1st Change Order 11/22/2016 KEVIN MADOK, CPA
MONROE COUNTY CLERK OF THE CIRCUIT COURT & COMPTROLLER
DATE: January 13, 2017
TO: Tammy Sweeting, Administrative Assistant
FROM: Pamela G. Hanc ��� I eputy Clerk
SUBJECT: November 22nd BOCC Meeting
Attached is a duplicate original of Item V2 Change Order No. 1 with Greentech Group
Solutions, LLC for the Key Largo Park residence spalling and deck repair project in the amount of
$25,607.16.
Should you have any questions, please feel free to contact me at ext. 3130. Thank you.
cc: County Attorney
Final}ce
File/
•
MONROE COUNTY /ENGINEERING/ PROJECT MANAGEMENT
CONTRACT CHANGE ORDER
PROJECT TITLE: CHANGE ORDER NO: 1
Key Largo Park Residence Spelling
and Deck Repair INITIATION DATE: November, 2016
TO CONTRACTOR: CONTRACT DATE: June 15, 2016
Greentech Group Solutions, LLD — `'1
P.O. Box 504422 c =
Marathon, FL 33050 ,J r C-- rr
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The Contract is changed as follows: " — ) C7 CO
The original (Contract Sum) (Guaranteed Maximum Price) $ .8;000.00 i
Net change by previously authorized Change Orders $ - 0.00, _?
The (Contract Sum) (Guaranteed Maximum Price) prior to this Change order was $ x2,000.00
The (Contract Sum) (Guaranteed Maximum Price) will be (increased) (decreased) - ,
(unchanged) by this Change Order $ 25,607.16
The new (Contract Suml (Guaranteed Maximum Price) including this Change Order is $ 107,607.16
The Contract Time will be (increased) (decreased) (unchanged) by 21 days
The date of Substantial Completion as of the date of this Change Order is .....................January 17, 2017
Detailed description of change order and justification:
Two legal storage units under residence buildina added to the scope of work per oermittina reauirements.
„.......;°'5, , rU- itional 21 days needed for substantial completion for the delivery of the doors.
4
N = Order is 31.23% of the original contract price.
b � ` If# ~ AC.:
• - J ,j ~j ' I h �..4 BOARD OF COUNTY COMMISSIONERS
f - Clerk OF M ROE COUNTY, RIDA osc i
.79 .yGl By
i 0 ate: t t i z /1 Mayor /Chairman V1
CONTRACTOR
8°V 1"
EENTECH GROUP SOLU • LLC. WITNESS TO C04. CTOR 4 I
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By:i �� By: , ci c
Title: �� Date: P-0 i o
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Date: 1 . Z/. /6 rr
STATE OF FLORIDA
COUNTY OF(J
On this �1_ day or} j , 2016, before me, q only appeared _ UG A •exez_. known to me to be the w
person whose name is subscribed above or who produced Trr.�netkNps identification, and acknowledged that he/she is LL
the person who executed the above contract with Monroe County for the Key Largo Park Residence Spelling and Deck Repair, for 0
the purposes therein contained. v7 Z
V 6 1 `iee KIMBERLY DOREN �i O kn 0
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Stamp and Signature of Notary Public . N
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Change Order Attachment per Ordinance No. 004 -1999
• Change Order was not included in the original contract specifications. Yes ® No ❑
If Yes, explanation: The Monroe County Planning Department requested that the building
residence be brought up to code by adding two legal storage units under the residential
building, where there existed one large space. Additional time needed for delivery of
materials.
• Change Order was included in the original specifications. Yes ❑ No
If Yes, explanation of increase in price:
• Change Order exceeds $25,000 or 5% of contract price (whichever is greater). Yes ® No ❑
If Yes, explanation as to why it is not subject for a calling for bids: These are changes to the
existing contract with the contractor. To bid these changes would cause more interruptions
and delays to the project.
• Project architect approves the change order. Yes ❑ No El
If no, explanation of why: The Architect is not responsible for Construction Administration
services.
