amended or supplemented by other provisions of Contract Documents. 19.4 To comply with the provisions of Section 952 of the Omnibus Reconciliation Act of 1980 (Public law 96.499) and Regulations, Contractor hereby agrees to make available to the Secretary of Health and Human Services ( "HHS "), the Comptroller General of the General Account Office ( "GAO "), or their authorized representatives, all contracts, books, documents and records relating to the nature and extent of the costs thereunder for a period of four (4) years after the furnishing of services thereunder. In addition, Contractor hereby agrees, if services are to be provided by subcontract with a related organization, to require by contract that such subcontractor make available to the HHS and GAO or their authorized representatives, all contracts, accounting records, documents and records relating to the nature and extent of the costs thereunder for a period of four (4) years after the furnishing of services thereunder. 19.5 Claims for Consequential Damages. Except for Owner's right to recover liquidated damages, Contractor and Owner waive claims against each other for consequential damages arising out of or relating to this Contract. This mutual waiver includes: 15 .1 damages incurred by the Owner for rental expenses, for losses of use, income, profit, financing, business and reputation, and for loss of management or employee productivity or of the services of such persons; and .2 damages incurred by the Contractor for principal office expenses including the compensation of personnel stationed there, for loss of use, for rental expenses, for losses of financing, business and reputation, loss of employee productivity or the services of such persons, and for loss of profit except anticipated profit arising directly from the Work. 19.6 If Contractor is delayed at any time in the commencement or progress of the Work by an act or neglect of the Owner or Architect, or of an employee of either, or of a separate contractor employed by the Owner, or by changes ordered in the Work, or by labor disputes, fire, by acts of God, unusual extraordinary weather events, unusual delay in deliveries, unavoidable casualties or other causes beyond the Contractor's control or responsibility, or by other causes which the Architect determines may justify delay, and the delay impacts the critical path of the Project's schedule, then the Contract Time shall be extended by Change Order for such reasonable time as the Architect may determine; however, the Contract Sum shall not be increased. It is the express and bargained for intent of the parties that the risk of any monetary damages caused by any delays described in this Section or any other delays from any other cause are accepted and assumed entirely by Contractor, and in no event shall any claim relating thereto for an increase in the Contract Sum be made or recognized. Contractor shall not make any claim nor seek any damages of any kind against Owner or Architect for any delays, impacts, disruptions, or interruptions of any kind. Contractor's sole remedy for any delay, impact, disruption, or interruption caused by any of the reasons listed in this Section shall be an equitable extension of time to perform the Work for each day of such delay that impacts the critical path schedule of the Project. ARTICLE 20 - TERMINATION OF THE CONTRACT 20.1 If the Architect fails to recommend payment for a period of 30 days through no fault of the Contractor, or if the Owner fails to make payment thereon for a period of 30 days, the Contractor may, upon seven additional days' written notice to the Owner and the Architect, terminate the Contract and recover from the Owner payment for all Work executed and for proven loss with respect to materials, equipment, tools, and construction equipment and machinery, including reasonable overhead and profit applicable to the Project. 