WEST VILLAGES IMPROVEMENT DISTRICT

CONTRACTOR'S PREQUALIFICATION STATEMENT (CONSTRUCTION OF PUBLIC INFRASTRUCTURE IMPROVEMENTS AND
MAINTENANCE SERVICES)

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Contractor

TABLE OF CONTENTS

REQUEST FOR QUALIFICATIONS ADVERTISEMENT NOTICE TO PROSPECTIVE BIDDERS
APPLICATION FOR CONTRACTOR PREQUALIFICATION SUPERVISORY PERSONNEL
COMPANY OWNED MAJOR EQUIPMENT STATUS OF CONTRACTS ON HAND
ALL PROJECTS APPLICANT COMPANY COMPLETED IN THE LAST TWO YEARS LIST OF ADDITIONAL DOCUMENTS FOR INCLUSION IN APPLICATION AFFIDAVIT FOR INDIVIDUAL
AFFIDAVIT FOR PARTNERSHIP AFFIDAVIT FOR CORPORATION
SWORN STATEMENT UNDER SECTION 287.133(3)(A), FLORIDA STATUTES. ON PUBLIC ENTITY CRIMES

CONTRACTOR CLASSIFICATION LISTING DETERMINATION OF QUALIFIED PROSPECTIVE BIDDER

REQUEST FOR QUALIFICATIONS
FOR CONSTRUCTION AND MAINTENACE SERVICES WEST VILLAGES IMPROVEMENT DISTRICT

The West Villages Improvement District ("District") requests Applications for Qualification from firms interested in providing construction and maintenance services for public infrastructure improvements. Upcoming projects include the construction of various infrastructure improvements and maintenance services in and around the District including i) earthwork/excavation and construction of roadways, stormwater management facilities, water and sewer facilities, irrigation facilities, landscape, hardscape, street lighting, and other public improvements and ii) maintenance services including exotic vegetation removal, and canaVdrainage, landscaping, lake and littoral maintenance, and streetlighting.

To be eligible to submit qualifications, firms must: i) hold all required applicable licenses in good standing and ii) be authorized to do business in the Sarasota County, and the State of Florida.

For construction services, any contractor pre-qualified and considered eligible by the Department of Transportation to bid to perform the type of work the project entails shall be presumed to be qualified to perform the project.

Applicants may request an Application for Qualification from Dewberry Engineers Inc. 2201 Cantu Court, Suite 107, Sarasota, Florida 34232, or via email to r_ Jlis(ciJ,dewben-y.com beginning April 14th, 2022, after 1:00 p.m. Applicants must submit one (I) dcctronic copy (PDF format on a OS13 flash drive), by 4:00 p.111. on Muy H,111• 2022. Address responses to: Mr. Richard Ellis, District Engineer, 2201 Cantu Court, Suite 107, Sarasota, Florida 34232.

Qualified firms will be selected based on experience, qualifications of personnel, and ability to perform construction or maintenance services. Packages will be reviewed and rated by a committee appointed by the District Board of Supervisors promptly after receipt of the submittals, with final selections expected to be made at a publicly noticed Board of Supervisors meeting held shortly thereafter.

At that time, all qualified firms may be assigned a project qualification and aggregate dollar limit for work under District contracts. All applicants will be promptly notified after the construction and maintenance finns are selected. The pre-qualification decisions of the Board of Supervisors shall be valid for a period of three (3) years, after which the Board of Supervisors may either extend the prequalification period for an additional two (2) years or open the prequalification process again, at its sole discretion. The District reserves the right to waive any informality in the qualifications submitted, to reject any and all qualifications submitted and to advertise for the services.

Pre-qualified firms will be eligible to bid on construction and maintenance projects subject to the applicants approved project classification and aggregate limit. Failure to pre-qualify may preclude the District from awarding contracts for construction and maintenance services to non-qualified firms.

Applicants may contact the District Engineer, Dewberry Engineers Inc., at 2201 Cantu Court, Suite 107, Sarasota, Florida 34232, or via email to  llis(iiJdewberry.com, until the qualifications submittal deadline for further information. All requests for information shall be in writing.

Any contractor submitting a Contractor's Prequalification Statement, which in its judgment is adversely affected by the District's rating as to the contractor's qualifications and wishes to protest such decision must file with the District a notice of protest in writing within seventy-two (72) hours (excluding Saturdays, Sundays and state holidays) after receipt of the notice of the District's ranking, and shall file a formal written protest within seven (7) days (including Saturdays, Sundays and state holidays) after the

date of filing of the notice of protest. The formal written protest shall state with particularity facts and law upon which the protest is based. Failure to timely file a notice of protest or failure to timely file a formal written protest shall constitute a waiver of all further proceedings under Florida law and the District's Rules of Procedure. You may obtain a copy of the District's Rules of Procedure by contacting the District Manager's Office at 2501A Burns Road, Palm Beach Gardens, FL 33410.

William Crosley, District Manager

Publication Date:

----- 2022

NOTICE TO PROSPECTIVE BIDDERS

The information required herein is for the purpose of fairly evaluating contractor qualifications to perform various construction·and maintenance activities for the West Villages Improvement District (the "District").

APPLICANTS FOR PREQUALIFICATION AS BIDDERS FOR THE WEST VILLAGES IMPROVEMENT DISTRICT CONTRACTS ARE HEREBY NOTIFIED THAT INCLUSION OF FALSE, DECEPTIVE OR FRAUDULENT STATEMENTS ON TIDS APPLICATION CONSTITUTES FRAUD. FURTHERMORE, YOU ARE HEREWITH NOTIFIED THAT THE WEST VILLAGES IMPROVEMENT DISTRICT CONSIDERS SUCH ACTION ON THE PART OF THE APPLICANT TO CONSTITUTE GOOD CAUSE FOR DENIAL, SUSPENSION, OR REVOCATION OF THE PROSPECTIVE BIDDER'S QUALIFICATION FOR BIDDING ON ITS PROJECTS.

Please be advised that this application must be complete within itself without reference to any other application or statement. All sections of the application shall be completed. If any of the requested information does not apply, it shall be indicated as "None" or "N.A." as applicable. Failure to make entries in every section of this application may result in a disqualification.

All financial information provided in this application and accompanying audited financial statements are exempt from public record laws pursuant to Section 119.071(1)(c), Florida Statutes, and will be kept confidential. District can request nnnnni.l1rntts"m'fd-nnnul'ti-r mittal...o.Luzy ·iJ finam:ial statements from any pr1.:qualilicd contractor.