• Change Order is correcting an error or omission in design document. Yes ❑No
Should a claim under the applicable professional liability policy be made? Yes ❑ No
Explain:
Greentech Group Solutions,LLC
CHANGE ORDER No 01
Project:Spoiling Repair and Wooden Deck Replacement-320 Laguna Avenue-Key Largo
Owner: Monroe County
Contractor:Greentech Group Solutions,LLC
PO#:Contrat Agreement
Original Purchase Order Amount $82,000.00
Net Changes from Previous Change Orders $0.00
Contract Amount prior to this Change Order... $82,000.00
Net Increase/(Decrease)of this Change Order $ 25,607.16
Contract Amount with all approved Change Orders $107,607.16
Change Order Description
This Change order includes the costs,overhead and profit to cover the additional scope of work not included on original contract scope of work
depicted on provided revision dated 5.16.16 and as it is listed below.
Item Description Quantity Unit Unit Value Total Value
Windows-Material
impact Windows 36X36-SOI.HUNG Zone 4 +46,neg-50,1 .1 Ea 5 368.00 $ 1,471,98
PT Wood and Hardware(Frame) LS $ 60.79 $ 60.79
2X4X 12-@4>$6,87Ea-Needed 7Ea Suhtotal_Oncludir tax)$51.69
T10x3 Inc Polymer Coated Exterior Screw 1 Box(Including tax)$9.10 >
Doors-Material
Steel Frame&Door DP Rating+75/-75-180 mph Zone 5 1 Fa S x70.75 5 3,483.00
PT Wood and Hardware(Frame) 1 1_u s 82,95 S 82. i
2X4X12-406.87F..a-Needed IOEs Subtotal(including_tax)$73.85
$10x3 Inc Polymer Coated Exterior Screw 1 Box(Including tax)$9.10
Smart Vent Hood-Material
Smar.Vent I -Material Ira 261 22 $ 2,089.72,
Paint-Materials
Paint-Primer coat I Ea $ 75,19 $ 75,19
Paint-Gildden Premium 1 Ill S 94.46 S 94,46
SUBTOTAL $ 7,358.09
Mark-up(10%n) s 735.81
TOTAL MATERIAL $ 8,093.89
Electrical Scope of Work(SUBCONTRACTOR)
Subcontractor-Galaxy Electric I 5,750 00 $ 5,75(300
Partitions and Walls(SUBCONTRACTOR)
S,i`°contractor-GA Contractors I 1.800,00 S I.800 00
SUBTOTAL $ 7,550,00
Mark-up(10%) $ 755,00
TOTAL MATERIAL $ 8,305.00
Greentech Labor
Based on
Crew.1 Foreman 1 Carpenter 2 Labor
Foreman(Salary$1.500 Weekly)
Carpenter(Hourly$16,25)
I.abur(Hourly$I4,25)X2
Total I four Cost/Crew:$82.2511 Iour
Bounden i)35%:$28.80 Hour
Total Direct Cost Crew:$11 I 05
Demolition-Labor
Esitmate time frame to demo additional scope ofwork 16 Hours I,, hater S I I I ,15 5 1,776.80
Windows-Labor
Estimated time frame per crew to install !Ea 36X36 Window-4 His I r, I lour $ III 05 $ 1,776 80
estimated time frame per crew to install [Fa 36X36 Window Frame-4 Elm $ -
Greentech Group Solutions,LLC
Door-Labor
Estimated time frame per crew to install I Ea Steel Door-4 l lrs 12 Hour S Ill05 $ 1,332,60
Estimated time frame per crew to install I Ga Door Frame-4 Hrs
Smart Vent Hood-Labor
Estimated time frame per crew to install I La Smart Vent(Concrete)-2 Hrs 8 l lour S 1 1 1.05 $ 888,40
Estimated time frame per crew to install I Ea Smart Vent(Wood Frame)-1 Hr 4 Hour S 111,05 S 444,20
Paint-Labor
Estimated Time frame to paint the additional scope of work 10 Hour $ 111,05 $ 1,110.50
SUBTOTAL $ 1,329.30
Mark-up(5%) $ 366 47
TOTAL MATERIAL. S 7,695.77
Others
Furnishing of Dumpsters I Ea S 575,00 $ 575.00
Furnishing of tools and special equipment(Chipping Hammer,Generator,etc) 1 LS S 800(.1.
