2013-28 Anchorage Park Module Building DemolitionRESOLUTION 2013 -28
A RESOLUTION OF THE VILLAGE COUNCIL OF THE VILLAGE OF
NORTH PALM BEACH, FLORIDA ACCEPTING A PROPOSAL
SUBMITTED BY DEVLAND SITE, INC. FOR THE DEMOLITION OF THE
ANCHORAGE PARK MODULE BUILDINGS AND AUTHORIZING THE
MAYOR AND VILLAGE CLERK TO EXECUTE A CONTRACT RELATING
TO SUCH SERVICES; AND PROVIDING FOR AN EFFECTIVE DATE.
WHEREAS, the Village issued a Request for Proposals ( "RFP ") for the demolition of the
Anchorage Park Module Buildings; and
WHEREAS, upon opening and evaluating the proposals, Village Administration recommends
accepting the proposal submitted by Devland Site, Inc. at a total cost of $14,300.00, in
accordance with the terms of the RFP; and
WHEREAS, the Village Council determines that the acceptance of the proposal recommended
by Village Administration is in the best interests of the Village.
NOW, THEREFORE, BE IT RESOLVED BY THE VILLAGE COUNCIL OF THE VILLAGE
OF NORTH PALM BEACH, FLORIDA as follows:
Section 1. The foregoing recitals are ratified as true and incorporated herein.
Section 2. The Village Council hereby accepts the proposal submitted by Devland Site, Inc.
at a total cost of $14,300.00, with funds expended from Village Account No. A8028 -33491
(Parks and Recreation — Contractual Services).
Section 3, The Village Council further authorizes and directs the Mayor and Village Clerk to
execute a contract with Devland Site, Inc. to perform such services in accordance with the terms
and conditions set forth in the Request for Proposals issued by the Village.
Section 4. This Resolution shall take effect immediately upon adoption.
PASSED AND ADOPTED THIS 9th DAY OF MAY, 2013.
(Village Seal)
MAYOR
ATTEST
VILLAGE CLERK
C nNTR A f T
This Contract is made as of the 91h day of May, 2013, by and between the VILLAGE OF
NORTH PALM BEACH, a municipal corporation organized and existing under the laws of the
State of Florida, hereinafter referred to as VILLAGE, and DEVLAND SITE, INC., a Florida
corporation, hereinafter referred to as the CONTRACTOR, whose Federal I.D. is 61- 1573804.
In consideration of the promises and mutual covenants herein contained, it is hereby agreed that
the CONTRACTOR shall provide to the VILLAGE all services requested under the Request for
Proposals for Anchorage Park Module Building Demolition and as further stated in
CONTRACTOR's Proposal and pursuant to the terms and conditions of this Contract.
ARTICLE 1. SERVICES OF THE CONTRACTOR.
A. The CONTRACTOR shall provide all goods and services as stated in the Proposal.
Documents and the Specifications referenced therein in accordance with the Proposal
(hereinafter referred to as "Work "), which are incorporated herein by reference, to that degree of
care and skill ordinarily exercised, under similar circumstances, by reputable members of its
profession practicing in the same or similar locality at the time the Work is provided.
B. The Work provided by the CONTRACTOR shall be commenced subsequent to the
execution and approval of this Contract and upon written notice from the VILLAGE to proceed.
ARTICLE 2. PERIOD OF SERVICE.
A. This Contract and the provision of all Work hereunder shall be completed by the
CONTRACTOR within ten (10) calendar days of a notice to proceed or for such other period of
time agreed to in writing by the parties in accordance with the terms and conditions of this
Contract.
B. The CONTRACTOR shall not be considered in default by reason of any failure in
performance of the Work if such failure arises out of causes reasonably beyond the control of the
CONTRACTOR or its subcontractors and without their fault or negligence. Such causes
include, but are not limited to: acts of God; natural or public health emergencies; labor disputes;
freight embargoes; unreasonable utility provider delays, unreasonable permitting delays and
abnormally severe and unusual weather conditions.
C. Upon the CONTRACTOR's request, the VILLAGE shall consider the facts and extent of
any failure to perform the Work and, if the CONTRACTOR's failure to perform was without it
or its subcontractor's fault or negligence, the Contract schedule and /or any other affected
provision of this Contract shall be revised accordingly; subject to the VILLAGE's rights to
change, terminate, or stop any or all of the work at any time.