20.2 If the Contractor defaults or persistently fails or neglects to carry out the Work in accordance with the Contract Documents, or fails to perform a provision of the Contract, the Owner, after seven days' written notice to the Contractor and without prejudice to any other remedy the Owner may have, may make good such deficiencies and may deduct the cost thereof, including compensation for the Architect's services and expenses made necessary thereby, from the payment then or thereafter due the Contractor. Alternatively, at the Owner's option, and upon certification by the Architect that sufficient cause exists to justify such action, the Owner may terminate the Contract and take possession of the site and of all materials, equipment, tools, and construction equipment and machinery thereon owned by the Contractor and may finish the Work by whatever method the Owner may deem expedient. If the unpaid balance of the Contract Sum exceeds costs of finishing the Work, including compensation for the Architect's services and expenses made necessary thereby, such excess shall be paid to the Contractor, but if such costs exceed such unpaid balance, the Contractor shall pay the difference to the Owner. 16 20.3 The Contract may be terminated by the Owner for convenience at any time upon seven (7) days written notice to the Contractor, 20.4 If the Owner terminates the Contract for reason stated in paragraph 20.3, the amount due the Contractor upon termination shall be the actual reasonable cost of the Work performed to date less the accumulative amount paid to date by the Owner. This total amount shall not exceed the Lump Sum Contract amount. This payment shall be Contractor's sole remedy for such termination. ARTICLE 21 - OTHER CONDITIONS OR PROVISIONS 21.1 Neither contractor, nor any of its personnel or subcontractors shall ever shut off any medical gas system at any time for any reason. Medical gas systems shall only be shut off by Owner's authorized engineering personnel according to Owner's policy. For all other utilities, Contractor, its personnel, and subcontractors shall follow Owner's written procedures for shutting off, adjusting, switching, or modifying any utility service. 21.2 Contractor and its subcontractors shall not discriminate against any employee or applicant for employment because of race, religion, color, sex, or national origin. 21.3 The Owner is a not - for - profit, tax exempt organization. The Contractor shall work with and assist the Owner to prevent payment of taxes not due. 21.3.1 Sales Tax Savings Program. Notwithstanding anything herein to the contrary, because Owner is exempt from sales tax and wishes to generate sales tax savings for the Project. Owner reserves the right to make direct purchases of various construction materials and equipment included in the Work. Before purchasing materials or equipment for the Project or a combination of like items that exceed $5,000 in cost. Contractor shall identify in writing to Owner all materials and equipment or a combination of like items to be included in the Work that will generate sales tax savings if purchased direct by Owner. Contractor shall comply with the written procedures for Owner Purchased materials provided by Owner to Contractor and shall incorporate a similar provision to this provision in all of its subcontracts requiring the Subcontractors' compliance with said procedures. Owner shall execute direct purchase orders with vendors for such Owner Purchased materials. The purchase orders shall contain Owner's Consumer Certificate of Exemption number. Owner shall acquire title to all Owner Purchased materials at the time same are delivered to the Project site. Owner shall obtain insurance on the Owner Purchased Materials and Owner shall assume all risk of loss and theft for the Owner Purchased Materials upon their delivery to the Project site and until they are incorporated into the real property. Vendors shall invoice Owner directly for the Owner Purchased Materials. Owner shall pay vendors directly for the Owner Purchased Materials. Contractor represents and warrants that it will use its best efforts to cooperate with Owner in implementing this sales tax savings program in order maximize cost savings for the Project. Upon the execution of a purchase order, Owner and Contractor shall execute a Change Order decreasing the Contract Sum by the total cost, including the saved sales tax for the materials or equipment purchased directly by Owner under said purchase order. With respect to all direct purchases by Owner, Contractor shall remain responsible for coordinating, installing, inspecting, storing, handling, warranting, installation, and quality control for all direct purchases. Notwithstanding anything herein to the contrary, Contractor expressly acknowledges and agrees that any materials or equipment directly purchased by Owner pursuant to this Paragraph shall be 17 included within and covered to the same extent as all other warranties and performance guarantees provided by Contractor pursuant to the terms of the Contract Documents, including bonds, Owner assigns to Contractor any and all warranties and rights Owner may have from any manufacturer or supplier of any such direct purchases by Owner. 21.3.2 Owner agrees to indemnify and hold harmless Contractor, its subcontractors, vendors and suppliers from and against the payment of or liability for any sales or use taxes arising out of or resulting from the Owner purchasing materials for the Project under the Owner's sales tax exempt status, and for which the Owner or the Contractor, subcontractors, vendors or suppliers should become liable, but only upon the condition that Contractor has properly complied with the Owner's written sales tax program procedures. This Agreement entered into as of the day and year first written above. Owner Contractor Di NS R ION, INC. S` ,rF rx'7 Y �._ + Title: c f ` Titl d` \71005\16 # 2178623 v 2 � ' 18 , . „elialtk EXHIBIT A RINDIDA Florida Hospital - Sleep Lab bid proposal May 7, 2010 Print Copies / Reproductions $ 180 Builders Risk Insurance by owner Building Permit / Impact Fees / Gov. Fees by owner Temporary Facilities $ 480 Supervision $ 7,500 Clean up / Hauling $ 2,700 Payroll Overhead $ 6,000 Final Cleaning $ 900 Dumpster by owner Demolition $ 7,000 Concrete Floor Infill $ 1,850 Rear HM Door Removal / Infili $ 1,600 Millwork $ 22,342 Rough Carpentry $ 1,500 Rough Materials $ 1,200 Finish Trim $ 6,200 Insulation (R -30 @ Deck) $ 2,920 Glass / Glazing $ 7,880 Doors / Frames & Hardware * $ 11 ,869 Door & Hardware Installation $ 1,500 Metal Studs / Drywall $ 22,578 Painting $ 7,550 Acoustical Ceiling $ 3,239 Floorcovering $ 17,311 Toilet Accessories $ 1,709 Fire Extinguishers $ 620 Plumbing (no new services) # $ 31,506 HVAC $ 9,880 Electrical $ 36,517 Subtotal $ 214,531 4% CM Fee $ 8,581 TOTAL $ 223,112 * the (3) 4' doors are quoted as flush, 6 panel doors are not available in 4' width # the water heaters are indicated to be installed above the ceiling - they will not fit above the ceiling, they will need to be placed in Janitor 126 or an additional closet blinds are not included Page 1 of 1 Exhibit B CONTRACT DOCUMENT LIST Fro e( t: hL7. E � 5 - Florida Hospital Zephyrhills -Sleep Lab Subcontractor °/Vend° : Contract Date: Paqe/Sht No.s Document Name Date Rev Date SP.1 SITE PLAN 1 4/20/10 A2.0 (DEMO PLAN 4/20/10 I AS.1 !FLOOR PLAN /INTERIOR ELEVATIONS j 4/20/10 1 A2.2 !REFLECTED CEILINGPLAN & DETAILS 1 4/20/10 I A2.3 WALL FINISHES PLAN r 4/20/10 A2.4 !FLOOR FINISHES PLAN 4/20/10 A4.0 !CABINET SECTIONS - 4/20/10 A5.0 'SCHEDULES & DETAILS 4/20/10 M0.1 SCHEDULES, LEGENDS & INDEX 4/20/10 ! M1.1 HVAC PLAN- NEW CONSTRUCTION 4/20/10 M2.1 1HVAC DETAILS 4/20/10 P0.1 ,SCHEDULES, NOTES & SHEET INDEX 4/20/10 P1.1 PLUMBING PLAN - NEW CONSTRUCTION 4/20/10 1 E0.1 SYMBOL LEGEND & DRAWING INDEX 4/20/10 j E1.1 'LIGHTING PLAN - NEW CONSTRUCTION 4/20/10 E2.1 POWER PLAN - NEW CONSTRUCTION 1 4/20/10 E3.1 ;SYSTEMS PLAN - NEW CONSTRUCTION 4/20/10 1 , 1 - - rt i - 1 r -- I -- -- -- — I, I i , Ciient$i: RODDCON _ ACORD,. T F C t `E OF LIABILITY !NSW ONCE 5/07 /2010 /YYY ') PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lanier Upshaw, inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1115 US Hwy 98 South HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 468 Lakeland, FL 33802 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Westfield Insurance Company 24112 Rodda Construction, Inc. INSURER B: Bridgefield Employers Insurance 10701 250 E. Highland Drive INSURER C: Lakeland, FL 33813 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR -ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSR[ TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD DATE (MMIDD LIMITS A GENERAL LIABILITY CMM4641613 12/31/2009 12/31/2010 EACH OCCURRENCE $1 AMAGE TO X COMMERCIAL GENERAL LIABILITY PREMISES Ea occ RENTED $150,000 _ CLAIMS MADE X OCCUR MED EXP (Any one person) $10,000 X PD Ded:1,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,000,000 POLICY PRO - JECT X LOC A AUTOMOBILE LIABILITY CMM4641613 12/31/2009 12/31/2010 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS _ BODILY INJURY $ X NON -OWNED AUTOS (Per accident) - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT _ $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS / UMBRELLA LIABILITY CMM4641613 12/31/2009 12/31/2010 EACH OCCURRENCE $10,000,000 X OCCUR f CLAIMS MADE AGGREGATE $10,000,000 _ _ $ DEDUCTIBLE $ X RETENTION $ 0 $ B WORKERS COMPENSATION AND 83037282 01/01/2010 01/01/2011 X WC Y LIM STATUT IS ER - I 1 EMPLOYERS' LIABILITY TOR ANY OFFICCER/ME EXCLUDED? E.L. EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder is included as additional insured with regards to the general liability as their interest may appear. Project: Sleep Lab / Pumonoiogist Office CERTIFICATE HOLDER CANCELLATION 10 Days for Non - Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Florida Hospital Zephyrhills DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL an DAYS WRITTEN 7050 Gall Blvd NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Zephyrhills, FL 33541 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRE ENTATIVE J"� I f 'A!' ACORD 25 (2009/01) 1 of 2 #S144343/M141214 c:11988 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JRW 6 _,.— f h IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) 2 of 2 #S144343/M141214 1 iiiiii IIjI IjIj III iioi 111111111111111111111111111111111 , 2010077830 LEGAL DESCRIPTION FOR PROPERTY ID: 34 25 21 0000 00300 0091 PAGE 01 OF 01 SC TP RG SUB BLOCK LOT * * * * COM AT NE COR OF'SE1 /4 OF SEC 34 TH ALG NORTH LINE THEREOF N89DEG 58'35 "W 1345.17 FT TO NLY EXTENSION OF WLY RIGHT —OF— WAY LINE OF GREEN SLOPE DRIVE TH SOODEG 07'42 "W ALG SAID LINE 1125.78 FT TH SO8DEG 39' 24 "W 77.38 FT FOR POB TH CONT SO8DEG 39' 24 "W 124.98 FT TH N89DEG 58' 40 "W 170.00 FT TH NOODEG 07' 42 "E 120.60 FT TH N89DEG 07'06 "E 188.56 FT TO POB TOGETHER WITH & SUBJECT TO AN EASMENT FOR INGRESS EGRESS & PARKING OVER & ACROSS PARCEL DESC IN OR 5102 PG 1681 AKA PARCEL 3 OR 5102 PG 1679 This Instrument Prepared By: Rept :1308168 Rec: 10.00 Name: Rodda Construction, Inc., 250 E. Highland Drive, Lakeland, FL 33813 DS: 0.00 IT: 0.00 06/02/10 C. Cook, Dpty Clerk Permit No. Tax Folio No. NOTICE OF COMMENCEMENT STATE OF Florida . COUNTY OF Pasco . THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Description of property: (legal description of property, and street address if available) Florida Hospital Sleep Canter Legal: 34- 25 -21- 0000 - 00300 -0091 7209 Green Slope Dr. St c Zephyrhills„ FL 33541 0 n 2 General description of improvement: Sleep lab demolition N `� 3. Owner/ Tenant information a Z a. Name and Address: Florida Hospital Zephyrhills, 7050 Gall Blvd,Zephyrhills, FL 33541 033F b. Interest in property: Owner (06 3- c. Name and address of fee simple titleholder (if other than owner): ,Pa 4. Contractor: U3 v R a. Name and address: Rodda Construction, Inc., 250 E. Highland Drive, Lakeland, FL 33813 •-• b. Phone number: 863 - 669 -0990 5. Surety o , v. a. Name and address: N/A Iamb., b Amount of bond $ o c. Phone number: 6. Lender o a. Name and address: N/A m b. Phone number: • 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided in section 713.13(1)(a)7., Florida Statutes: a. Name and address: b. Phone number: 8. In addition to himself Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(6)., Florida Statutes: a. Name and address: Rodda Construction, Inc., 250 E. Highland Drive, Lakeland, Fl 33813 b. Phone number: 863- 669 -0990 9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE % Y THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMP ' : ' ' PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR P r TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MU: BE RE RDE 0 0 OSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAINFINANCI G CONS LT W • 0 R LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE 7- C0 Ea. C ME 0 j i / f % i�' fir x �/ ' 6/(/`�li' ,c ✓ • (Signatu e . Own r or Owner's i Officer/Director/Partner/Manager) '' ---- ■ 1 (Signatory's Title/Office) � / /� The foregoing instrumqqt was ac nowledged before me this : U d ay of 4.24 , y EN S. {`t° � aF (name of person) as 11_,) 1 re r (ty ' of authority, ... e.g. officer, true /p $ttornev in ct) for (nam of party on behalf - whom ' nstrument wa ex cured). �r�... . .. ..0 .......U.....b.. : � _ a � 2010 THL, b 6cCA� LUM m 4 !! �i - -...-A 4 Ii i . / / �- �n ��, r Comm# D�Q728233 nature o otary Pu, :c - State o lo ' a) ' s E re 1/18/2y Assn., t � Florida NOtB (Print, Type, or Stamp Com 'ssioned Name of Notary Public) Personally Known OR Produced Identification Type of Identification Produced STATE OF FLORIDA, COUNTY OF PASCO THIS IS TO CERTIFY THAT THE FOREGOING IS A TRUE AND CORRECT COPY OF THE DOCUMENT ON FILE OR OF PUBLIC RECORD IN THIS OFFICE !VI MY HAND AN OFFICIAL SEAL THIS DAY OF 2 O/D PAU O'NEI / L, CL & COMPTROLLER BY 6 / 14 (AAA1/ /A (A ; C ,� DEpu-Y CLERK