0 31i0.00
SUBTOTAL S 1,375.00
Mark-up(10%) $ 13750
TOTAL MATERIAL $ 1,512.50
TOTAL $ 25,607.16
NOTES:ADDITIONAL TIME REQUESTED TO COMPLETE THE LISTED SCOPE OF WORK IS 21 CALENDAR DAYS
Ohange Order Amount
Net Total $ 25,607.16
Total $ 25,607.16
•
All rather Terms and Conditions of the original Purchase Order Remain t inrhangal
It is further understood and agreed that all terms and conditions of said Contract as it may herebefore have been modified shall be
and remain the same,
This writing comprises the full and entire agreement between the parties affecting the work provided for herein.No other agreement
or understanding of any nature concerning the same has been entered into or will be recognized.Contractor has made no
inducements or representations to Subcontractor whatsoever except as expressely herein stated.No oral modification of this
Change Order has any force of effect.
This Change Order authorization includes not only all direct costs of the subcontractor such as labor,material,job overhead,and
profit marked but also includes all costs for modifications or changes in sequence of work to be performed,delays,rescheduling,
disruptions,extended direct overhead and general overhead,acceleration,material or other escalation which includes wages,
and other impact costs.
f
Accepted: Accepted
Greentech Group Solutions,LLC Monroe County
By: Date: By: Date:
Title: Title:
PO#:GREENTECH
Job Name:
Job Address:
FORESTEK, LLC Onote l/ 517914
88521 OVERSEAS HWY
TAVERNIER, FL 33070 Ship Date:10/31/2016
Sales Person:Renee Bartle
Detailed with Locations
Customer Cash '132
Account#
Phones(305)393-2749 Fax#
Line# Item Description Quantity Line Pricing
0001 SH700 ALUM SINGLE HUNG 700 Ordered: 4.t Prko. S.elt Prlca. Ext.Price
(1.00) 4 00 5487.00 $342.32 S1,369.28
Configuration:36.X38.X,STD,112"FL,W.EQUAL,G,G 5116,GR•NO GRID•SGI..SWEEP.1816K.LSII.L..x.
Certification 1 ype:MIAMI NOA Selection:16-0714.06
Frame Type:.51-LANGE Vent Configuration:EQUAL
t c Window Style:STD Size Selection:CUSTOM
Size Ref:TTT Width:36.0000
Height:36.0000 Actual Size:36 X 36
Rough Masonry:36 3/4 X 36 Wood Frame:35 1/4 X 35 1/4
Egress:32 1/2 X 11 3/4(2.652 SOFT) Frame Color:While
Does unit need to meet Turtle Code:NO Glass Family:Laminated
Glass:5!16"LAMI(1/8AN-.090 PVB-1/8 AN) Interlayer Type:PV13090
Glass Color:GRAY Low E:NONE
Privacy Glass:NONE Gdd Type:NO Grid
Screen Type:1816 Charcoal Stainless Steel Package:N
Anchor Group:C.SH700 Boxing Options:None
Lock Type:Sweep Latch Decralite:N
l.mtd Sash Stop:N Vent Ht:18.2070
CAR#:16-0714.06 PositivctesignPressure:64.0000
NegaliveDesignPressure:80.0000 PANumber:FL-239
EnorgyStar:NONE CondensationResistance:13 0000
U F:1.0700 SotarHealGainCoeft:0.5300
VT:0.4900 VTCOG:0.5900
Location Notes:
TOTAL LIST AMOUNT: $1948.00
TOTAL SALE AMT: $1,369.28
TOTAL CUSTOMER $102,70
TAX:
$1,471.98
NET SALE AMOUNT:
Please verify all quantities,sizes and options. if you would like to place this order please initial each product you are
ordering and sign by the total.