The properly completed Contractor's Prequalification Statement shall be submitted to the District Engineer, Richard Ellis at Dewberry Engineers Inc., 2201 Cantu Court, Suite 107, Sarasota, Florida 34232. Any questions with regard to the requests for information contained herein shall be addressed to the District Engineer, Dewberry Engineers Inc., at 2201 Cantu Court, Suite 107, Sarasota, Florida 34232, or via email to rellis(i1),dewben-y.com.

Schedule of Pertinent Dates

Descriotion	Date	
RFO "Pickup" Date	Thursday, Aoril 14th, 2022 after 1:00 o.m.	
RFO Due Date	Mondav, Mav 16th, 2022, at 4:00 P.m.	
Committee Meeting Date to Evaluate
Qualifications Statements	Tuesday, May 17th at 11:00 a.m.	
Board Meeting to Formally Approve Prequa1ified Contractors	Thursday, May 19th at 11:00 a.m.	

CONTRACTOR  PREQUALIFICATION STATEMENT

Application for Contractor Pregualification (Attach Additional Sheets if Necessary)
DATE SUBMITTED	2022
Applicant	#r:()y	/i)l!4(:J,tt.J-1',  S'yS'/lhl-tS"'"W/lA I A Partnership
[Companfeamri	/ 	-V--A Corporation
I_/ A Subsidiary Corporation

Parent Company Name   AJ+-"-_'A- 	 _

Parent Company Address:

Street Address

2  ,f._0---'/	:..._N

	()_W_e_-re,;  l_l_A.l_t:_

;;_/Q_b_.	 _

P. 0. Box (if any)	_

City	IMp,,tltvo	8eJtJ-c.A_	State -- ,:":-( -.-------

ZipCode	'330'1<,

Telephone	{J -9? I -  7 3 S"O
1st Contact Name	few N	N DIA.I !KIL<·
2nd Contact Name	IJllfl#r-"1	.biz.nf  €>t-

Fax no. 	 _
Title <!A,vf7u)/  /e.J,L
Title D,ll.t. 71)/L t>t' J',,-lc"'.S

Applicant Company Address (if different):
Street Address 	,r»t e__________________ _
P. 0. Box (if any)	 _

City 	 State 	 Zip Code 	_

Telephone 	

Fax no. 	 _

1st Contact Name	Title 	 _

2nd Contact Name 	 Title 	 _

List the location of the office from which the applicant would perform work for the West Villages Improvement District work.

Street Address	ZCo I	N
City	(),,-,-.,.,(Jtf-lv O 	 I-J
Telephone ' q'52/- Cl? I  -- 13..ri)

/owf:12.l /Nt!
State		Pl-	Zip Code_ _'3_o_ _rr_ Fax no.		 _

1st Contract Name.	 Title	_

Is the applicant Company incorporated in the State of Florida? yes	no ( )

If yes, provide the following:

Is the Company in good standing with the Florida Department of State Division of Corporations? yes	no ( )

If no, please explain 	

Date incorporated	//'	 ) l, - 1, f Y	Charter No.  
If no, provide the following:	AJ/ /r

/,/_3_/_ _{p_/ 

The State with whom the appl, t company is incorporated in?		

Is the company in good standing with the State? yes ( ) no ( )

In no, please explain 	

Date incorporated 	 Charter No. 	_

Is the applicant company authorized to do business in the State of Florida? yes ( ) no (
Is the applicant company a registered or licensed contractor with the State of Florida? yes p{) no ( ) Provide copies of all licenses listed.

If yes, provide the following:

	 	 o/

T_2Pe ofregistration (i.e. certified general contractor, certified electrical contractor, etc.)	_

:t"iUl IJ-7/0 ,v	SPR.1.#l.	IVV7Ul<.TOl'L
License No. S CC../ 31 / S"I 'lo 3	Expiration Date	g,_ 31  - 2 o Z-  "Z-
Qualifying individual	/.Ill-'1-IAN  D.  .btte/let- Title	
List company(s) currently qualified under this license 	 _
f/oov ,t.	/l»./'1µ1	 .s- e	.
Is the applicant Company a registered or licensed Contractor with Sarasota County? yes	no( )

Has the applicant Company performed work for an independent special district previously?
) no()

Is the applicant company prequalified by the Florida Department of Transportation? yes ( ) no

If yes, provide the following:

Work Class Ratings 	 _

Maximum Capacity Rating		

9.	Name of Applicant's Bonding Company---' -'4-_, '--l._[P=-=L..'---=.:£ ,.; l)_t"Jl.t_/V_l_7  	&_ll  ,_l'_0_/1.-_...A...t..z.._O""""AJ

Address	

ll¥t?J	(};;,.U#'IONJ	3TF s«J . J'lltlJl)lEm"f w.r S-sft '2-.

Approved Bonding Capacities:	Aggregate Limit
Single Project Limit
Total Current Contracts Bonded

$	 t:>OO, DoO
$	/0'->0000
$	-'iJ-

Note: All bonds and insurance policies obtained by Applicant required herein shall be issued by companies authorized to do business in the State of Florida and shall have a financial strength rating of A or better, and a financial size category of X or higher, as rated by AM. Best Company.

Name of Applicant's Bonding Agenc-y- 'B 'lf.J_o_ _ _

 ,_,f 

a_ _d--'f,J_N	_

Address

/J 012,n,	'i3o1c..J..t	Sm.G=. r	t)14-y,o,vt11-.  L		37-17  f.o
I			I

ContactName    7-+y_L-€.  :'l'L-
I

'l)=	f-'--/3_o_ _D	

Phone	3K(, - :2 39-  S-703

List the Applicant's total annual dollar value of work completed for each of the last three (3) years starting with the latest year and ending with the most current year (2019) /l f lllfl  (2020) /.i.. 3 /1,f, l- , (2021) /0. c/ fl11 l	'
List the classification(s) (refer to attached listing) of work the applicant is applying for prequalification based on the applicant company's ability to self perform the work (excluding general contracting).
//l,t16tlnol"		l"I	Sf»77otv		
1$1/S'TJfl(..(_11-'701V -J'Erl.Ylec --		
JhVO	JI,! A-I Nre-Jvlf  NC...,?		

What are the applicant company's current insurance limits? If contractor does not have a certain category of coverage listed below, please note none. (provide a copy of applicant's certificate of insurance)

General Liability Automobile Liability Workers Compensation
Contractor's Pollution Liability Umbrella Liability/Excess Liability Contractors Additional Insured Status

$ I, DOD, i)(J0
$ /, l>oi,1 ,>o,.,
$ I oo.:, ooo 
$ S, Ooo   o,>OO
$	,

General Liability 	 _
Auto Liability		 Per Project Aggregate Limit
General Liability  2	i) Do  o   o
Waiver of Subrogation in favor of District
General Liability	- X	 _
Auto Liability	- X: ---
Workers' Compensation		

Expiration Date

Note: Applicant must provide a certification that their insurance carrier is authorized to conduct business in Florida.
Coverage must be provided on a primary, non-contributory basis.