D. Notwithstanding the foregoing, the CONTRACTOR shall not be entitled to an increase in
the agreed to compensation in this Contract or payment or compensation of any kind from the
VILLAGE for direct, indirect, consequential, impact or other costs, expenses or damages,
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including but not limited to costs of acceleration or inefficiency, arising because of delay,
disruption, interference or hindrance from any cause whatsoever. Provided, however, that this
provision shall not preclude recovery or damages by the CONTRACTOR for hindrances or
delays due solely to fraud, bad faith or active interference on the part of the VILLAGE or its
agents. Otherwise, the CONTRACTOR shall be entitled only to extensions of the schedule in
this Contract as the sole an exclusive remedy for such resulting delay, in accordance with and to
the extent specifically provided above.
ARTICLE 3. VILLAGE'S REPRESENTATIVE.
Unless otherwise specified by the VILLAGE, the VILLAGE's representative shall be the
Village's Community Development Director.
ARTICLE 4. COMPENSATION AND METHOD OF PAYMENT.
A. The VILLAGE agrees to compensate the CONTRACTOR in accordance with
CONTRACTOR's Proposal in response to the RFP. The total and cumulative amount of this
Contract shall not exceed FOURTEEN THOUSAND THREE HUNDRED AND NO /100
DOLLARS ($14,300.00).
B. CONTRACTOR shall invoice the VILLAGE on the form provided as Exhibit "A" and
include such information as requested in Exhibit "A ". CONTRACTOR shall submit an invoice
for the total amount of compensation upon completion of the Work. The invoice will be
reviewed and approved by the VILLAGE'.s representative, indicating that the Work has been
provided and rendered in conformity with the Contract and then will be sent to the Finance
Department for payment. Provided that the Work has been satisfactorily completed and all liens
have been released, the VILLAGE agrees to pay CONTRACTOR within ten (10) days following
the VILLAGE representative's approval.
C. Work undertaken or expenses incurred that exceeds an amount set forth in this Contract
without prior written authorization from the VILLAGE shall be the liability of the
CONTRACTOR.
D. CONTRACTOR waives consequential or incidental damages for claims, disputes or
other matters in question arising out of or relating to this Contract.
E. In order for both parties herein to close their books and records, CONTRACTOR will
clearly state "final invoice" on the CONTRACTOR's final /last billing to the VILLAGE. This
certifies that all Work has been properly performed and all charges have been invoiced to the
VILLAGE. Since this account will thereupon be closed, any and other further charges if not
properly included in this final invoice are waived by the CONTRACTOR. The VILLAGE will
not be liable for any invoice from the CONTRACTOR submitted thirty (30) days after the
provision of the Work.
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F. If the VILLAGE disputes any invoice or part of an invoice, VILLAGE shall notify
CONTRACTOR of such dispute within fifteen (15) days of receipt of the invoice. VILLAGE
reserves the right to off -set, reduce or withhold any payment to CONTRACTOR in accordance
with the terms and conditions of this Contract.
ARTICLE 5. INDEMNIFICATION.
A. To the fullest extent permitted by applicable laws and regulations, the CONTRACTOR
shall indemnify and save harmless and defend the VILLAGE, its officials, agents, servants, and
employees from and against any and all claims, liability, losses, and/or causes of action arising
out of or in any way related to the services furnished by the CONTRACTOR pursuant to this
Contract, including, but not limited to, those caused by or arising out of any act, omission,
negligence or default of the CONTRACTOR and/or its subcontractors, agents, servants or
employees.
B. The CONTRACTOR shall not be required to indemnify the VILLAGE, its officials,
agents, servants and employees when the occurrence results solely from the wrongful acts or
omissions of the VILLAGE, its officials, agents, servants and employees. The terms of this
Section shall survive completion of all services, obligations and duties provided for in this
Contract as well as the termination of this Agreement for any reason.
C. Nothing contained in this Contract shall create a contractual relationship with or a cause
of action in favor of a third party against either the VILLAGE or the CONTRACTOR, nor shall
this Contract be construed a waiver of sovereign immunity beyond the limited waiver provided
in § 768.28, Florida Statutes.
ARTICLE 6. PERSONNEL.
A. The CONTRACTOR represents that it has, or will secure at its own expense, all
necessary personnel required to perform the Work under this Contract. Such personnel shall not
be employees of or have any contractual relationship with the VILLAGE.
B. All of the Work required hereunder shall be performed by the CONTRACTOR or under
its supervision, and all personnel engaged in performing the Work shall be fully qualified and, if
required, authorized or permitted under state and local law to perform such Work.