Quote# 517914
Print Dale 9/27/2016
11/17101E: Weallter$11:eld 2 in 1 in.x 12 it 4 Prime Gm ind OuniatA Pt e3sue e.Fn.:alert Imilibt,N-253920- ho Home Divot
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Product Overview
Forth.it1.)31 corporal ieris:ve Selor:hon of nallS an,:f screws.look ior Getp.roic, Info & Guides
Int)it130pUfar bfe.1!),1 Of 1ii.iterel'5 A:neor-a No matte v.-hal the rirn;oct or what
the jOh:GriP,RItO haS frit! faSteninc}SOkft.ii)0, ri,oro are many size,;
;lad styles of na,k avail;3bla c•avi!rilchonit r I 1nt trailinioltr2s
fasttir.,•:74, knew paco ti•r•;charlgirig todinology l'asimws nooriswiry
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extrairloa fir compronnsori hasod opon tho las•aner erred Fasteners hiram
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FOREST TEK LUMBER PAGE NO 1
88521 OVERSEAS HIGHWAY
TAVERNIER FL 33070-2048
www.keyslurnber.com
PHONE: (305) 852-4300
YOUR WINDOW AND DOOR SPECIALIST
GUARANTEED LOW PRICE
COST NO: JOB NO: PURCHASE ORDER: REFERENCE: TERMS: CLERK: DATE I TIME:
000 GREEN TECH SOL HVHZ STEEL DOORS CASH KA 9/30/16 7:19
TERMINAL:562
SOLD TO: SHIP TO: EXP.DATE:2/28/17
"""' CASH "'"'
SALESPERSON:KA KEN ARTMANN
TAX:001 FL STATE-MONROE COUNT
ESTIMATE: 575801/1
LINE SHIPPED [ORDERED UM SKU DESCRIPTION LOCATION UNITS PRICE/ PER EXTENSION
1 Steel Frame&Door-HVHZ&
2 4 EA ZZ001575801011 Unit 3/0 x 6/8 FLUSH SO 4 810.00 !EA 3,240.00
3 Steel Frame&Door-HVHZ&
4 90min
5 DP Rating+75/-75
6 -Welded-P&D Frame w/
7 Expansion Bolts
8 -Double Bore
9 -1"Bumper Threshold Oulswing
10 -Weatherstrip
11 -US 32 BBD Hinges
12 SO
13 LEAD TIME IS 3+/-WEEKS SO
TAXABLE 3240.00
NON-TAXABLE 0.00
SUBTOTAL 3240.00
TAX AMOUNT 243.00
nb *5000515801 E31001 n TOTAL 3483.00
TOT WT:0.00 X
Rece:ved By
•
FOREST TEK LUMBER PAGE NO 1
88521 OVERSEAS HIGHWAY
TAVERNIER FL 33070-2048
www.keyslumber.com
PHONE: (305) 852-4300
YOUR WINDOW AND DOOR SPECIALIST
GUARANTEED LOW PRICE
DUST NO: JOB NO: PURCHASE ORDER: REFERENCE: TERMS: CLERK: DATE f TIME:
*5 000 GREEN TECH SOL SMART VENT CONCRETE CASH KA 9/30/16 8:11
TERMINAL:562
SOLD TO: SHIP TO: EXP.DATE:2128/17
**" CASH "*" KIM
SALESPERSON:KA KEN ARTMANN
TAX:001 FL STATE-MONROE COUNT
ESTIMATE: 575816/1
LINE SHIPPED ORDERED UM SKU DESCRIPTION LOCATION UNITS PRICE/ PER EXTENSION
1 4 EA SMV SMART VENT CONCRETE 40D 4 242.99 /EA 971 96
2 16"X8" 40D ,}.)