Has the applicant company been ci!	by OSHA for any job site or company office/shop safety violations in the past two years? yes ( ) no

If yes, please describe each violation, fine, and resolution 	 _

What is the applicant's current worker compensation rating? 	

._'?'f	 _

Has the applicant company experienced any worker injuries resulting in a worker losing more than ten (10) working days as a result of the injury in the past two years? yes ( ) no

If yes, please describe each incident 	 _

Please state whether or not your company or any of its affiliates are presently barred or suspended [ro;n
bidding or contracting on any state, local or federal-aid contracts in any state(s)? Yes   	No A--
If so, state the name(s) of the company(ies) 	 _

the state(s) where barred or suspended 	 _ and the period(s) of debarment or suspension 		

What is the construction or maintenance experience of the principal supervisory construction or maintenance personnel of your organization? (Attach resumes here.)

INDIVIDUAL'S NAME	PRESENT POSITION OR OFFICE	MAGNITUDE AND TYPE OF WORK*	YEARS OF CONSTRUCTION
/MAINTENANCE
EXPERIENCE	YEARS WITH FIRM	IN WHAT CAPACITY?	
EHMl/ ,l.-	/IVSTYKL .
/116 ,1...	l'() f	s		1	/ltJM.fl
"'l:A/5 71't{..(,,,	
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:J/IS"ON IJtf...tl,.._bp	Ta.I/NI c.l A1v	ftM1ce		<-/	Tce,,f./-	
Jill. Ctt.ot,Jt. II	, , 4,	II S""1.t//tt		/)	rtc..t./	
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*Give in sufficient detail for the District to evaluate your experience in the classifications of work for which you are requesting prequalification.

Have you ever failed to complete any work awarded to you? Yes why?	

No_X_	If so, where and

Has any officer or partner of your organization ever been an officer, partner, or owner of some othV
organization that has failed to complete a construction or maintenance contract? Yes	 No

If so, state name of individual, other organization and reason therefore.

List any and all litigation with owners or major subcontractors to which the Applicant has been a party in the last five (5) years and describe the outcome or resolution.

Has the Applicant or any of its affiliates ever been either disqualified or denied prequalification status by a governmental  entity?	N {)	If	so,  discuss  the  circumstances  surrounding  such  denial  or
disqualification as well as the date thereof. 	

Within thutt five (5) years, has the Applicant failed to complete a project within the scheduled contract time?	0   If so, discuss the circumstances surrounding such failure to complete a project on time as well as the date thereof.

-I--	  

Does the Applicant have adequate equipment to perform normal construction or maintenance operations for
each class of work for which prequalification is sought?  Yes	No	If no, please explain:

SUPERVISORY PERSONNEL
CompanyName	f/aOVeYL-	 /1;""'f1JV,,	$'  .r	 ff-j'7tt11R17uN	Date	5'°-/D-],,u2,,..,_
What is the experience of the key management and supervisory personnel of the applicant company for both administration as well as operations? (Attach resumes of key 1 here}

INDIVIDUAL'S NAME	

PRESENT TITLE	
DESCRIPTION OF DIRECT JOB RESPONSIBILITIES	YEARS OF EXPERIENCE IN PRESENT POSITION	TOTAL YEARS OF
RELATED EXPERIENCE	
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/2us5	1hI. e,(,r,ose	:CT JU,4,-,tf AC,tt-	l' .f M/1/f/9ut-/h :-:- ,11	J-	3S-	
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COMPANY OWNED MAJOR EQUIPMENT
(Attach additional sheets if necessary)

I	,

-	~	- ....- -	--  ...,,. IL6 I<..,, r' -•

QUANTITY	

DESCRIPTION	

CAPACITY	NO. LOCATED IN	
			
FLORIDA	
OTHER	
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Company Name

STATUS OF CONTRACTS ON HAND
(Attach additional sheets if necessary)
lit>ov "?t.	IZ r/(/	 fr .r	{}/l.p()d#t70/V	Date	S-	/6-2,i:>),v-

Furnish requested information about all of applicant's active contracts, whether as prime or subcontracts; whether in progress or awarded but not yet started; and regardless of with whom contracted. All amounts to be shown to nearest $1,000. Contractor may consolidate and list as a single item all contracts which individually do not exceed 3% of total active contracts and in total do not exceed 20% of the active total contracts.
	
Applicant's Uncompleted Amount as of this Date	

Comnletion Date	

Owner, Location and Descrirtion of Project	Current Contract Amount as
Prime	Current Contract Amount as
Subcontractor	
Current
Amount Sublet to Others	

As Prime Contractor	

As Subcontractor	
Original
Contract Date	
Approved
Revised Date	
Current Estimate Date	
	
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Subtotal Uncomrleted Work	
$	
$		
		
Total Uncompleted Work on Hand	1$	I				

STATUS OF CONTRACTS ON HAND Company Name:  HOOVER PUMPING SYSTEMS CORPORATION

OWNER/LOCATION	
DESCRIPTION OF PROJECT	Current Contract Amount
As Subcontractor	UNCOMPLETED AS OF THIS DATE	