C. All of the CONTRACTOR's personnel (and all sub - contractors) shall comply with all
VILLAGE requirements governing conduct, safety, and security while on VILLAGE property.
ARTICLE 7. TERMINATION.
A. This Contract may be cancelled by the CONTRACTOR upon ten (10) days prior written
notice to the VILLAGE's representative in the event of substantial failure by the VILLAGE to
perform in accordance with the terms of this Contract through no fault of the CONTRACTOR.
It may also be terminated, in whole or in part, by the VILLAGE, with or without cause, upon ten
(10) days written notice to the CONTRACTOR. Unless the CONTRACTOR is in breach of this
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Contract, the CONTRACTOR shall be paid for Work rendered to the VILLAGE's satisfaction
through the date of termination. After receipt of a Termination Notice and except as otherwise
directed by the VILLAGE, the CONTRACTOR shall:
1. Stop work on the date and to the extent specified.
2. Terminate and settle all orders and subcontracts relating to the performance of the
terminated work.
3. Transfer all work in progress, completed work, and other materials related to the
terminated work to the VILLAGE.
4. Continue and complete all parts of the work that have not been terminated.
ARTICLE 8. FEDERAL AND STATE TAX.
The VILLAGE is exempt from payment of Florida State Sales and Use Tax. The
CONTRACTOR shall not be exempted from paying sales tax to its suppliers for materials used
to fill contractual obligations with the VILLAGE, nor is the CONTRACTOR authorized to use
the VILLAGE's Tax Exemption Number in securing such materials.
ARTICLE 9. INSURANCE.
Prior to commencing any Work, the CONTRACTOR shall provide certificates evidencing
insurance coverage as required in the Proposal Documents. All insurance, other than Worker's
Compensation, to be maintained by the CONTRACTOR shall specifically include the VILLAGE
as an Additional Insured.
ARTICLE 10. SUCCESSORS AND ASSIGNS.
The VILLAGE and the CONTRACTOR each binds itself and its partners, successors, executors,
administrators, and assigns to the other party of this Contract and to the partners, successors,
executors, administrators and assigns of such other party, in respect to all covenants of this
Contract. Except as above, neither the VILLAGE nor the CONTRACTOR shall assign, sublet,
convey or transfer its interest in this Contract without the written consent of the other. Nothing
herein shall be construed as creating any personal liability on the part of any officer or agent of
the VILLAGE, nor shall it be construed as giving any rights or benefits hereunder to anyone
other than the VILLAGE and the CONTRACTOR.
ARTICLE 11. GOVERNING LAW, VENUE AND REMEDIES.
A. This Contract shall be governed by the laws of the State of Florida. Any and all legal
action necessary to enforce the Contract will be held in Palm Beach County.
B. No remedy herein conferred upon any party is intended to be exclusive of any other
remedy, and each and every such remedy shall be cumulative and shall be in addition to every
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other remedy given hereunder or now or hereafter existing at law or in equity or by statute or
otherwise. No single or partial exercise by any party of any right, power, or remedy hereunder
shall preclude any other or further exercise thereof.
ARTICLE 12. INDEPENDENT CONTRACTOR RELATIONSHIP.
The CONTRACTOR is, and shall be, in the performance of all Work under this Contract, an
Independent Contractor, and not an employee, agent, or servant of the VILLAGE. All persons
engaged in any of the Work performed pursuant to this Contract shall at all times, and in all
places, be subject to the CONTRACTOR's sole direction, supervision, and control. The
CONTRACTOR shall exercise control over the means and manner in which it and its employees
perform the Work.
ARTICLE 13. ACCESS AND AUDITS.
The CONTRACTOR shall maintain adequate records to justify all charges, expenses, and costs
incurred in estimating and performing the Work for at least three (3) years after completion of
this Contract. The VILLAGE shall have access to such books, records, and documents as
required in this ARTICLE for the purpose of inspection or audit during normal business hours, at
the CONTRACTOR's place of business. In no circumstances will CONTRACTOR be required
to disclose any confidential or proprietary information regarding its products and service costs.
ARTICLE 14. NONDISCRIMINATION.
The CONTRACTOR warrants and represents that all of its employees are treated equally during
employment without regard to race, color, religion, disability, sex, age, national origin, ancestry,
marital status, or sexual orientation.
ARTICLE 15. ENFORCEMENT COSTS.