TAXABLE 971.96
NON-TAXABLE 0.00
SUBTOTAL 971.96
TAX AMOUNT 72.90
nb *5000575816E31001 \
TOTAL 1044.86
TOT WT: 0.00 X
Received By
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•
..Galaxy PROPOSAL
305-' -4 0 4 2
Proposal Date: 10/10/2016
Proposal#: 1452
Bill To:
Green Tech- P.O. Box 504422
Description Est. Hours/Qty. Rate Total
Provide Electrical Control Breaker Panel(Exterior) •
Provide new wiring for: GFI's 2ea. 3 Way Switch Light I I I
4Ea, Smoke Detector 2Ea,
Relocate existing lines to be wired from proposed
Exterior Control Breaker Box.
t i
Includes all labor equipment and material
5,750.00 I 5,750.00
Work to be perfomed at 320 Laguna Av, Key Largo {
as per drawings dated 5-16-16 (rev per Fema)
Engineer Timmins Engnieering, LLC
i r
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I
Total $5,750.00
SIGNATURE
Page ] o 13
15 1�p
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C o 41: - 0 t
South Florida
( Orki: a ior"
Proposal No. 16-1020-01 Revised Date: 11/08/2016
Proposal Submitted To: Job Address:
Greentech Group Solutions LLC 320 Laguna Avenue
143 Sioux St. Key Largo, Fl. 33036
Tavernier, FL 33070
Project: Partition and Exterior Plywood Wall Installation to Subject Property:
We hereby propose to furnish the materials and perform the labor necessary for the
completion of the above mentioned project.
Initial
Page 2 o13
Scope of work:
• Install partitions as per Engineer drawings dated 12th of Feb 2016 (Sheet #2)
• Remove All Partition and Gypsum Board Construction Debris from Job Site.
• Paint by others.
• Electrical work by others.
• Plumbing work by others.
• A/c work by others.
*** GA Contractors is responsible for only Partition, depicted on Engineer Drawings,
GA is not responsible for any finish (paint, knock down texture, etc).******
• Note: Prh'C E1£I0i:lii aiii)_jec( 'a z`in l a#1(ii';}Pe(: Ci{ liiti ;?€i Iti an an tltitiznai,.Any altCY"ati0ns or
ion.; {i3;.';£ti(in{' Nam.invoi,Intl, i.'\tra {i3E3at"or ii:.ttl'1'ia{ti wilt be aet:Eriitmtnl.3tcd at an :£Ett�tif�F't43�eo t.
* NOW: i't rtft!{ ;•t•£; i3!'i` 1101 1l3c'{£t:.?t;£i i!'? 113fti t.;01nai4'.
• NOW: l':33£,itlf:C?' ilanS :Ire 1?f71 iett'itid^tt.
+E :'4.:)ie; {if 3'cit3? Sihk t:' lh is?5':Ei£'ti:1Ei1;lt.Rr d" to acts iii \aturc.
• riCe k 14000 for only 311
All Materials guaranteed as specified by FLBC and the above work performed in
Accordance to the drawings and specifications submitted and completed in a Professional
and Workmanlike manner.
Project Total S1,800.00
Initial
•,
Page 3 o13
Payments to be made as Followed:
Is' Payment - 45% upon signing of the contract
2" Payment- 45% to installation of gypsum board
A.rd
.5 Payment— 10°/a upon completion of job
13V Pt-opw.00l & fl sg.al Contract Ro.,,svf,11 gotit P)trtios 6)1. 401).
Signature: Date:
GA Representative
The Above prices, specifications and terms are satisfactory to me and are hereby
accepted. You are authorized to complete this contract and
Payment will be made as outlined above.
Signature: Date:
uthorized Customer
7539 Gulf Stream Blvd. Marathon Fl 33050
(. A CON 1,r;ACTORS011.11F 1 A 1 1:.(. ..0A1
Cell# 305-440-2812 Cell # 305-680-8000
Jorge Rafael
LICENSED & INSURED
Initial
e t �
t
INVOICE
ROCK & SAND Date Invoice#
10/19/2016 38133
Bifl To Delivered To(Job Site)
GREENTECH GROUP SOLUTIONS LLC CURRY HAMMACK STATE PARK
PO BOX 504422 56200 OVERSEAS HWY
MARATHON FL 33050 MARATHON,,FL 33050
EURANY 305.903-2944 code0636
'a derecha,nadamas que entres
•
•
P.O. No. Terms Project
VERBAL JUAN Credit Card
- Description Ordered S.O.No. Unit Price/ Rale Amount
EXCHANGE OF 20-YARD QUIPSTER 1 15-21666 575.00 575.00
Phone# E-mail Follow Us Online! Subtotal
5575.00
(305)743-5680 accounting@discountrocksand.com www.DiscountRockandSand.com
Thank You For Your Business! Sales Tax S0.00
We Accept: Visa,Mastercard,Discover,American Express.Business&Personal Checks. Total S575.00
Please mail payment to: Payments/Credits
so.00
Discount Rock & Sand, Inc.
P.O. Box 504484-Marathon. FL 33050 BALANCE DUE $575.00
ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE(MIAIDD/YYYY)
11/29/2016
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 poilcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms end 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 rCMOMNEACT David Sheppard
Keys Insurance Services AtC NNo Ex11c (305)743-0494 lac,No):(305)743-0582
5800 Overseas Hwy AQDRE55:dhhpppard@keyainaurance.com
P.O. BOX 500280 INSURER(S)AFFORDING COVERAGE NAIC
Marathon FL 33050 INsuRERA:International ins Co of Hanover SE
INSURED INSURER a Allstate Insurance
Greentech Group Solutions LLC wsunEnc:Florida Citrus Business & Ind
P.O. BOX 504422 INSURERD:
INSURER E:
Marathon FL 33050 INSURERF:
COVERAGES CERTIFICATE NUMBER:Master GL 16-17 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.
LIIP TYPE OF INSURANCE INN D I WVI)I POLICY NUMBER I(POLICY
M DOtYYYYI IIMM:OO'Y POLICY YYYI P I LIMITS
X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE S 1,000,000
A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 100,000
PREMISESIEaoavrrencal S
X IG06C003762-D2 11/23/2016 11/23/2017 MED EXP(Any one person( S 5,000
PERSONAL&ADV INJURY S 1,000,000
GEM_AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S 2,000,000
X POLICY n JECT PRO• LOC PRODUCTS-COMP/OPAGG S 2,000,000
OTHER.
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ i,000,000
(Ea actadent)
x ANY AUTO BODILY INJURY(Per person) S
B ALL OWNED SCHEDULED
AUTOS AUTOS X 64E233553 00 5/2/2016 5/2/2017 BODILY INJURY(Par accident) S
NON OWNED PROPERTY IDAMAGE
HIRED AUTOS „ AUTOS PPE
PIP.Bas}c S 10,000
UMBRELLA UAS OCCUR EACH OCCURRENCE S
EXCESS LIAB CLAIMS-MADE I AGGREGATE $
I DOD I 1 RETENTION$ i S
WORKERS COMPENSATION X I SPE TATUTE I I ERH
AND EMPLOYERS'LIABILITY Y/N ANY PRCPRIETORPARTNEREXECUfIVE E L EACH ACC'DENT $ 500,000
CFFICERMEMBER EXCLUDED? I Y J N/A
C (Mandatory In NH) 10645259 6/3/2016 6/3/2017 E.L.DISEASE-EA EMPLOYEE S 500,000
II yes.describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE•POUCY LIMIT I S S00,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES IACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
It is understood and agreed that Explosion Hazard, Collapse Hazard, and Underground Property Hazard (XCU)
are included coverages to policy SIG06C0037 62 02
APPROV BY
BY
CERTIFICATE HOLDER CANCELLATION
(305)295-4321 Rivera-Chris@monroecounty-
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Monroe County B.O.C.C. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1100 Simonton Street ACCORDANCE WITH THE POLICY PROVISIONS,
Key West, FL 33040
AUTHORIZED REPRESENTATIVE
G Betancourt/DSHEP
®19B8-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS025(201401)
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