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1st Change Order 10/18/2023 CULVERT INSTALLATION WATER QUALITY IMPROVEMENT PROJECT, CANAL#259 BIG PINE KEY, MONROE COUNTY, FL MONROE COUNTY CONTRACT CHANGE ORDER PROJECT TITLE: Canal 259 CHANGE ORDER NO: ooi INITIATION DATE: 9/27/2023 TO CONTRACTOR: LPS Utilities Inc. CONTRACT DATE:12/7/2022 DBA LPS Contracting The Contract is changed as follows: The original (Contract Sum) (Guaranteed Maximum Price)....................................... $760,000.00 Net change by previously authorized Change Orders................................... .............. 000-00 The (Contract Sum) (Guaranteed Maximum Price) prior to this Change order was... .........$760,000.00 The (Contract Sum) (Guaranteed Maximum Price) will be (increased) (decreased) (unchanged) by this Change Order.......$ 000-00 The new (Contract Sum) (Guaranteed Maximum Price) including this Change Order iS......$760,000.00 The Contract Time will be (increased) (decreased) (unchanged) by............. ....................90 days The date of Substantial Completion as of the date of this Change Order is......................... 10/27/23 Detailed description of change order and justification: Unforseen site conditions.Post-restoration improvements. This change Order is % of the original contract price. 0% Not valid until signed by Owner, Architect (if applicable), and Contractor Gregory W. Corning Digitally signed by Gregory W.Corning ENGINEER: Date:2023.09.27 16:35:00-04'00' Date CONTRACTOR: 7-Z7-Z3 Date Digitally signed by Rhonda Haag SUSTAINABILITY PROGRAM MANAGER: Rhonda Haag Date:2023.09.28 11:47:08-04'00' Date ........... COUNTY/DEPUTY ADMINISTRATOR Z e_ 10/18/2023 Approved as to form and legal sufficiency: Date Monroe County Attorney's Office 10-2-2023 D1111aH11i9d by Cynthia L.Hall DN:-Cynthia L.Hall, 1-1y MCC, u' T all- cynthia@ onroecounty-fl -'Date 20231 0.02 10 36 22-g040'US 0 APPLICATION FOR PAYMENT 01027-Page 147 of 221 CULVERT INSTALLATION WATER QUALITY IMPROVEMENT PROJECT, CANAL#259 BIG PINE KEY, MONROE COUNTY, FL Change Order Attachment per Ordinance No. 004-1999 • Change Order was not included in the original contract specifications. Yes 0 No ❑ If Yes, explanation: Post-restoration improvement requests. • Change Order was included in the original specifications. Yes ❑ No EZ If Yes, explanation of increase in price: • Change Order exceeds $25,000 or 5% of contract price (whichever is greater). Yes ❑ No Fv1 If Yes, explanation as to why it is not subject for a calling for bids: • Project engineer approves the change order. Yes SZ No ❑ If no, explanation of why: • Change Order is correcting an error or omission in design document. Yes ❑No 2 Should a claim under the applicable professional liability policy be made? Yes ❑ No Explain: APPLICATION FOR PAYMENT 01027-Page 148 of 221 DATE(MM/DD/YYYY) ACTOR" CERTIFICATE OF LIABILITY INSURANCE 9i28i2023 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 policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Hausman Kunkel, Inc. PHONE JaSOn Domnanovich FAX 40 S. Prospect A/C No Ext: 630-894-7802 A/C,No): E-MRoselle IL 60172 ADDRESS: jason@h-kinc.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Navigators Specialty Ins Co 36056 INSURED LPSUTIL-01 INSURER B: Progressive Express 10193 LPS Utilities, Inc DBA LPS Contracting INSURERC:American Longshore Mutual Asso 524126 3509 Lily Pond Road Woodstock IL 60098 INSURERD: Evanston Insurance Company 35378 INSURERE: Markel Insurance Company 38970 INSURER F: COVERAGES CERTIFICATE NUMBER:1598231219 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY Y NY22MPK15772801 7/2/2023 7/2/2024 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $50,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY� PE� LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y 03217826 1/27/2023 1/27/2024 COMBINED SINGLE LIMIT $1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A UMBRELLA LIAB X OCCUR NY22LIA15772802 7/2/2023 7/2/2024 EACH OCCURRENCE $3,000,000 X EXCESS LAB CLAIMS-MADE AGGREGATE $3,000,000 DED RETENTION$ $ C WORKERS COMPENSATION 1261445Y 7/27/2023 7/27/2024 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICE R/M EMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Equipment Floater OM 9CD9899-3 7/2/2023 7/2/2024 Limit 437,766 E Equipment Floater IM MKLM3IM0054950 6/28/2023 6/28/2024 Limit 107,440 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:Culvert Installation Water Quality Improvement Project Canal#259 Big Pine Key, Monroe County, Florida Monroe County Board of County Commissioners are named as Additional Insureds in respect to General Liability and Auto Liability as required by written contract.Workers Compensation includes USL&H Act coverage. 98k � T. Pol requirements met: RSA 9.28, 2(A_&AC-PAy.-�.- ._. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of County Commisioners ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street, Ste 2-205 Key West FL 33040 AUTHORIZED REPRESENTATIVE USA @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD From: Haag-Rhonda To: Bradlgy-Brian u: Flatt--)ac� Subject: wv:COI Request for Monroe County Canal zsyCulvert Date: Tuesday,November oo'zozz3y3:zopw Attachments: Attachment E.-Insurance.E�guirements.p, Brian, the vendor(LPS) for the attached contract for canal 2S9 has provided the attached COL It does not contain pollution liability as specified in the contract exhibit.You had previously advised LPS could complete n waiver,which[gave Lothem.They subsequently asked the question below. What now? ' rb From: Brian Johnson<brianjohnson@|ps-contracting.com> Sent:Tuesday, November 420223:28PK4 To: Haag-Rhonda<Haag-Rhonda@K4onroe[ounty-FL.5ov> Subject: Re:[0| Request for Monroe County Canal 259Culvert NCAUTION m Hey Rhonda, We have u$3 million umbrella policy that would cover pollution related incidents,can this he used(o satisfy the requirements?|[ao|can get the waiver filled out. OnTue,Nov 0,2022a( I:30P&4Haag-Rhonda wrote: Included in the insurance requirements is the requirement for pollution liability. [didn't see that included on the COL Do you carry that? [f not you can request n waiver,using the attached form. Please advise... Thank you, Rhonda From: Brian Johnson< � Sent:Tuesday, November 4202212:51PK4 To: Haag-Rhonda< > Subject:[0| Request for Monroe County Canal 259Culvert — CAUTION:This email originated from outside of the County.Whether you know the sender or not, do not N click links oropen attachments you were not expecting. Please see attached, let one know i[you need anything else! Brian Johnson'Project Manager We Offer Financing As Low As 0%APRM Click--->lil(.(.i,2s.//,rr�,,(,."(11(,.,,,,Illlicoiii/l,.��,iiiti�(,.,,rs/l�,..Ia y ............. ........... ............ ........... PLEASE NOTE OUR CHANGE OF ADDRESS: Physical Address: 300..........S a d o v s k 1 Ca L i s e v ay Suite 308 Key Colony Beach, FL 33051 Mailing Address: PO Box 510802 L.-.`.Y C 212.n.y EI 3 3 0 5 1... Office:305-240-9882 Email: )s-coryLracCing.c.orn .......................... Website: Brian,Johnson,-Project Manager I We Offer Financing As Low As 0%APR!!! Click--->b I;( .............. PLEASE NOTE OUR CHANGE OF ADDRESS: Physical Address: 300 Sadowski Causeway Suite 308 Key Colony Beach,FL 33051 Mailing Address: PO Box 510802 Key Colony Beach,FL 33051 Office: 305-240-9882 Email: b ian..... ohnaon (�jj Website: I ichnov.coinii I)s contractim