If any legal action or other proceeding is brought for the enforcement of this Contract, or because
of an alleged dispute, breach, default or misrepresentation in connection with any provisions of
this Contract, the successful or prevailing party or parties shall be entitled to recover reasonable
attorney's fees, court costs and all expenses (including taxes) even if not taxable as court
awarded costs (including, without limitation, all such fees, costs and expenses incident to
appeals), incurred in that action or proceeding, in addition to any other relief to which such party
or parties may be entitled.
ARTICLE 16. AUTHORITY TO PRACTICE.
The CONTRACTOR hereby represents and warrants that it has and will continue to maintain all
licenses and approvals required to conduct its business and provide the Work under this
Contract, and that it will at all times conduct its business and provide the Work under this
Contract in a reputable manner. Proof of such licenses and approvals shall be submitted to the
VILLAGE's representative upon request.
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ARTICLE 17. SEVERABILITY.
If any term or provision of this Contract, or the application thereof to any person or
circumstances shall, to any extent, be held invalid or unenforceable, to remainder of this
Contract, or the application of such terms or provision, to persons or circumstances other than
those as to which it is held invalid or unenforceable, shall not be affected, and every other term
and provision of this Contract shall be deemed valid and enforceable to the extent permitted by
law.
ARTICLE 18. MODIFICATIONS OF WORK.
A. The VILLAGE reserves the right to make changes in the Work, including alterations,
reductions therein or additions thereto. Upon receipt by the CONTRACTOR of the VILLAGE's
notification of a contemplated change, the CONTRACTOR shall, in writing: (1) provide a
detailed estimate for the increase or decrease in cost due to the contemplated change, (2) notify
the VILLAGE of any estimated change in the completion date, and (3) advise the VILLAGE if
the contemplated change shall effect the CONTRACTOR's ability to meet the completion dates
or schedules of this Contract.
B. If the VILLAGE so instructs in writing, the CONTRACTOR shall suspend work on that
portion of the work affected by the contemplated change, pending the VILLAGE's decision to
proceed with the change.
C. If the VILLAGE elects to make the change, CONTRACTOR shall not commence work
on any such change until the CONTRACTOR receives written authorization from the
VILLAGE.
ARTICLE 19. PROTECTION OF WORK AND PROPERTY.
A. The CONTRACTOR shall continuously maintain adequate protection of all Work from
damage, and shall protect the VILLAGE's property and adjacent private and public property
from injury or loss arising in connection with the Contract. Except for any such damage, injury,
or loss, except that which may be directly due to errors caused by the VILLAGE or employees of
the VILLAGE, the CONTRACTOR shall provide any necessary materials to maintain such
protection.
B. Until acceptance of the Work by the VILLAGE, the VILLAGE's property shall be under
the charge and care of the CONTRACTOR and the CONTRACTOR shall take every necessary
precaution against injury or damage to the work by the action of elements or from any other
cause whatsoever, and the CONTRACTOR shall repair, restore and make good, without
additional Work occasioned by any of the above causes before its completion and acceptance.
C. The CONTRACTOR will also take every necessary precaution to ensure the safety of the
VILLAGE, public and other guests and invitees thereof at or near the areas where work is being
accomplished during and throughout the completion of all work.
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D. The CONTRACTOR shall have the responsibility to repair, rebuild or restore to its
former condition any and all portions of existing utilities, structures, equipment, appurtenances
or facilities, other than those to be paid for under the specifications, which may be disturbed or
damaged due to his construction operations. The CONTRACTOR shall return all swale areas
back to their original condition, including, but not limited to, repairing broken sprinklers, filling
in ruts caused by the parking of vehicles, and replacing damaged grass.
ARTICLE 20. EXISTING UTILITIES AND STRUCTURES.
It shall be the responsibility of the CONTRACTOR to determine the exact location of
underground utilities and facilities. The VILLAGE assumes no liability for damages sustained
or costs incurred because of the CONTRACTOR's operation in the vicinity of existing utilities
or structures. The CONTRACTOR shall notify the respective utility companies when their
existing utilities conflict with the new construction and shall coordinate his construction work
with the relocation work of the utility companies, if applicable.
ARTICLE 21. NOTICE.
All notices required in this Contract shall be sent by certified mail, return receipt requested, and
if sent to the VILLAGE shall be mailed to:
Village of North Palm Beach
Attn: Ed Green, Village Manager
Village of North Palm Beach
501 U.S. Highway One
North Palm Beach, FL 33408
and if sent to the CONTRACTOR shall be mailed to:
Devland Site, Inc.
