Notice of Intent to Look to Bond {
Customer: American Bridge Company
File No: 2358 I FL I PUBLIC 1 OWNER Project: Tom's Harbor Bridge Repair
Notice Requested by and Return To: Rec. ID: M9OXRBJ7
Symons by Dayton Superior Corporation
2400 Arthur Avenue
Elk Grove Village, IL 60007 I Job No: 8603214326
NOTICE OF INTENT TO LOOK TO THE BOND - Public Project
Florida Statutes Title 18 Chapter 255.05(2)
TO: PUBLIC AGENCY OR AUTHORITY: TO: LENDER, SURETY OR BONDING COMPANY
Monroe County Board of Commissioners Fidelity & Deposit Company of Maryland
1100 Simonton St. 1400 American Lane
Key West, FL 33040 i Schaumburg, IL 60196
TO: ORIGINAL CONTRACTOR OR ¶' Bond Number 8969432
REPUTED CONTRACTOR '1 FROM: CLAIMANT
American Bridge Company ° ∎G ` Symons by Dayton Superior Corporation
5430 W. Tyson Ave. ev, 2400 Arthur Avenue
Tampa, FL 33611 Elk Grove Village, IL 60007
4 4 1/
NOTICE TO PUBLIC ENTITYIAUTHORITY
Claimant hereby declares that he has supplied labor, materials, or supplies as described below and payment has not yet been made therefor.
The undersigned has entered into a contract to perform labor or furnish materials for the below described project, and will look to you and your
sureties for payment if the person ordering such materials and labor fails to pay for them.
1. General description of the labor, services, equipment or materials fumished by Claimant: See Exhibit C
2. Amount due Claimant: $9,500.00
3. The name of the person who contracted for purchase of that labor, services, equipment or materials: American Bridge Company, 5430 W.
Tyson Ave., Tampa, FL 33611, Phone: (813) 254 -4127, Fax: (813) 259 -4754
4. The description of the jobsite: Tom's Harbor Bridge Repair, Mile Marker 61, Duck Key, FL 33050 in the County of Monroe
5. Name of the Public Entity /Project: Monroe County Board of Commissioners, 1100 Simonton St., Key West, FL 33040, Phone: (305)
295 -4306
VERIFICATION
I declare that I am authorized to file this NOTICE OF INTENT TO LOOK TO THE BOND - Public Project (Florida Statutes Title 18 Chapter
255.05(2)) on behalf of the claimant. I have read the foregoing document and know the contents thereof; the same is true of my own
knowledge. I declare under penalty of perjury under the laws of the State of Florida that the foregoing is true and correct. Executed at Elk Grove
Village, IL on October 11, 2012 for Symons by Dayton Superior Corporation, 2400 Arthur Avenue, Elk Grove Village, IL 60007, Phone: (847)
391 -4700. -
By: Phillip Klikas, Jr. PhD, Contracts Manager
PROOF OF SERVICE BY MAIL AFFIDAVIT
I declare that I served copies of the above NOTICE OF INTENT TO LOOK TO THE BOND - Public Project (Florida Statutes Title 18 Chapter
255.05(2)) by First Class Certified Retum Receipt Requested or Registered Mail service, postage prepaid, addressed to each of the parties at
the addresses shown above on October 11, 2012. I declare under penalty of perjury under the laws of the State of Florida that the foregoing is
true and correct. Executed at Elk Grove Village, IL on October 11, 2012.
By: c.. 44X— X A_ Tina Kuhar, Contracts Administrator
CAy
Exhibit C - Complete Description Of Materials Or Labor Supplied
Owner: Monroe County Board of Commissioners, 1100 Simonton St., Key West, FL 33040, Phone: (305) 295 -4306
Project: Tom's Harbor Bridge Repair, Mile Marker 61, Duck Key, FL 33050 in the County of Monroe
The following is a complete list, to the best of our knowledge, of all Materials or Labor, which by agreement, were
supplied or will be supplied by: Symons by Dayton Superior Corporation, 2400 Arthur Avenue, Elk Grove Village,
IL 60007, Phone: (847) 391-4700.
Concrete Forms and Construction Materials
•SYMNS
To our valued Symons / Dayton Superior Customers,
Enclosed you will find a preliminary notice for your upcoming job as
required by your state laws. This is simply a notice and is not meant to
imply any type of lien is being or will be placed on this project. Hopefully,
the job will go well; payments will be received; any issues which may arise
will be settled amicably with your sales rep; and this form will prove to be
unnecessary.
We have found that given current overall economic conditions, many jobs
around the country have been delayed; cancelled; customers have suddenly
gone out of business; etc. And in far too many states, without a proper
notice, Dayton Superior is unable to assert any type of legal remedy for
monies owed and often for rental equipment abandoned at the jobsite.
Therefore, legally, we are obligated to send out these notices as a matter of
public record. It is NOT our intention that this be construed as a reflection
on any customer's financial ability to pay its bills. We are simply
establishing our legal rights if the need were to arise.
If you would like to discuss further, please feel free to call me directly
at 847 - 391 -4714.
We do greatly appreciate your business.
cerely,
LI
James R. Benka
Senior Vice - President — Finance
Symons Division of
Dayton Superior Corp.
2400 Arthur Avenue, Elk Grove Village, II., 60007 • 847/391 -4714 • FAX: 847/635 -9287 •
jimbenka@daytonsuperior.com