TIMBER CREEK	Pump Station	194,000	194,000	
DEL WEBB OAK CREEK	Pump Station	63,000	63,000	
CORKSCREW SHORES TENNIS COURTS	Pump Station	37,000	37,000	
RANCHETTE SQUARE TOWNHOMES	Pump Station	37,000	37,000	
LEGACY PARK AT TRADITION	Pump Station	72,000	72,000	
TIMBER CREEK	Pump Station	49,000	49,000	
BLACK DIAMOND	Pump Station	40,000	40,000	
SAVANNA LAKES NORTH	Pump Station	163,000	163,000	
WEST VILLAGES TRANSFER	Pump Station	328,000	328,000	
BROWARD COUNTY TY PARK	Pump Station	38,000	38,000	
AURORA CONDOMINIUM	Pump Station	14,000	14,000	
WEST VILLAGES--VILLAGE E	Pump Station	118,000	118,000	
VERDANA VILLAGE	Pump Station	255,000	255,000	
SEMINOLE IMPROVEMENT DISTRICT	Pump Station	218,000	218,000	
VALENCIA WALK	Pump Station	190,000	190,000	
VERANDA ESTATES	Pump Station	112,000	112,000	
VALENCIA GRANDE	Pump Station	130,000	130,000	
SONOMA OAKS	Pump Station	77,000	77,000	
TERRANO AT VALENCIA GOLF AND CC	Pump Station	51,000	51,000	
TERRANO AT VALENCIA GOLF AND CC	Pump Station	183,000	183,000	
KINGS GATE	Pump Station	192,000	192,000	
SOUTH PORT SQUARE	Pump Station	53,000	53,000	
LINDSFORD REPLACEMENT	Pump Station	74,000	74,000	
AVENIR	Pump Station	163,000	163,000	
DEL WEBB AT TRADITION SOUTHERN GROVE	Pump Station	126,000	126,000	
CITY OF VENICE	Pump Station	43,000	43,000	
INTERNATIONAL PARKWAY MEDICAL CENTER	Pump Station	29,000	29,000	
EXTRA SPACE STORAGE	Pump Station	19,000	19,000	
COLLIER COUNTY BIG CORKSCREW ISLAND	Pump Station	58,000	58,000	
BECKER TURNPIKE	Pump Station	34,000	34,000	
BROWARD COUNTY SEPTAGE	Pump Station	92,000	92,000	
GRAN PLACE AT WELLEN PARK	Pump Station	25,000	25,000	
SOLTICE POC	Pump Station	29,000	29,000	
PALM BEACH COUNTY LAKE WORTH HIGH SCHOOL	Pump Station	50,000	50,000	
SAWGRASS CORPORATE PARK	Pump Station	64,000	64,000	
SAVANNA LAKES NORTH	Pump Station	53,000	53,000	
WEST 4th AVENUE APARTMENTS	Pump Station	41,000	41,000	
WEST 4th AVENUE APARTMENTS	Pump Station	37,000	37,000	
CITY OF CAPE CORAL CULTURAL PARK	Pump Station	32,000	32,000	
LOTUS PALM	Pump Station	150,000	150,000	
VINTERRA	Pump Station	128,000	128,000	
IRON MOUNTAIN	Pump Station	25,000	25,000	
THE ALCOVE	Pump Station	96,000	96,000	
SANCTUARY AT DAYTONA	Pump Station	53,000	53,000	
THE BRIDGES HOA - EAST	Pump Station	86,000	86,000	
HIGH POINT PUD	Pump Station	53,000	53,000	
VERANDA OAKS	Pump Station	71,000	71,000	

TOTAL		4,245,000	4,245,000	

Company Name

th PROJECTS APPLICANT COMPANY COMPLETED IN THE LAST TWO YEARS

1

Ve.I'!'	/?,Mr.,t1/ A-:J	$' Yfn?ttf'	{]"1/'7<i'Mtl , ,.,	nare	!: - IO• z,0 -,, 1.,

List all projects completed in the last two years for which the contract value individually exceeded 3% of the applicant's annual total work completed for the year the project arted. Include in the list projects that were started earlier than two years but were com1,leted within the last tw0 1ears.

Project Name/Location	
Final Contract Amount	

Prime or Sub1	
Classification
of Work Performed	Year Started/ Completed	

Owner Name/Location2	Name & Phone Number of Owner's Representative on
this Project3	
	
,,..-.,						
	CL	A I	JJ r				
	c...;.., -						

							

							

1 'Prime or Sub' should indicate whether applicant performed the work as a prime contractor or as a subcontractor.
'Owner Name/Location' should indicate the Owner of the project if the applicant performed the work as a prime contractor or the general contractor if the applicant performed the work as a subcontractor.
'Name & Phone Number of Owner's Representative on this Project' should list a reference from the business entity listed in the previous column familiar with applicant's contract performance.
14

PROJECTS APPLICANT COMPANY COMPLETED IN THE LAST TWO YEARS

Company Name:	HOOVER PUMPING SYSTEMS CORPORATION

PROJECT NAME/ LOCATION	CONTRACT AMOUNT	
PRIME/ SUB	CLASSIFICATION OF WORK
PERFORMED	YEAR
STARTED/COMPLETED	

RIVERSTONE AT NAPLES HOA:8915-Riverstone at Naples:Pump 8915	
273,000.00	
Pump Station-FlowGuard	
2020	
NEWBERG IRRIGATION INC:8963-West Port Master:Pump 8963	225,000.00	Pump Station-FlowGuard	2020	
2020 - OTHER JOBS	6,562,000.00	Pump Station-FlowGuard	2020	
2021 - OTHER JOBS	5,373,000.00	Pump Station-FlowGuard	2021	
LENNAR HOMES - SARASOTA:9127-Wellen Park Golf Course:Pump 9127	207,000.00	Pump Station-FlowGuard	2022	
TOLL BROTHERS LAND DEVELOPMENT:9150-Solstice:Pump 9150	139,000.00	Pump Station-FlowGuard	2022	
SPECIAL DISTRICT SERVICES INC.:9160-West Villages Harvest Pond:Pump 9160	77,000.00	Pump Station - FlowGuard	2022	
TAYLOR MORRISON OF FLORIDA:9180-Skye Ranch:Pump 9180	244,000.00	Pump Station-FlowGuard	2022	
PALM BEACH POLO CLUB HOA, INC:9172-Palm Beach Polo POA:Pump 9172	88,000.00	Pump Station-FlowGuard	2022	
KOLTER LAND PARTNERS LLC:9159-Central Park Pod:Pump 9159	72,000.00	Pump Station-FlowGuard	2022	
SUNNY GROVE LANDSCAPING INC:9189-Del Webb Oak Creek:Pump 9189	191,000.00	Pump Station-FlowGuard	2022	
SUNNY GROVE LANDSCAPING INC:9178-Timber Creek:Pump 9178	195,000.00	Pump Station-FlowGuard	2022	
MCJ VENTURES LLC:9194-Legacy Park at Tradition:Pump 9194	72,000.00	Pump Station-FlowGuard	2022	
2022 - OTHER JOBS	1,048,000.00	Pump Station-FlowGuard	2022	

LIST OF ADDITIONAL DOCUMENTS FOR INCLUSION IN APPLICATION

Please include the following additional information with this application:

Applicants shall provide letters of recommendation from at least two agencies or finns with direct knowledge of the applicant's key personnel and work performance in sufficient detail to assist in rating the applicant's ability to perform the classification of work for which the applicant is applying for prequalification. The letters must contain specific information regarding the following:

Specific projects, including project numbers and location.
Size of projects by dollar value.
Description of projects and classes of work performed with applicant's own employees and equipment.
Whether projects were timely completed.
Whether the applicant was cooperative and facilitated changes to the project when required.

Applicants shall list the name of any subcontractor(s) that may be utilized to complete any work falling within the scope of the Contractor Classification Listing(s) for which the Applicant is submitting its Application for Qualification.

(Continued on Next Page)

The undersigned hereby authorize(s) and request(s) any person, firm or corporation to furnish any pertinent information requested by the West Villages Improvement District, or their authorized agents, deemed necessary to verify the statements made in this application or attachments hereto, or necessary to determine whether the West Villages Improvement District should prequalify the applicant for bidding on its construction or maintenance projects, including such matters as the applicant's ability, standing, integrity, quality of performance, efficiency and general reputation.

The undersigned acknowledges and consents to the use of the evaluation criteria set forth under the Section herein titled "Determination of Qualified Prospective Bidder.

#1: ,,,.L-

The undersigned acknowledges that the West Villages Improvement District can terminate its use of the prequalification list for bidding purposes at any time.

tom

//,wQL ;tMf'tl	f v.rm--sa,ylMfllf!<)! 	
Name of Applicant	1y /
/4:111A1 g  MulNl.r'	aNm.o/le,,._
[Type Name and Title of Perso• n Signing]

This_/_b_dayof	MA--V
I 

, 2022

(Corporate Seal)

Sworn to before me this -- /_D

Notary Public/Expiration Date (Seal)

day of	/14¥  ,2022.

,,,• \!••,,	ANNE M STROBEL

S•	•§ Commission I HH 220926

Notary Public-State ot Florida

1'i	.,$  My Commission Expires

,,,,,ff,f.'i,,''

April 10, 2026

Applicant acknowledges receipt of the following addenda: Addendum No. 	 _ Addendum No. 		 _

Date 		 _ Date 	 _

AFFIDAVIT FOR INDIVIDUAL

State of		 County of		

ss:

		 being duly sworn, deposes and says that the statements and answers to the questions concerning experience contained herein are correct and true as of this date; and that he/she understands that intentional inclusion of false, deceptive or fraudulent statements on this application constitutes fraud; and, that the District considers such action on the part of the applicant to constitute good cause for denial, suspension or revocation of a certificate of qualification for bidding on West Villages Improvement District projects.

Signature Print Name

Sworn to before me this 	day of 	 2022.

Notary Public/Expiration Date: (SEAL)

AFFIDAVIT FOR PARTNERSHIP

State of		 County of		

ss:

is    a    member    of    the    firm    of
	, being duly sworn, deposes and says that the statements and answers to the questions of the foregoing experience questionnaire are correct and true as of the date of this affidavit; and, that he/she understands that intentional inclusion of false, deceptive or fraudulent statements on this application constitutes fraud; and, that the District considers such action on the part of the applicant to constitute good cause for denial, suspension or revocation of a certificate of qualification for bidding on West Villages Improvement District projects.

Signature Print Name

Sworn to before me this 	 day of 		2022.

Notary Public/Expiration Date: (SEAL)

AFFIDAVIT FOR CORPORATION

State of

County of		

ss:

ven.....
(title)-----,--, -- --------,....-----.,...,....----------------
of the	r r  or1	-tJ

(a corporation described herein)  ing duly sworn, depos s and says that the statements and answers to the questions in the foregoing concerning experience are correct and true as of the date of this affidavit; and, that he/she understands that intentional inclusion of false, deceptive or fraudulent statements in this application constitutes fraud; and, that the District considers such action on the part of the applicant to constitute good cause for denial, suspension or revocation of a certificate of qualification for bidding on West Villages Improvement District projects.
(Officer must sign here)
&-o,lr	/hoye,t..-	
Print Name

CORPORATE SEAL

, 2022.

/Riw\Notary ublic-State of Florida
;::;	;;; Commission I HH 220926
..:,;t .-;;,r -2 M\' Cr,,mmission Expires

,	fl,,	ANNE M STROBEL

11liuil'"	•\)_.!it 1 (J. 2026

Notary Public/Expiration Date:

(SEAL)

SWORN STATEMENT UNDER SECTION 287.133(3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES

THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS.

1.	This sworn statement is submitted to West Villages Improvement District for Prequalification of Construction and/or Maintenance Contractors.

2.

and (if applicable) its Federal Employer Identification Number (FEIN) is	S"'J- 2 c/'/ f IO l,
(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: 	 .)
3.	My name is _  _,[t'-'-"'eJJ=-.:...:1/V  .g'-=-'.'----L..ft/._'DW._'/J,-_c.._-=-•	andmy relationship to the

entity named above is

  N_rrlu--'--"--..L./_,	/qr._, =------------------- 

I understand that a "public entity crime" as defined in Section 287.133(l)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.

I understand that "convicted" or "conviction" as defined in Section 287.133(l)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere.

I understand that an "affiliate" as defined in Section 287.133(l)(a), Florida Statutes, means:

A predecessor or successor of a person convicted of a public entity crime; or,

An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.

I understand that a "person" as defined in Section 287.133(l)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term

"person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity.

Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Please indicate which statement applies.)
Y Neither the entity submitting this sworn statement, nor any officers, directors, executives, shareholders, employees, members, or agents who are active in management of the entity, nor any
affiliate of the entity, have been charged with and convicted of a public entity crime subsequent to July 1, 1989.

	The entity submitting this sworn statement, or one or more of the officers, directors, executives, partners, shareholders, employees, members or agents who are active in management of the entity or an affiliate of the entity, has been charged with and convicted of a public entity crime subsequent to July 1, 1989, AND (please indicate which additional statement applies):

There has been a proceeding concerning the conviction before an Administrative Law Judge of the State of Florida, Division of Administrative Hearings. The final order entered by the Administrative Law Judge did not place the person or affiliate on the convicted vendor list. (Please attach a copy of the final order.)

The person or affiliate was placed on the convicted vendor list. There has been a subsequent proceeding before an Administrative Law Judge of the State of Florida, Division of Administrative Hearings. The final order entered by the Administrative Law Judge determined that it was in the public interest to remove the person or affiliate from the convicted vendor list.. (Please attach a copy of the final order.)

The person or affiliate has not been placed on the convicted vendor list. (Please describe any action taken by or pending with the Florida Department of Man gement	ices.)