Attn: Carl Deveaux, Vice - President
1302 Wingfield Street
Lake Worth, FL 33460
The foregoing names and addresses may be changed if such change is provided in writing to the
other party.
ARTICLE 22. ENTIRETY OF CONTRACTUAL AGREEMENT.
The VILLAGE and the CONTRACTOR agree that this Contract sets forth the entire agreement
between the parties, and that there are no promises or understandings other than those stated
herein. None of the provisions, terms and conditions contained in this Contract may be added to,
modified, superseded or otherwise altered, except by written instrument executed by the parties
hereto.
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ARTICLE 23. TERMINOLOGY AND CAPTIONS.
All pronouns, singular, plural, masculine, feminine or neuter, shall mean and include the person,
entity, firm or corporation to which they relate as the context may require. Wherever the context
may require, the singular shall mean and include the plural and the plural shall mean and include
the singular. The term "Contract" as used herein, as well as the terms "herein ", "hereof',
"hereunder ", "hereinafter" and the like mean this Contract in its entirety and all exhibits,
amendments and addenda attached hereto and made a part hereof. The captions and paragraph
headings are for reference and convenience only and do not enter into or become a part of the
context of this Contract, nor shall such headings affect the meaning or interpretation of this
Contract.
ARTICLE 24. WAIVER.
Failure of a party to enforce or exercise any of its right(s) under this Contract shall not be
deemed a waiver of that parties' right to enforce or exercise said right(s) at any time thereafter.
ARTICLE 25. PREPARATION.
This Contract shall not be construed more strongly against either party regardless of who was
more responsible for its preparation.
ARTICLE 26. MATERIALITY.
All provisions of the Contract shall be deemed material. In the event CONTRACTOR fails to
comply with any of the provisions contained in this Contract or exhibits, amendments and
addenda attached hereto, said failure shall be deemed a material breach of this Contract and
VILLAGE may at its option and without notice terminate this Contract.
ARTICLE 27. EXHIBITS AND CONTRACT DOCUMENTS.
Each exhibit and other contract documents referred to in this Contract forms an essential part of
this Contract. The exhibits and other contract documents, if not physically attached, should be
treated as part of this Contract and are incorporated herein by reference.
ARTICLE 28. LEGAL EFFECT.
This Contract shall not become binding and effective until approved by the Village Council of
the Village of North Palm Beach.
ARTICLE 29. SURVIVABILITY.
Any provision of this Contract that is of a continuing nature or imposes an obligation that
extends beyond the term of this Contract shall survive its expiration or earlier termination.
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ARTICLE 30. DEFAULT.
A. Notwithstanding anything contained in this Contract to the contrary, the parties agree that
the occurrence of any of the following shall be deemed a material event of default and shall be
grounds for termination:
1. The filing of a lien by any sub - CONTRACTOR, sub - contractor or third tier sub-
contractor including, but not limited to materialmen, suppliers, or laborers, upon
any property, right of way, easement or other interest in land or right to use within
the territorial boundaries of the VILLAGE which lien is not satisfied, discharged
or contested in a court of law within thirty (30) days from the date of notice to the
CONTRACTOR;
2. The filing of any judgment lien against the assets of CONTRACTOR related to
the performance of this Contract which is not satisfied, discharged or contested in
a court of law within thirty (30) days from the date of notice to the
CONTRACTOR; or
3. The filing of a petition by or against CONTRACTOR for relief under the
Bankruptcy Code, or for its reorganization or for the appointment of a receiver or
trustee of CONTRACTOR or CONTRACTOR's property; or an assignment by
CONTRACTOR for the benefit of creditors; or the taking possession of the
property of CONTRACTOR by any governmental officer or agency pursuant to
statutory authority for the dissolution or liquidation of CONTRACTOR; or if a
temporary or permanent receiver or trustee shall be appointed for
CONTRACTOR or for CONTRACTOR's property and such temporary or
permanent receiver or Trustee shall not be discharged within thirty (30) days from
the date of appointment.
4. Due to circumstances within the control of the CONTRACTOR, CONTRACTOR
fails to provide the Work under this Contract on schedule as agreed to by
CONTRACTOR in this Contract.
B. CONTRACTOR shall provide written notice to the VILLAGE of the occurrence of any
event of default within five (5) days of CONTRACTOR's receipt of notice or knowledge of any
such default.
ARTICLE 31. TIME IS OF THE ESSENCE/LIOUIDATED DAMAGES.