STATE OF _ _cff.c. ,-.,9-" /t_l_/J_lr_
COUNTYOF---"6J= v l.CJ-=--'-'-llttiJ =----

Print Name AA	/{)	

'''"7

Date:		

PERSONALLY APPEARED BEFORE ME, the undersigned authority, 	 _

 {tV'I._IJ t_,_M_u	'

who, after first being sworn by me. affixed his/her signature in the

(name of individual signing)

11

space provided above on this 	(_IJ	 day of	Jl,1 o/	2022.
	fit ,
NOTARY PUBLIC

My commission expires:

r. J,I /

CONTRACTOR CLASSIFICATION LISTING

Construction

Excavation/Earthwork

Roadways, including Paving, Repair and Resurfacing

Stonnwater Management Facilities

Water and Sewer Facilities

Irrigation Facilities

Landscape Installation

Hardscape Facilities

Streetlighting

Maintenance

Exotic Vegetation Removal

Canal/Drainage Maintenance

Landscape and Irrigation Maintenance

Lake and Littoral Maintenance

Streetlighting

DETERMINATION OF QUALIFIED PROSPECTIVE BIDDER

The West Villages Improvement District ("District") is authorized to maintain a list of qualified contractors ("Qualified Prospective Contractors") to submit bids for the procurement of District construction and maintenance projects. Any Qualified Prospective Contractor desiring to submit a bid to provide work for the District must submit a properly completed Contractor's Prequalification Statement to the District Engineer for review and evaluation.

The District shall evaluate the Contractor's Prequalification Statement and based on the District's judgment of the information provided, shall issue in writing to the contractor, the District's rating as to the classification(s) of the Work and the maximum Bid dollar amount for which the Qualified Prospective Contractor can submit a Bid to the District.

A Qualified Prospective Contractor shall mean a prospective contractor which in the sole judgment of the District has the capability, in all respects, to perform fully the contract requirements, and the business integrity and reliability which will assure good faith performance. In determining the Qualified Prospective Contractor's qualifications, the following criteria will be considered:

The ability, capacity, and skill of the contractor to perform the contract or provide the work required;

Whether the contractor can perform the contract or provide the work promptly, or within the time specified, without delay or interference;

The character, integrity, reputation, judgment, experience, and efficiency of the contractor;

The quality of performance of previous contract or work. For example, the following information will be considered:

The cost overrun incurred by owners on previous contracts with contractor;

The contractor's compliance record with contract general conditions on other projects;

The contractor's record for completion of the work within the Contract Time or within Contract Milestones and contractor's compliance with scheduling and coordination requirements on other projects;

The quality, availability, and adaptability of the goods or work to the particular use required;

The contractor's demonstrated cooperation with owners, architects, engineers, and others on previous contracts; and;

Whether the work performed and materials furnished on other contracts were m accordance with the contract documents; and

Whether contractor has performed previous work for an independent special district.

The previous and existing compliance by the Prospective Bidder with laws and ordinances relating to contracts or work;

The sufficiency of the financial resources and ability of the contractor to perform the contract or provide the work;

The ability of the contractor to fulfill its guarantee and warranty period;

Such other information as may be secured by the Board having a bearing on the decision to award a contract to include, but not be limited to:

The ability, experience, and commitment of the contractor to properly and reasonably plan, schedule, coordinate, and execute the work; and,

Whether the contractor has ever been debarred from bidding or found ineligible for bidding on any other projects.

The District will make such inquiries and investigations as deemed necessary to verify and evaluate the applicant's statements regarding:

The necessary organization and management including experience possessed by the applicant's employees;

Adequate equipment, as shown on the equipment list, to perform normal operations for each class of work in the industry such as that called for in the contract documents in force at the time of application;

For construction services, any contractor pre-qualified and considered eligible by the Department of Transportation to bid to perform the type of work the project entails shall be presumed to be qualified.

If herein required, or if requested by the District at any time after the conclusion of the initial pre­ qualification process, the Qualified Prospective Contractor shall submit a certified financial statement(s) in a form acceptable to the District, prepared no later than the past 180 days, indicating current financial resources, current bonding capacity, liabilities, capital equipment, in its sole discretion, may adjust the Qualified Prospective Contractor's Prequalification contract limits

Furthermore, a Qualified Prospective Contractor acknowledges the right of the District to determine a Qualified Prospective Contractor to be not qualified to submit a Bid in response to the District's Advertisement for Bids at the sole determination of the District for, but not necessarily limited to, any of the following specific reasons:

Failure to submit a properly completed Contractor's Prequalification Statement in accordance with the above requirements;

Failure of the Qualified Prospective Contractor's rating by the District as to classification of the Work and the maximum Bid dollar amount to meet the requirements of the Bid;

Reason to believe that collusion exists among Bidders;

Determination of lack of competency as may be revealed by qualification statements, financial statements, experience records, or other sources;

The Qualified Prospective Contractor's uncompleted work load which, in the judgment of the Board, may cause detrimental impact on timely completion of the project being bid; or

The Qualified Prospective Contractor's Surety is unacceptable to District.

Submission of excessive or unreasonable suggested modifications to the District's Standard Form of Construction or Maintenance Contract.

Any contractor submitting a Contractor's Prequalification Statement, which in its judgment is adversely affected by the District's rating as to the contractor's qualifications and wishes to protest such decision must file with the District a notice of protest in writing within seventy-two (72) hours (excluding Saturdays, Sundays and state holidays) after receipt of the notice of the District's ranking, and shall file a formal written protest within seven (7) days (including Saturdays, Sundays and state holidays) after the date of filing of the notice of protest. The formal written protest shall state with particularity facts and law upon which the protest is based. Failure to timely file a notice of protest or failure to timely file a formal written protest shall constitute a waiver of all further proceedings under Florida law and the District's Rules of Procedure. You may obtain a copy of the District's Rules of Procedure by contacting the District Manager's Office at 2501A Bums Road, Palm Beach Gardens, FL 33410.

4884-9891-9193.l	25

Ron Desantis, Governor

STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INl!>OSTRY LICENSING BOARD
THE IRRIGATION SPECIAL	CITOR E	CERTIFIED UNDER THE
PROVISIONS	· APTER 4	-	Slf>ATUTES

-
HOOVER PU,M-P-	· YSTEMS CORPORATtON
J3UR PLAC,E
RO Al PALM BEACH	FL 33414

LICEN!iE NUMBER! SCC1 1f51903
EXPIRATION DATE: AUGUST 31, 2022

Always verify licenses online at MyFloridalicense.com

Do not alter this document in any form.

This is your license. It is unlawful for anyone other than the licensee to use this document.

CONTRACTOR'S OPERA TING CERTIFICATE SARASOTA COUNTY
Registered Irrigation Specialty Contractor
EXPIRES :9/30/22 LICENSE# SIS - 77
HOOVER, BRENT
HOOVER PUMPING SYSTEMS CORP 2801 N POWERLINE RD
POMPANO BEACH FL 33069
USA

NAME,ADDRESS OR STATUS CHANGE MUST BE SENT TO THIS OFFICE WITHIN 30 DAYS
MAIL TO: PLANNING AND DEVELOPMENT SERVICES BUSINESS CENTER
1001 SARASOTA CENTER BLVD SARASOTA, FLORIDA 34240
(941) 861-5214

Signature: --------------

WALLET CARD- TEAR HERE	FOLD HERE	CUT HERE

IMPORTANT REMINDER
TO CERT./REG CONTRACTORS
Chapter 489, Pt. 1 requires:

That the state registration or certification number of each contractor shall appear in any ADVERTISING MEDIUM used by contractor.

That a contractor may only d/b/a his name as it appears on his state registration / certification card(s) and that all contract forms shall comply accordingly.

(OFFICE USE ONLY)

tegistered Irrigation Specialty Contracto

LICENSE# HOOVER, BRENT

SIS - 77

HOOVER PUMPING SYSTEMS CORP 2801 N POWERLINE RD
POMPANO BEACH FL 33069 USA

16 136461000 00 LR	PLANNING & DEVELOPMENT SERVICES BUSINESS CENTER
SARASOTA COUNTY

Printed On:  9/2/20

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DIVISION OF CORPORATIONS

I
(
..org

Deµartment of State I D_ivision of Corporations I Search Recor,ds / Search by Entity Name /

Detail by Entity Name
Florida Profit Corporation
HOOVER PUMPING SYSTEMS CORPORATION
Filing Information
Document Number	H31261

FEI/EIN Number	59-2498106
Date Filed	11/26/1984
State	FL
Status	ACTIVE
Last Event	REINSTATEMENT
Event Date Filed	09/10/1993
PrinciP.al Address
BRENT HOOVER
2801 N POWERLINE RD POMPANO BEACH, FL 33069

Changed: 04/13/2009
Mailing Address
BRENT HOOVER
2801 N POWERLINE RD POMPANO BEACH, FL 33069

Changed: 04/13/2009
Registered Agent Name & Address
FERENCIK LIBANOFF BRANDT AND BUSSTAMANTE 150 S. PINE ISLAND RD.
STE 400
FORT LAUDERDALE, FL 33324
Name Changed: 04/27/2011 Address Changed: 05/03/1999
Officer/Director Detail Name & Address

Title DPS HOOVER, BRENT

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2801 N Powerline RD Pompano Beach, FL 33069

TitleT, VP

HOOVER, DONNA
2801 N Powerline RD Pompano Beach, FL 33069

Annual Regorts
Report Year	
Filed Date	
2020	03/18/2020	
2021	03/11/2021	
2022	03/04/2022	

Document lmag§	

03104/2022 -- ANNUAL REPORT!	View image in PDF format
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03/1812020 c-.ANNUAL REPORT]	View image in PDF format
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	============:

0412.712011 --_ANNUAL_REPORTI

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02/1912010 --_ANNUAL_REPORTi	View image in PDF format
::==========-==:-7
0411312009 --ANNUAL REPORT:! ==Vi=ew=ima=ge=in=PD=F fo=rm=al =:,

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0.1/2.2I2008 --_ANNUAL.REPORTj

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View image in PDF format

===========:

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:.===========!
02/01/2005 -- ANNUAL REPORT;[ ::V=iew=im=ag=e =in =PD=F f=orm=a=t =:

:============:

02/19/2004_--ANNUAL_REPORT]	View image in PDF format

	============:

0810512003_--_ANNUAL_REPORTj	View image in PDF format	j
Q.2@/2QQ2 -- ANNUAL R!;_f'_QE:J! :=V=iew=im=a=ge=in =PD=F =form=a=t =!
01/26/2001_-- ANNUAL_REPQRT:! ==V=iew=im=a=ge=in =PD=F f=orm=a=t =:
04/19/2000-- ANNUAL REPORT'	View image in PDF format
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;

::==========

=:

05/03/19\19.--ANNUAL REPQRTj

01/22/1998 -- ANNUAL.REPORT!

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============:
Q3J.Q3Ll99Lc_ANNUAL REP.QR.;I! ::V=iew=im=a=ge=in =PD=F f=orm=a=t =:
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Florida Department of State, Division of Corporations

	DATE (MM/DD/YYYY)
03/25/2022	
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  Denise D'Abato
NAME:	ro .		
Brown & Brown of Florida, Inc.			
P.O. Box 2412		E-MAIL	denise.dabato@bbrown.com
ADDRESS:	
		
INSURER(S) AFFORDING COVERAGE	
NAIC#	
Daytona Beach	FL 32115-2415	INSURER A:  FCCI Insurance Company	10178	
INSURED		INSURER B: Travelers Property Casualty Company of America	25674	
HOOVER PUMPING SYSTEMS, CORP.		INSURER C:  National Trust Insurance Company	20141	
2801 NORTH POWERLINE RD		INSURER D:  Continental Casualty Company	20443	
		INSURER E:		
POMPANO BEACH	FL 33069	INSURER F:		

ACORD®	CERTIFICATE OF LIABILITY INSURANCE	I

COVERAGES	CERTIFICATE NUMBER·	22-23	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.	
1.. ..
LTR	TYPE OF INSURANCE	
INSD	wvo	POLICY NUMBER	POLICY EFF
IMM/0D/YYYYI	POLICY""
IMM/DD/YYYYl	LIMITS	

A
R	-X
-	COMMERCIAL GENERAL LIABILITY
:J CLAIMS-MADE [81OCCUR			

GL100076294-00	

04/01/2022	

04/01/2023	EACH OCCURRENCE	$ 1,000,000	
								U'Alor...,,;n;;; 1vn ,lt::.U
PREMISES 1Ea occurrence I	$ 1,000,000	
								MED EXP /Any one oerson)	$ 10.000	
								PERSONAL & ADV INJURY	$ 1,000,000	
									$ 2,000,000	
	GEN'LAGGREGATE LIMIT APPLIES PER:						GENERAL AGGREGATE		
	POLICY [8j f &  [81LOC						PRODUCTS - COMP/OPAGG	$ 2,000,000	
	- OTHER:								
								$	

C	AUTOMOBILE LIABILITY			

CA100076296-00	

04/01/2022	

04/01/2023	; llNGLE LIMIT	s 1,000,000	
	-	ANY AUTO						BODILY INJURY (Per person)	$	
		OWNED	-
AUTOS ONLY HIRED AUTOS ONLY	SCHEDULED
-	AUTOS						BODILY INJURY (Per accident)	$	
			-	NON-OWNED
AUTOS ONLY								
										ROPERTY DAMAGE
Per accident	$	
										PIP	$ 10,000	
		UMBRELLA LIAB						EACH OCCURRENCE	$ 5,000,000	
B	X	OCCUR
EXCESS LIAB	CLAIMS-MADE			CUP-IT435725-22	04/01/2022	04/01/2023			
								AGGREGATE	, -	$  5,000,000	
		DED I XI RETENTION $ 1O,OOO						PRODS/COMPLETED	$  5,000,000	
	WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY	YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE □
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below	

NIA					IPER	I
STATUTE		
							E.L. EACH ACCIDENT	$	
							
E.L. DISEASE- EA EMPLOYEE	
$	
							E.L. DISEASE· POLICY LIMIT	$	

A	
INLAND MARINE			
CM100076293-00	
04/01/2022	
04/01/2023	
RENTED	
$100,000	
							INSTALLATION	$200,000	
DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be a1tached If more space Is required)
SEE NOTES FOR POLICY COVERAGE FORMS BANKUNITED, NA ISAOA IS ADDITIONAL INSURED AND A WAIVER OF SUBROGATION APPLIES, AS REQUIRED BY WRITTEN CONTRACT AND IF APPLICABLE, PER THE FORMS LISTED ON THE ATTACHED ADDITIONAL REMARKS SCHEDULE.	
CERTIFICATE HOLDER	CANCELLATION
	
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.	
	AUTHORIZED REPRESENTATIVE	

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD

AGENCY CUSTOMER ID: 	 LOC#:
ADDITIONAL REMARKS SCHEDULE	Page	of

AGENCY
Brown & Brown of Florida, Inc.	NAMED INSURED
HOOVER PUMPING SYSTEMS, CORP.	
POLICY NUMBER
CARRIER	I NAICCOOE		
		
	EFFECTIVE DATE:	
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25	FORM TITLE: Certificate of Liability Insurance: Notes OTHER NAMED INSUREDS:
HOOVER IRRIGATION CORPORATION
SEATON RENTALS, LLC

CRIME­ CARRIER: D
POLICY NUMBER: 596721532
EFFECTIVES DATES: 04/01/2022-04/01/2024 LIMIT: 3RD PARTY-$100,000

CURRENT BLANKET POLICY FORMS:

GENERAL LIABILITY
CGL 0841013-ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS-AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU- ONGOING OPERATIONS AND PRODUCTS-COMPLETED OPERATIONS (INCLUDING ONGOING AND COMPLETED OPERATIONS, ADDITIONAL INSURED-ARCH/ENG /SURVEYORS EMPLOYED BY OTHERS, PRIMARY AND NON- CONTRIBUTORY)
CGL 088 0115 - FIRST CHOICE CONTRACTORS LIABILITY ENDORSEMENT (PER PROJECT, PER LOCATION, ADDITIONAL INSURED- LESSOR OF EQUIPMENT. ADDITIONAL INSURED - MGR OR LESSOR OF PREMISES, ADDITIONAL INSURED-STATE OR POLITICAL, WAIVER OF SUBROGATION)

AUTO LIABILITY:
CAU 058 0519 -AUTO FIRST CHOISE ENDORSEMENT (ADDITIONAL INSURED, WAIVER OF SUBROGATION)
CAU 082 0115-AUTOMATIC INSURED-BUSINESS AUTO POLICY PRIMARY/NON-CONTRIBUTING WHEN REQUIRED BY CONTRACT (PRIMARY NON-CONTRIBUTORY)

UMBRELLA/EXCESS LIABILITY:
1) EU0001 0716- EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE (FOLLOWS FORM OVER THE GENERAL LIABILITY, AUTO LIABILITY AND EMPLOYERS LIABILITY, ADDITIONAL INSURED, PRIMARY AND NON- CONTRIBUTORY, WAIVER OF SUBROGATION)

HOOVPUM-02	l"'.4RLEJ

ACORD

CERTIFICATE OF LIABILITY INSURANCE

I

DATE (MMIDD/YYYY)
3/25/2022

1

PRODUCER
Insurance Office of America 2056 Vista Parkway, Suite 350 West Palm Beach, FL 33411

I cT Dianthe Charron
rti8,Ntio, Ext): (561) 459-3285

I FAX

(A/C, Nol:

L hs·Dianthe.Charron@ioausa.com
INSURER(Sl AFFORDING COVERAGE 	

--

NAIC-#--

INSURER A: Associated Industries Insurance Compan',/, Inc  23140

INSURED

Hoover Pumping Systems Corporation 2801 N. Powerline Road
Pompano Beach, FL 33069

I

INSURER F:

I

INSURER E:

I

INSURERD:

I t,j_S_U_RER B :			 INSURERC:		I

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).

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.

COVERAGES	CERTIFICATE NUMBER·	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.		-
INJ!l,	TYPE OF INSURANCE	fil:-	POLICY NUMBER	,.i:21-&%M"lvi POLIC'(EXP	LIMITS

l

-	COMMERCIAL GENE□RAL LIABILITY

-

EACH OCCURRENCE	- $

CLAIMS-MADE
-	f	'

-

-

'LAGGREGATE LIMIT APPLIES PER:

□

OCCUR
-
□

DAMAGE TO RENTED
<ilEa.0.CGUfJen<<eJ_   $_
MED EXP 1/vlv one llersonl	$

GENERAL AGGREGATE

$

PERSONAL & ADV INJURY	s

BODILy INJURY (Per_£llrson) . $

F

POLICY OTHER:

1 'c?r

LOC

PRODUCTS • COMP/OP AGG  $
$

---

AUTOMOBILE LIABILITY

oAU=TOeSoONLY
HIRED AUTOS ONLY

---;

ANY AUTO

SCHEDULED

AUTOS
NON-OWNED AUTOS ONLY

F

COMBINED SINGLE LIMIT
..JE.., fiident\

$	-----  -

$

$

$

I	UMBRELLA LIAB   OCCUR
EXCESS LIAB	CLAIMS-MADE

OED	RETENTION$
A WORKERS COMPENSATION

□

AND EMPLOYERS' LIABILITY	YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED?

N/A

WC1180687

4/1/2022

4/1/2023

BODILy INJURY (Per ac-9.denl\
FP 7 fc d1;, t?AMAGE

EACH OCCURRENCE	$

AGGREGATE	$
s

FR

XffnrrFI	OTH-
E.L. EACH ACCIDENT	s

1,000,000
1,000,000

(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below

I	I

E.L. DISEASE - EA EMPLOYEJ $
E.L. DISEASE - POLICY LIMIT I s
I	I

1,000,000

DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)

	
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE	
	THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN	
	ACCORDANCE WITH THE POLICY PROVISIONS.	
	AUTHORIZED REPRESENTATIVE	
		
	(:-hJ t<L;,	

CERTIFICATE HOLDER	CANCELLATION