Time is of the essence in all respects under this Contract, and the parties agree that the
VILLAGE will suffer financial loss if the work contemplated herein is not completed within the
time specified, including any authorized extensions. The parties also recognize the delays,
expense and difficulties involved in proving in a legal proceeding the actual loss suffered by the
VILLAGE if the work is not completed on time. Accordingly, instead of requiring any such
proof, the VILLAGE and CONTRACTOR agree that as liquidated damages for delay (but not as
a penalty) CONTRACTOR shall pay to the VILLAGE an amount equal to $500.00 per day for
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each calendar day that expires after the time specified for completion. Liquidated damages may
be deducted from payments due to the CONTRACTOR.
ARTICLE 32. WAIVER OF SUBROGATION.
CONTRACTOR hereby waives any and all rights to Subrogation against the VILLAGE, its
officers, employees and agents for each required policy. When required by the insurer, or should
a policy condition not permit an insured to enter into a pre -loss agreement to waive subrogation
without an endorsement, then CONTRACTOR shall agree to notify the insurer and request the
policy be endorsed with a Waiver of Transfer of Rights of Recovery Against Others, or its
equivalent. This Waiver of Subrogation requirement shall not apply to any policy, which a
condition to the policy specifically prohibits such an endorsement, or voids coverage should
CONTRACTOR enter into such an agreement on a pre -loss basis.
ARTICLE 33. INSPECTOR GENERAL
CONTRACTOR is aware that the Inspector General of Palm Beach County has the authority to
investigate and audit matters relating to the negotiation and performance of this Contract, and in
furtherance thereof may demand and obtain records and testimony from CONTRACTOR and its
subcontractors and lower tier subcontractors. CONTRACTOR understands and agrees that in
addition to all other remedies and consequences provided by law, the failure of CONTRACTOR
or its subcontractors or lower tier subcontractors to cooperate fully with the Inspector General
when requested may be deemed by the VILLAGE to be a material breach of this Contract
justifying its termination.
ARTICLE 34. REPRESENTATIONSBINDING AUTHORITY.
The persons executing this Contract represent that they have the full power, authority and legal
right to execute and deliver this Contract and perform all of its obligations under this Contract.
[Remainder page blank — signatures on next page]
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IN WITNESS WHEREOF, the VILLAGE and CONTRACTOR hereto have made and executed
this Contract as of the day and year first above written.
VILLAGE OF NORTH PALM BEACH
BY:
WILLIAM L. MA EL, MAYOR
ATTEST:
BY:
MELISSA TEAL, ILLAGE CLERK
APPROVED AS TO FORM AND
LEGAL SUFFICIENCY:
r
BY:
VILLAGE ATTORNEY
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EXHIBIT "A"
INVOICE FORM AND REQUIREMENTS
(FORM ATTACHED)
APPLICATION FOR PAYMENT NO.
To: VILLAGE OF NORTH PALM BEACH (OWNER)
From:
Contract: Anchorage Park Module Building Demolition
For Work accomplished through the date of 201 .
1.
Original Contract Price:
$
2.
Net change by Change Orders and Written Amendments (+ or -):
$
3.
Current Contract Price (1 plus 2):
$
4.
Total completed and stored to date:
$
5.
Retainage (per Agreement):
Ten percent (10 %) of completed Work,
material and equipment purchased:
$
6.
Total completed and stored to date less retainage (4 minus 5):
$
7.
Less previous Application for Payments:
$
8.
DUE THIS APPLICATION (6 MINUS 7):
$
Accompanying Documentation:
CONTRACTOR'S Certification: The undersigned CONTRACTOR certifies that (1) all previous
progress payments received from OWNER on account of Work done and goods purchased under the
Contract referred to above have been applied on account to discharge CONTRACTOR's legitimate
obligations incurred in connection with Work, materials and equipment covered by prior Applications
for Payment numbered 1 through inclusive; (2) title of all Work, materials and equipment
incorporated in said Work or otherwise listed in or covered by this Application for Payment will pass
to OWNER at time of payment free and clear of all Liens, security interests and encumbrances, and (3)
all Work, materials and equipment covered by this Application for Payment are in accordance with the
Contract Documents and not defective.
Dated
State of
County of
Subscribed and sworn to before me this
day of 7201 _
Notary Public
My Commission expires:
Un
Contractor
Payment of the above AMOUNT DUE THIS APPLICATION is recommended.
Dated By: