Golden Gem Community Development District

Agenda November 13, 2024

Agenda

Golden Gem
Community Development District

219 E. Livingston Street, Orlando, Florida 32801 Phone: 407-841-5524 – Fax: 407-839-1526
November 6, 2024

Board of Supervisors Golden Gem Community Development District

Dear Board Members:

The meeting of the Board of Supervisors of the Golden Gem Community Development District will be held Wednesday, November 13, 2024 at 10:30 a.m. at the offices of GMS-CF, 219 E. Livingston Street, Orlando, Florida. Following is the advance agenda for the regular meeting:

Roll Call
Public Comment Period
Approval of Minutes of the September 11, 2024 Meeting
Consideration of Infrastructure Change Order #4 for RCS Construction Co.
Ratification of Execution of the Wyld Oaks Plat
Ratification of Series 2024 Requisitions #11 - #19
Staff Reports
Attorney
Engineer
District Manager’s Report
Balance Sheet and Income Statement
Ratification of Funding Requests #9 - #10
Other Business
Supervisor’s Requests
Adjournment

The balance of the agenda will be discussed at the meeting. In the meantime, if you should have any questions, please contact me.

Sincerely,
George S. Flint
George S. Flint District Manager

Cc:	Alyssa Willson, District Counsel Kevin Roberson, District Engineer

Enclosures

Minutes

MINUTES OF MEETING GOLDEN GEM
COMMUNITY DEVELOPMENT DISTRICT

The regular meeting of the Board of Supervisors of the Golden Gem Community Development District was held Wednesday, September 11, 2024 at 10:30 a.m. at the Offices of GMS-CF, 219 E. Livingston Street, Orlando, Florida.

Present and constituting a quorum were:

Craig Linton, Jr.	Chairman
H.M. Ridgely, III	Vice Chairman
Taylor Edwards	Assistant Secretary
Duane “Rocky” Owen	Assistant Secretary
George Hamner, Jr.	Assistant Secretary Also present were:
George Flint	District Manager
Alyssa Wilson by phone	District Counsel
Kevin Roberson by phone	District Engineer

FIRST ORDER OF BUSINESS	Roll Call
Mr. Flint called the meeting to order and called the roll. Five Board members were present constituting a quorum.
SECOND ORDER OF BUSINESS	Public Comment Period
Mr. Flint stated no members of the public were present to provide comment.

THIRD ORDER OF BUSINESS	Approval of Minutes of the June 12, 2024
Meeting
Mr. Flint presented the minutes of the June 12, 2024 Board of Supervisors meeting. He asked if the Board had any comments or corrections to the minutes.

On MOTION by Mr. Hamner, Jr., seconded by Mr. Linton, Jr., with all in favor, the Minutes of the June 12, 2024 Meeting, were approved.

September 11, 2024	Golden Gem CDD

FOURTH ORDER OF BUSINESS	Consideration	of	Resolution	2024-41
Designating Regular Monthly Meeting Date, Time and Location for Fiscal Year 2025
Mr. Flint presented Resolution 2024-41 to the Board. The proposed regular monthly meeting date, time and location is the second Wednesday in this location at 10:30 a.m. The Board agreed with the proposed meeting date, time, and location.

On MOTION by Mr. Ridgely, III., seconded by Mr. Linton, Jr., with all in favor, Resolution 2024-41 Designating Regular Monthly Meeting Date, Time and Location for Fiscal Year 2025, was approved.

FIFTH ORDER OF BUSINESS	Consideration	of	Resolution	2024-42
Ratifying, Confirming and Approving the Sale of the Series 2024 Bonds
Mr. Flint presented Resolution 2024-42 to the Board stating this ratifies, confirms, and approves the sale of the Series 2024 bonds. Ms. Wilson explained that this is a standard form of resolution that they provide after the closing and sale of the bonds. She added that this ratifies all actions associated with closing of bonds of the Chair and staff. Mr. Flint further explained that they finalize the assessments when they issue the bonds, but this resolution ratifies all the actions taken by the Chair and staff and signing and executing everything necessary.

On MOTION by Mr. Hamner, Jr., seconded by Mr. Linton, Jr., with all in favor, Resolution 2024-42 Ratifying, Confirming and Approving the Sale of the Series 2024 Bonds, was approved.

SIXTH ORDER OF BUSINESS	Consideration  of  Disclosure  of  Public
Finance (Series 2024 Bonds)
Mr. Flint explained that statutes require the District take certain steps to disclose the fact that the District has issued bonds. He explained that one way they handle this is a recording of a lien associated with the debt service assessment. He noted they also have a disclosure of public financing that gets recorded in the public record so that anyone purchasing property within the boundaries of the District during the title work, this disclosure will come up in the title work and it discloses the fact that the property is within the CDD that bonds have been issued. He added that it generally describes the bonds, the amounts, the assessment levels, what they’re being used, how the assessments are being collected and who they would contact if they had questions. The question was asked who they would contact if they had questions. Mr. Flint responded that they would

September 11, 2024	Golden Gem CDD

contact this office with any questions. He stated their address and contact information is in the notice of disclosure. He asked for any more questions on the disclosure. Hearing none, Ms. Wilson requested approval in substantial form in an abundance of caution.

On MOTION by Mr. Edwards, seconded by Mr. Linton, Jr., with all in favor, Disclosure of Public Finance (Series 2024 Bonds), was approved in substantial form.

SEVENTH ORDER OF BUSINESS	Ratification of Series 2024 Requisitions #1-
#10
Mr. Flint stated they have a number of requisitions that have been processed for the Series 2024 bonds. He explained that Board approval is not necessary prior to processing those; however, they like to get them on the agenda, so they get in the public record, and they are ratified by the Board. The question was asked what the approval process was. Mr. Flint explained that there was a form of requisition that has to be signed by an authorized representative of the District and by the District Engineer. He further explained that the District Engineer signs it certifying that the costs that are included are consistent and in accordance with the District Engineer’s report that the Board approved. He added that it has to be signed by the District and normally that would be the Chair or Mr. Flint, himself, as District Manager.
Mr. Flint presented Requisitions #1-#10. He explained that many of these requisitions are for RCS Construction Co. Inc. He stated that contract was assigned to the District, so they District is actually the party that is under contract with RCS. He explained that the backup for these requisitions are prepared by the District Engineer and there is a process behind the scenes. He added that there is also some notice they have to give one of the other party’s involved because there is some shared cost obligations.

On MOTION by Mr. Linton, Jr., seconded by Mr. Hamner, Jr., with all in favor, the Series 2024 Requisitions #1-#10, were ratified.

EIGHTH ORDER OF BUSINESS	Staff Reports
Attorney
Ms. Wilson asked if there was an update on anticipated closings with any third parties. The response was that the closing with Madison, their first multi-family closing, is still scheduled for October 31. It was explained that there have been a few conversations that that may get amended to be 30 days or so later, but as of right now, it’s still looking to be October 31. Ms. Wilson asked

September 11, 2024	Golden Gem CDD

Mr. Edwards to coordinate at some point a call as they get a little bit closer with herself, Mr. Flint, and some team members associated with the closing on that to make sure they are prepared to help with any assessment related items. Mr. Edwards responded that he would set up the call. Ms. Wilson didn’t have anything further to report to the Board but was available for questions. Hearing no questions, the next item followed.

Engineer
Consideration of Change Orders #2 & #3 with RCS Construction Company
Mr. Roberson presented two change orders to the Board. He stated that Mr. Edwards and himself have been working with the contractor and the numbers are slightly different than what is in the packet. He explained that the one labeled Change Order #2 was essentially trying to get the construction plans up to date with some site plan changes that have been occurring over the last five or six months. He further explained that most of that had to do with changing of utilities and driveway locations. He explained that Change Order #3 is regarding adding some sleeving to Sadler Road. He discussed the differences to both change orders. Change Order #2 went up as of last night to $294,214 and Change Order #3 went down as of last night to $30,360. Ms. Wilson requested approval in substantial form to what is presented subject to revisions that will incorporate the modifications that Mr. Roberson just described.

On MOTION by Mr. Ridgely, III, seconded by Mr. Edwards, with all in favor, the Change Orders #2 & #3 with RCS Construction Company, was approved in substantial form.

Mr. Ridgely, III stated they got one additional change order last night from the contractor that is not shown at all in draft form in this packet. He asked if there was a way to approve that at this meeting. Mr. Flint responded yes; if they know the dollar amount and the change order number, the Board can consider a motion approving it subject to review by District Engineer and Counsel. Mr. Roberson stated this additional change order would be for the mass grading side of the contract. He stated the total value of this change order is an increase of $327,000. They delegated authority subject to staff review.

On MOTION by Mr. Linton, Jr., seconded by Mr. Hamner, Jr., with all in favor, the Additional Change Order Increase of $327,000, was approved.

September 11, 2024	Golden Gem CDD

District Manager’s Report
Balance Sheet and Income Statement
Mr. Flint reviewed the unaudited financial statements through the end of August. He asked for any questions. There was no action required.

Ratification of Funding Request #6 – #8
Mr. Flint reviewed the Funding Requests #6 - #8.

On MOTION by Mr. Linton, Jr., seconded by Mr. Edwards, with all in favor, Funding Requests #6-#8, were ratified.

NINTH ORDER OF BUSINESS	Other Business
There being no comments, the next item followed.

TENTH ORDER OF BUSINESS	Supervisor’s Requests
There was a question regarding the bond sales asking if it was possible to get a registry list of the purchasers of the lands. Mr. Flint stated they could reach out to the underwriter, but they generally don’t know who the bond holders are unless there is an issue where they have to get bond holder consent. Mr. Flint is going to ask the underwriter to find out.
ELEVENTH ORDER OF BUSINESS	Adjournment

On MOTION by Mr. Hamner, Jr., seconded by Mr. Linton, Jr., with all in favor, the meeting was adjourned.

Secretary/Assistant Secretary	Chairman/Vice Chairman

Section IV

CONTRACTOR:	RCS Construction Co.
OWNER:	Golden Gem Community Development District
PROJECT:	Infrastructure - Wyld Oaks
CONTRACT DATE:	12/03/2023	CHANGE ORDER NUMBER: 04 CHANGE ORDER DATE: 10/08/2024

CHANGE ORDER

The Owner hereby gives the Contractor this Change Order for, and the Contractor agrees to provide and perform, the materials and Work described below:
Addition for builders risk coverage concerning Infrastructure - Wyld Oaks Project.

1.	Original Contract Sum	$	14,205,206.49	
2.	Total net change by previous Change Orders	
$	30,360.00	
3.	Contract Sum prior to this Change Order	
$	14,745,227.07	
4.	Contract Sum will be increased with this Change Order	
$	25,615.00	
5.	Adjusted Contract Sum including this Change Order	
$	14,770,842.07	

This Change Order represents the entire and integrated agreement between the parties and supersedes all prior negotiations and Qualifications; but this Change Order and the Work contemplated herein is, except as otherwise specifically provided herein, subject to all the terms and conditions of the Contract including, without limitation, those concerning payment.

OWNER
Double “B” Development

By: 				 Print Name:			 Title:			 

Date:	

CONTRACTOR

RCS Construction Co., Inc.

By: 				 Name:	 		 Title:		

Date:	

.

Infrastructure - Wyld Oaks Date: 10/08/2024
Change Order -04

Revision #10 FM/RU Tap

Golden Gem Roadway Work

CO #	General Description	Quantity	U/M	Unit Cost	Notes	Days	Total CO	
	Revision 10				`			
1	Patch Force Main Tap on Golden Gem Raod	1	LS	$1,490.00		0.5	$	1,490.00	
2	1.25" Mill of Golden Gem 100'	1	LS	$4,620.00		1	$	4,620.00	
3	Overlay 1.25" SP 9.5 Asphalt	1	LS	$13,205.00		1	$	13,205.00	
4	MOT/Markings	1	LS	$4,700.00		1	$	4,700.00	
5	Layout/As-Built	1	LS	$1,600.00		2	$	1,600.00	

								

								

TOTAL CHANGE ORDERS TO DATE	Total Days	5.5	$	25,615.00

Section V

SHANNON SURVEYING, INC.
499 NORTH S,R, 434 - SUITE 2045 ALTAMONTE SPRINGS, FLORIDA, 32714

WYLD	OAKS

SHEET 1 OF 4

PLAT
BOOK	PAGE

(407) 774-8372	LB # 6898	A REPLAT OF KELLY PARK CROSSINGS, PLAT BOOK 111, PAGES 122 AND 123 AND A PORTION OF SECTION 13, TOWNSHIP 20 SOUTH, RANGE 27 EAST
CITY OF APOPKA, ORANGE COUNTY, FLORIDA

WYLD OAKS
DEDICATION

LEGAL DESCRIPTION:

A Replat of Kelly Park Crossings, according to the plat thereof as recorded in Plat Book 111, Pages 122 and 123, Public Records of Orange County, Florida and a portion of Section 13, Township 20 South, Range 27 East, Orange County, Florida, being more particularly described as follows

Beginning at the South quarter corner of Section 13, Township 20 south, Range 27 East, Orange County, Florida; thence run S89'31'40"W, along the South line of the Southwest quarter of said Section 13 for a distance of 1356.86 feet;  thence departing said South line, run N00'29'47"W for a distance of 673.93 feet to a point on the North line of the North 1/2  of  the  Southwest quarter of the Southwest quarter of said Section 13; thence run S89'23'24"W along said North line for a distance of 1325.15 feet; to a point on the Easterly right of way line of Golden Gem Road, as recorded in Official Records Book 61, Page 315 of the Public Records of Orange County, Florida;  thence departing said North
line, run N00'21'03"W along said Easterly right of woy line for a distance of 2018.83 feet to a point on the North line of the Southwest quarter of aforesaid Section 13; thence run N00'29'36"E, continuing along said Easterly right of way line for a distance of 2603.70 feet to a point on the South right of way line of Kelly Park Road according to Deed Book 398, Page 190 of the aforesaid public records; thence departing said Easterly right of w.ay line, run N89'53'52"E, along said South right of way line for a distance of 1324.32 feet; thence departing said South right of way line, run S00'04'14"E for a distance of 853.16 feet; thence run N89'34'17"E for a distance of 160.19 feet; thence run S00'25'43"E for a
distance of 30.00 feet; thence run N89'34'17"E, along a line parallel with the South line of the Northeast quarter of the Northwest quarter of

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VICINITY MAP
NOT TO SCALE
KELLY PARK ROAD

KNOW ALL MEN BY THESE PRESENTS, That Kelly Pork VB Development, LLC, a Delaware limited liability company, being the owners in fee simple of the lands described in the foregoing caption to this plat, hereby dedicates said lands and plat for the uses and purposes therein expressed as shown hereon and dedicates Sadler Road & Effie Drive & Tracts D & E to the perpetual use of the public.
IN WITNESS WHEREOF, the undersigned, Kelly Park VB Development, LLC, a Delaware limited liability company,  has caused  these presents  to  be
executed and acknowledged fY its  undersigned representative thereunto duly authorized on this o<"	day of	Oc+•b r 	, 2024.
Kelly Pork VB Development, LLC,
a Delaware limited liability company
By: KPVB Acquisition, LLC,
a Delaware limited liability company, its Member
By: WO Assignment  LLC,
a Florido limited liability company, its Member
By:	c!=r '[5q
Printed Name: Kevin Barry Title: Manager

said Section 13 for a distance of 476.16 feet; thence run N00'21'18"W for a distance of 579.54 feet; thence run S89'53'52"W for a distance of

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66.00 feet;  thence run N00'21'18"W for a distance of 256.00 feet to a point on the  South right of way line of Kelly Park Road according to

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Document Number 20140460923 of the aforesaid Public Records of Orange County, Florida; thence run the following 2 courses along said South
right of way line: N89'53'52"E for a distance of 588.40 feet; thence run S00'29'13"E for a distance of 35.75 feet to a point on the South limited access right of way line of State Rood Number 429/Wekivo Parkway; thence run the following courses along the South and West limited

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access right  of  way line:  N89'17'56"E  for  a distance  of  90.86  feet;  thence run  S47'15'37"E  for  a distance  of  44.44  feet;  thence  run

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couNTY oF 1NwriJJ Rivt:£

S03'35'05"E for a distance of 266.15 feet; thence run S00'49'55"E for a distance of 485.06 feet to the point on a non tangent curve, concave Northeasterly having a radius of 2003.86 feet, with a chord bearing of S17'19'29"E, and a chord distance of 152.02 feet; thence run Southeasterly along the arc of said curve through a central angle of 04'20'51" for a distance of 152.05 feet to a point on a non tangent line; thence run S19'30'03"E for a distance of 334.38 feet to a point on a non tangent curve, concave Westerly having a radius of 1815.86 feet, with a chord bearing of S09'55'47"E, and a chord distance of 603.87 feet; thence run Southerly along the arc of said curve through a central angle of 19'08'34" for a distance of 606.68 feet to a point of tangency; thence run S00'21'30"E for a distance of 800.00 feet; thence run S02'15'59"E for a distance of 360.40 feet; thence run S00'22'19"E for a distance of 845.51 feet; thence run S88'57'47"W for a distance of
249.88 feet; thence run S00'38'28"E for a distance of 1350.83 feet to the point of beginning.

Contains 13,254,910 square feet or 304.291 acres, more or less.

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PONKAN ROAD

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The foregoing instrument was acknowledged before me by means of
IXJ physical presence or D online notarization, this _lk:!_day of Oc:h,be 
by Kevin Barry, as Manager of WO Assignment, LLC, a Florido limited liability company, which is the Member of KPVB Acquisition, LLC, a Delaware limited liability company,  which is a member  of Kelly Park VB
Development, LLC, a Delaware limited liability company, on behalf of the company, who is l8J personally known to me or D hos produced as
identification.

NOTICE: THIS PLAT, AS RECORDED IN ITS GRAPHIC FORM, IS THE OFFICIAL DEPICTION OF THE SUBDIVIDED LANDS DESCRIBED HEREIN AND WILL IN NO CIRCUMSTANCES BE SUPPLANTED IN AUTHORITY BY ANY OTHER GRAPHIC OR DIGITAL FORM OF THE PLAT.

NOTARY OF PUBLIC	)_

GENERAL NOTES:

Bearings shown hereon are based on the South line of the Southwest 1/4  of Section 13-20-27 as being S89'31'40"W as shown on the plat of Kelly Pork Crossings, Plat Book 111, Pages 122 and 123, Public Records of Orange County, Florida.
All lot lines ore radial, unless otherwise noted non-radial.

Signature of Notary:= =""	­
Printed Nome: ob«ti ('l\iott!  )
Commission Number: Hff (7(,33/
My Commission Expires: 9-)2-/).&

NOTICE: THERE MAY BE ADDITIONAL RESTRICTIONS THAT ARE NOT RECORDED ON THIS PLAT THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY.

DEDICATION

..............	SHERRI MINCEY

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f """f\ MYCOMMISS!ON#HH 176331
EXPIRES:September 22, 2025
•'!_.'.J.•.if.F.•.f.i..,.O •••  Bonded Thfu Notary N,ljcUndendefl

All platted utility easements shall provide that such easements shall also be easements for the construction, installation, maintenance, and operation of coble television services; provided, however, no such construction, installation, maintenance, and operation of cable television services shall interfere with the facilities and services of an electric, telephone, gos, or other public utility. In the event a cable television company damages the facilities of a public utility, it shall be solely responsible for the damages. This section shall not apply to those private easements granted to or obtained by a particular electric, telephone, gas, or other public utility. Such construction, installation, maintenance, and operation shall comply with the national electrical safety code as adopted by the Florido Public Service Commission.

Tracts A and B shown hereon are designated as stormwoter retention/detention tracts and ore hereby reserved by Kelly Park VB Development, LLC for conveyance by separate instrument to Golden Gem Community Development District established pursuant to Chapter 190, Florida Statutes, or a non-profit property owners' association. Tract C previously has been conveyed to Golden Gem Community Development District and is designated as stormwater retention/detention tract.

The property which is the subject of this Plat is encumbered by that certain Declaration of Covenants, Easements & Restrictions far W d Oaks doted November 21, 2023 under Instrument No. 20230677899 of the Public Records of Orange County Florido as amended, which establishes various covenants, easements and restrictions applicable to the property and provides for owners within the property to be members of Wyld Oaks Community Association, Inc., a Florida a non-profit corporation.

KNOW ALL MEN BY THESE PRESENTS, That LIT Cadence West Kelly Phase I, LLC, a Delaware limited liability company, by virtue of Special Warranty Deed recorded in Official Records Doc# 20230343656, Public Records of Orange County, Florida, being the owners in fee simple of the lands described in the foregoing caption to this plot,. hereby dedicates said lands and plat for the uses and purposes therein expressed as shown hereon and dedicates nothing to the perpetual use of the public.
IN WITNESS WHEREOF, the undersigned, LIT Cadence West Kelly Phase I, LLC, a Delaware limited liability company, by virtue of Special Warranty Deed recorded in Official Records Doc# 20230343656, has caused these presents to be executed and acknowledged by its undersigned Officer thereunto duly authorized on this 	 day of 	 , 2024.
LIT Cadence West Kelly Phase I, LLC, a Delaware limited liability company
By: Cadence Kelly GP 1 LLC,
a Florida limited liability company, its managing member

By:-----------
Printed Name: 		 Title: 	_ Signed in the presence of:

Golden Gem Community Development District

As owner of Tract C of the  plot hereof by virtue of Special Warranty Deed recorded in Official Records Doc# 20240349059, Public Records of

By:-----------
Printed Name: 	

STATE OF 	 _

By:------------
Printed Name: 	_

COUNTY OF 	_

SHEET INDEX

SHEET 1 OF 4	-  Legal description, dedication,
Surve_yors notes & legend

SHEET 2 OF 4	-  Plat Boundary

SHEETS 3 & 4  -  Lot and Easement geometry

LEGEND:

Orange County, Florida, the Chair/Vice-Choir of the Board of Supervisors of the Golden Gem Community Development District hereby consents to and joins in to the recording of this instrument and the dedications shown hereon.

Choir

Witness

CERTIFICATE OF APPROVAL BY MUNICIPALITY
THIS IS TO CERTIFY, that on 	 the City Council of the City of Apopka approved the foregoing plat.
CERTIFICATE OF APPROVAL BY

The foregoing instrument was acknowledged before me by means of
D physical presence or D online notarization, this   	day of 	 _ by	 , as 	of Cadence Kelly GP 1 LLC, a Florida limited liability company, as the managing member of LIT Cadence West Kelly Phase I, LLC, a Delaware limited liability company, on behalf of the
company, who is D personally known to me or D has produced as identification.
NOTARY OF PUBLIC
Signature of Notary:	 _ Printed Name: 		 _ Commission Number: 		 _ My Commission Expires:. 	 _

o - RECOVERED 4"x4" CM PRM LB 6723 UNLESS OTHERWISE NOTED
0 - RECOVERED AS NOTED
@ -  SET NAIL & DISK PCP 4671
(PERMANENT CONTROL POINT)
-  INDICATES CENTERLINE
# -  NUMBER
CM - CONCRETE MONUMENT
CCR - CERTIFIED CORNER RECORD ID - IDENTIFICATION
LB - LICENSED BUSINESS CERTIFICATION NT - NON TANGENT
ORB - OFFICIAL RECORDS BOOK PB - PLAT BOOK
PG -  PAGE
RM - PERMANENT REFERENCE MONUMENT
P.T. -  POINT OF TANGENCY
P.0.L. -  POINT ON LINE
D - DELTA (CENTRAL ANGLE) CB - CHORD BEARING
R - RADIUS L -  LENGTH

Mayor, City of Apopka Attested by City Clerk

City Clerk, Susan M. Bone

QUALIFICA110N STATEMENT OF SUR,

Date

Dote
D MAPPER

APOPKA PLANNING COMMISSION
THIS IS TO CERTIFY, that on 	2024
the Apopka Planning Commission approved the foregoing plat.

Chairman	Date

QUALIFICA110N STATEMENT OF REVIEWING SURVEYOR
Pursuant to Section 177.081, Florida Statutes, I have reviewed this plat for conformity to Chapter 177 of the Florida Statutes and that said plat complies with the technical requirements of that Chapter; provided however, that my review does not include field verification of any of the coordinates, points or measurements shown on this plot.

CERTIFICATE OF APPROVAL BY CITY ENGINEER
THIS IS TO CERTIFY, that on 	 the foregoing plot was examined and approved by:

City Engineer:	Dote

CERTIFICATE OF APPROVAL BY COUNTY COMPTROLLER
HEREBY CERTIFY that the foregoing plot was recorded in Orange County Official Records
on ---------- as Doc No.---------------
County Comptroller in and for Orange County, Florida

CL -  CENTERLINE
PRM - PERMANENT REFERENCE MARKER

Printed Nome: Registration No.

Dote

By: 	

SHANNON SURVEYING, INC.	WYLD	OAKS	SHEET 2	OF 4
499  NORTH S.R. 434  -  SUITE 2045
ALTAMONTE SPRINGS, FLORIDA, 32714
(407)  774-8372	LB#  6898	A REPLAT OF KELLY PARK CROSSINGS, PLAT BOOK 111, PAGES 122 AND 123	PLAT
BOOK	PAGE 	
AND A PORTION OF SECTION 13, TOWNSHIP 20 SOUTH, RANGE 27 EAST CITY OF APOPKA, ORANGE COUNTY, FLORIDA
KELLY PARK ROAD				NORTHWEST CORNER OF		SOUTH LIMITED ACCESS RIGHT OF WAY LIN	 NORTHEAST CORNER OF THE NORTHWEST 1 / 4 OF	KELLY  PARK  ROAD-		OF STATE ROAD 429/WEKIVA PARKWAY	THE NORTHWEST 1/4  OF
SECTION 13-20-27	RIGHT OF WAY VARIES	SECTION 13-20-27
CCR #0047868				SOUTH RIGHT OF WAY LINE			CCR #0047869 RECOVERED 3 / 4"	NORTH LINE OF THE NORTHWEST]			OF KELLY PARK ROAD PER	N89"17'56" 	 RECOVERED 5/8" IRON ROD, NO ID		1/4  OF SECTION 13-20-27	N89"53'52: •E		DOC. #20140460923		90.86'	 IRON ROO, NO ID
I	2648.06	_  _ 	---	_		

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<O	RECOVERED 3/4"
N	IRON PIPE, NO ID

S89'15'04"W	NORTH LINE OF THE SOUTHEAST 1/4  OF
I I			SECTION  13-20-27
i ·-	S89"15'12"W  2700.09'
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WEST LINE OF THE	n
SOUTHWEST 1/4  OF	p
SECTION 13-20-27	0
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LEGEND:
D - RECOVERED 4"x4" CM PRM LB 6723	SET 4X4 PRM UNLESS OTHERWISE NOTED
0 - RECOVERED AS NOTED	SHANNON 46711	t
@ -  SET NAIL & DISK PCP	4671
(PERMANENT CONTROL POINT)
<i;_ -  INDICATES CENTERLINE
# - NUMBER	SOUTHEAST CORNER OF
CM -  CONCRETE MONUMENT	THE SOUTHEAST 1/4
CCR - CERTIFIED CORNER RECORD	OF SECTION 13-20-2
ID -  IDENTIFICATION
LB - LICENSED BUSINESS CERTIFICATION
NT -  NON TANGENT	SOUTH LINE OF THE SOUTHEAST 1 /4
ORB - OFFICIAL RECORDS BOOK	I	OF SECTION 13-20-27 ----
PB -  PLAT BOOK
PG - PAGE	N88"41'31"E	2650.71'
RM - PERMANENT REFERENCE MONUMENT	SOUTHWEST CORNER	0-
P.T. -  POINT OF TANGENCY
P.O.L. -  POINT ON LINE	THE SOUTHWEST 1/4
D - DELTA (CENTRAL ANGLE)	OF SECTION 13-20-2	INT OF BEGINNING
CB - CHORD BEARING	CCR #0063349	THEAST CORNER OF LOT 2, KELLY PARK CROSSINGS/
R - RADIUS	RECOVERED 6"X6"	SOUTH 1/4 CORNER OF SECTION	13-20-27
L -  LENGTH
CL -  CENTERLINE	CM, NO ID	CCR #0047875, RECOVERED 6"X6" CM, NO ID
PRM - PERMANENT REFERENCE MARKER	

SHANNON SURVEYING, INC.
499 NORTH S.R. 434 - SUITE 2045 ALTAMONTE SPRINGS, FLORIDA, 32714
(407) 774-8372	LB#  6898

WYLD	OAKS
A REPLAT OF KELLY PARK CROSSINGS, PLAT BOOK 111, PAGES 122 AND 123 AND A PORTION OF SECTION 13, TOWNSHIP 20 SOUTH, RANGE 27 EAST
CITY OF APOPKA, ORANGE COUNTY, FLORIDA

SHEET 3	OF 4

--1s11.1s--795_02,

PLAT BOOK

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SADLER ROAD
66.00' RIGHT OF WAY

SADLER ROA0-
65.oo· RIGHT OF WAY

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PER ORB 3552, PG 2524 &
ORB 3584, PG 2376

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400' WIDE DISTRIBUTION EASEMENT GRANTED TO FLORIDA POWER CORPORATION RECORDED MARCH 10, 2009 IN OFFICIAL RECORDS
BOOK 9840, PAGE 3622. SUBJECT TO A 10' WIDE EASEMENT,

1301.75'

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LINE	BEARING	LENGTH	
LI	N89"23'24"E	300.00'	
L2	S00"21'03"E	10.00'	
L3	S89"23'24"W	300.00'	
L4	N89"23'27"E	750.00'	
L5	S00"21'03"E	8.00'	
L6	S89"23'27"W	750.00'	
L7	N89"37' 48"E	107.41'	

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0,919 AC.±	STORMWATER	g

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89.403 AC.±	,

31.021 AC.±

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6	JEASEMENT PER ORB
0	6446, PG 1394
2	LI 7=='j
·-	L3

CURVE TABLE	
CURVE	RADIUS	DELTA	LENGTH	CH. BEARING	CHORD	
Cl	1569.00'	07"41'38"	210.69'	N86'31'23"W	210.53'	
C2	1631.00'	07"41'38"	219.02'	S86'31'23"E	218.85'	

;l	SOUTHWEST CORNER "'		OF TRACT C

CORPORATION EASEMENT PER ORB 2321, PG 332

\

-10.00' DISTRIBUTION EASEMENT
PER ORB 3552, PG 2524 &
ORB 3584, PG 2376

.-	S89"30'21"W
N		1304.38'	
0
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3	LOT6
9,007 AC.±		
0"'
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!EASEMENT PER ORB	

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\	S89"23'24"W	1325.15'	SET 4X4 PRM

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SHANNON 4671

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LEGEND:
El - RECOVERED 4"x4" CM PRM LB 6723 UNLESS OTHERWISE NOTED
0  - RECOVERED AS NOTED
@ -  SET NAIL & DISK PCP 4671
(PERMANENT CONTROL POINT)
{i_ - INDICATES CENTERLINE

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# - NUMBER
CM - CONCRETE MONUMENT

0	0"'

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I
/					S89"31'40"W
PARK VIEW PRESERVE PHASE PLAT BOOK 109, PAGE 109

1356.86'	_/

1

POINT OF BEGINNING
SOUTHEAST CORNER OF LOT 2, KELLY PARK CROSSINGS/ SOUTH I /4 CORNER OF SECTION 13-20-27 CCR #0047875, RECOVERED 6"X6" CM, NO ID

wN
3 st

CCR - CERTIFIED CORNER RECORD ID - IDENTIFICATION
LB - LICENSED BUSINESS CERTIFICATION NT - NON TANGENT
ORB - OFFICIAL RECORDS BOOK PB - PLAT BOOK
PG -  PAGE
RM - PERMANENT REFERENCE MONUMENT
P.T. -  POINT OF TANGENCY
P.O.L. -  POINT ON LINE
D - DELTA (CENTRAL ANGLE) CB - CHORD BEARING
R - RADIUS L -  LENGTH
CL -  CENTERLINE
PRM - PERMANENT REFERENCE MARKER

	

		

						

		

						

					

	

		

		

						

		

Section VI

REQUISITION

The undersigned, an Authorized Officer of Golden Gem Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture between the District and U.S. Bank Trust Company, National Association, Fort Lauderdale, Florida, as trustee (the "Trustee"), dated as of June 1, 2024 (the "Master Indenture"), as amended and supplemented by the First Supplemental Trust Indenture between the District and the Trustee, dated as of June 1, 2024 (the Master Indenture as amended and supplemented is hereinafter referred to as the "Indenture") (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):
Requisition Number: 11

Name of Payee:	RCS Construction Co. Inc.

Amount Payable:	$972,328.42

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance, if applicable):
Fund, Account and/or subaccount from which disbursement is to be made:
Series 2024 Acquisition and Construction Account

The undersigned hereby certifies that obligations in the stated amount set forth above have been incurred by the District, that each disbursement set forth above is a proper charge against the Series 2024 Acquisition and Construction Account and the subaccount, if any, referenced above, that each disbursement set forth above was incurred in connection with the acquisition and construction of the Phase 1 Project and each represents a Cost of the Phase 1 Project, and has not previously been paid.
The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate entitled to retain.

A-1

Originals or copies of the invoice(s) from the vendor of the property acquired or services rendered with respect to which disbursement is hereby requested are on file with the District.
GOLDEN GEM COMMUNITY DEVELOPMENT DISTRICT

Authorized	fi

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY
If this requisition is for a disbursement from other than the Costs of Issuance Account, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Phase 1 Project and is consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and specifications for the portion of the Phase 1 Project with respect to which such disbursement is being made; and (iii) the report of the Consulting Engineer attached as an Exhibit to the First Supplemental Trust Indenture, as such report shall have been amended or modified on the date hereof.

Consulting Engineer

Kevin M Roberson
Kimley-Horn and Associates, Inc

A-2

APPLICATION AND CERTIFICATION FOR PAYMENT	AJA DOCUMENT G702	PAGE ONE OF	PAGES	4

TO OWNER:
Kelly Park VB Development, LLC 660 Beachland Blvd.
Vero Beach, FL 32963 FROM CONTRACTOR:
RCS CONSTUCTION CO. INC. 295 E. HWY 50 SUITE I CLERMONT, FL3471I CONTRACT FOR:

PROJECT: Infrastructure - Wyld Oaks	APPLICATION NO:

PERIOD TO:
VIA ARCHITECT:

PROJECT NOS: CONTRACT DATE

3

8/15/24

Distribution to: OWNER
ARCHITECT CONTRACTOR

CONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is anached.

The undersigned Contractor cenifies that to the best of the Contractor's knowledge, information and belief the Work covered by lhis Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Cenificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due.

ORIGINAi. C'ONl RACT SllM
Net change by Change Orders
CONIR,\C'l SUM 10 DAIT(l ,nc I +21

't"'•

l O I AL COM PL LIU) & STORFD TO

S	14,205,206.4()
)	215,176.20
s	14,420.382.o<l
$	3,)8(),2)7.00

CONTRACTOR:	RCS CONSTRUCTION CO., INC.

DATE	(Column G on G703)
5. RETAINAGE:

By:

Date:

",OOA.r...	\•

A.E. •  •

	5_ % of Completed Work	$153,814.35 (Column D + Eon G703)
	5 % of Stored Material	$15.647 50 (Column Fon G703)
Total Retainage (Lines Sa+ 5b or

Stat

·'ce

f:o';f!st

Notary Public State of Florida Comm# HH276425
Expires 6/19/2dz6

Total in Column I ofG703)	$	169,461.85
6 ro I AL r ARNLD l LSS RrT AINAGI·	s	3,219,775.1"
(Line 4 Less Line 5 Total)

ENGINEER'S CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on-site observations and lhe data comprising the application, lhe Engineer cenifies lo lhe Owner that to the best of lhe

7. LESS PREVIOUS CERTIFICATES FOR
PAYMENT (Line 6 from prior Cenificatc) S CURRFNT PAYMI.Nl Ol,f
9 81\LANCT IO l lNISII. INCl.llDIN(, RH AINAGI
(Line 3 less Linc 6)

Total Completed and Stored To Dale Allocated To Cadence Total Relainage At 5%
Total Allocated To Cadence. Less Retainage Less Previous Balances Due By Cadence Current Payment Due By Cadence

Total Completed and Stored To Date Allocated To COD Total Retainage Al 5%
Total Allocated To COD, Less Retainage Less Previous Balances Due By COD

,
$	2,073,201.15
$	1,146,574.00 •••
$	11.200,607.54

$544,550.29
$27,227.51
$517,322.78
$343,077.20
$174,245.58

$2,844,686.71
$142,234.34
$2,702,452.37
$1,730,123.95

Engineer's knowledge, information and belief the Work has progressed as indicated,
the quality of the Work is in accordance with the Contract Documents, and the Contractor is enlilled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED ........... $	1,146,574.00

(A11ach explanation (fa11101111t certified differsji-0111 the amount applied. fllitial al/figures 011 this Application and onthe Co11tin11atio11 Sheet that are changed to conform with the 0111011111 certified.)
ENGINEER:	A	_JJ	Kevin Roberson, Kimley-Horn and Assoc.
By:	u-<"  "" -	Date:	9_-_3_-24	_
This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.

Current Payment Due By COD	$972,328.42

CHANGE ORDER SUMMARY
Total changes approved in previous months by Owner Total a roved this Month
IOIALS
NF I C'IIANGI S by Change Order

ADDITIONS	DEDUCTIONS
$215,176.20

S2 I 5.176.20	$0.00
$2 IS,176.20

I'-JJQ l.P'"::r-

•

;AIA DOCUMENT G702 APPLICATION ANO CERTIFICATION FOR PAYMENT 1992 EDITION AIA et992	THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE, N.W, WASHINGTON, OC 20006-5292
Users may obtain validation of this document by requesting a completed AIA Document D401 - Certification of Document's Authenticity from the Licensee.
•••  Contractor agrees that 0-.,·ucr will pm• II'///, 11·hat/1111d111f! 1s am,lable ll'hich mat uot equal the Current Parmeut Due. Am•unpaid balance ,w/1rema111011acco11ut for 011'11er to pal' ,nth /11111re f11uds.
Note: Items in RED FONT arc automatically calculated from the G703 form or from items within this G702 Form. Do NOT hand enter these items on this sheet.

CONTINUATION SHEET	A/A DOCUMENT G703	p._.1fl/f•P.. •

AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT. contaJning
Comractor's signedcc:n1ficat1on 1s anachC'd.

A	ll	c-	I)	I	,,		G	II	I	)	K	I	M	N	0		
r!l·M
NO	

< tn<'n	

rn:sCRll'TION OF WORK

on111t ons.	:t.al on. !'-iurvrv	SCllfDIJI.Fll
,V_ALUE	w	(;0 11'L I ;I)	MATER
l'RESF.N"ll,Y STORl;J> (NOTCN
l)QKF.)	lOTJ\L
COMPIF.IH) ANDS'IOREI> l"O DATE
(l}+b+F)	

(G•C)	llALANCF
'IOFINlSII
(C0G)	
Rl:iAINAGE
{II: VARIABU:
RA'll!)	Cons,dcn:d
"Shared
lmprm'CllX."111M	
Pcm:nt Ehg1b\c
For Pa)TIW.."111
Uy Cadence	Tcol.11 Cfll"l1pleh:d And Stcn-dToD.alc Higible F(lr Payment UyCadt..""OCC	
TOIAICadence
Rdamagc 5•1	Pcra.111 Hi1ubk
FIVl'l)'TIICIII
UyCDD	To1al C'f'fllplctcd /\nd Sieved fo Dale Hil)bleFor Pi)11ll. 1
UvCOI)	
·1oul('I)()
Rl.1.:unagc(t• S••	
				MtOM l'Rb 'IVIJS APPI.ICA'IION (l)+F)	nus PERIOD													
			Q ntily	Unil		'lotal															
																					
1.	MOBILIZATION	1	LS	$13	750.00	Sl3 750.00	Sl3 750.l)(l	S0.00		Sl3 750.00	100"/4	S0.00	S687.50	Yes	17.00%	S2 337.50	Sll6.88	83JlM4	Sll,412.50	S570.63	
2.	GENERAL CONDITIONS	I	LS	$221 250.00	S22 I ,250.00	S70 000.00	SJS,000.00		SIOS 000.00	47%	S116 250.00	ss 250.00	Yes	17.00%	$17,850.00	$892.50	83.00%	S87,150.00	S4 357.50	
3.	PERFORMANCE BOND	1	LS	$103 750.00	S/03 750.00	$103 750.00			5103 750.00	100"/4	S0.00	ss 187.50	Yes	17.00%	Sl7,637.50	S881.88	U.00%	S86,112.50	S4 305.6)	
4.	LAYOUTIA5BUILTS	1	LS	S96 518.75	$96,518.75	Sll,<20.00	SI 1,000.00		S32.420.I)()	34%	S64 098.75	SI 621.00	Yes	17.(K)%	SS,511.40	5275.57	83.<ml	S26 908.60	SI 345.43	
5.	5WWWP	1	LS	528	750.00	S28 750.00	SJ 000.00	S6,000.00		S9,000.00	31%	$19,750.00	$450.00	Yes	17.00%	SI 530.00	S76.50	83.00"/4	S7470.00	S373.50	
6.	51LTFENCE	21818	LF	S1.81	S39 490.58	526 100.00	S7,000.00		533,100.00	84%	56,390.58	51,655.00	Yes	17.00%	55	627.00	5281.35	83. /4	S27.473.00	51 373.65	
7.	TREE PROTECTION	2930	LF	$6.73	S/9718.90	S0.00			S0.00	0%	Sl9.718.90	S0.00	Yes	17.00%	S0.00	S0.00	8).00	S0.00	S0.00	
8.	CONSTRUCTION ENTRY	2	EA	S12 647.28	$25,294.56	S0.00	S8,MOO.OO		S8 800.00	35%	SI6,494.56	S440.00	Yes	17.00%	Sl,4%.00	$74.80	SJ.00%	S7 304.00	S365.20	
9.	MASS GRADING	31971	CY	$2.81	S89 838.51	$61 250.1)()	$14 000.00		S75,250.00	84%	$14.588.51	SJ 762.50	Yes	17.<m,	Sil	792.50	S639.63	8].00%	$62.457.50	SJ.I22.88	
10.	ROADWAY GRADING	1	LS	$97	182.84	$97 182.84	$19 000.00	$20 200.00		$39 200.00	4M♦	$57 982.84	SI 960.00	Yes	17.00%	S6,664.00	S33l.20	83.oo,•	S.12 536.00	Sl,626.RO	
11.	SOD BEHIND CURB	10613	SY	$3.69	S39 161.97	S0.00			S0.00	0%	SJ9 161.97	S0.00	Yes	17.00"/4	S0.00	S0.00	83.00%	so.no	S0.00	
12.	10" FORCE MAIN	5244	LF	$70.72	S370 855.68	SIS9 700.00	Sl6,000.00	S0.00	Sl75,700.00	47%	Sl95 155.68	S8,785.00	Yes	17.00%	S29.869.00	SI 493.45	83.00%	S/45831.00	$1 291.55	
13.	10" PLUG VALVE	14	EA	ss	619.75	S78 676.50	S58,750.00	S0.00	S0.00	S58 750.00	75%	Sl9 926.50	S2 937.50	Yes	17.00%	S9,987.50	S499.l8	83.00%	S48,762.50	S2 438.D	
14.	12"Xl0" WET TAP	2	EA	$16 066.18	SJl,132.36	S0.00		Sll,300.l)(l	SI1,300.00	35%	S20 832.36	S565.00	Yes	17.()()%	SI 921.00	S96.05	83.00%	S9,J79.00	S468.95	
15.	6" FORCE MAIN	648	LF	$50.13	S32 484.24	Sl 200.00	S3 30<1.00	S6 300.00	Sl2,800.00	39%	Sl9,684.24	S640.00	Yes	17.00%	$2 176.00	SI08.80	83.00"/4	S10 624.00	S53l.l0	
16.	6" PLUG VALVE	12	EA	S3 905.17	S46 862.04	S7 054.00		S7,IOO.OO	Sl4 154.00	30%	$32,708.04	S707.70	Yes	17.00%	S2,406.18	Sl20.3I	83.00%	S 11.747.82	$587.]9	
17.	4" FORCE MAIN	20	LF	$36.17	S723.40	S0.00			S0.00	0%	$72).40	S0.00	Yes	17.00%	S0.00	S0.00	83.00%	S0.00	SOJXl	
18.	4" PLUG VALVE	1	EA	$2 366.34	$2 366.34	S690.00		S0.00	S690.00	29%	Sl,676.34	$34.50	Yes	17.CIO%	SI 17.:J0	SS.87	SJ.oo,•	S57l.70	S28.64	
19	FORCE MAIN FITTINGS	1	LS	578 184.45	S7!J.I84.45	S66,952.l)(I		S0.00	S66.952.00	86%	Sil 232.45	SJ,347.60	Yes	17.00%	$11381.84	S569.09	83. ·	sss 570.16	S2 778.51	
20.	TESTING	1	LS	$12 278.25	Sil 278.25	Sll.00	S2,I00.00		S2,I00.00	17%	s10.m.2s	$105.00	Yes	17.00%	S357.00	S/7.85	83.00'/4	SI 743.00	S87.I5	
21.	18" HOPE	931	LF	SS0.28	S46 810.68	532 856.00	S0.00	S0.00	532 856.00	70%	Sil 954.68	SI 642.80	Yes	17.00%	$5,585.52	$279.28	SJ.om•	$27 270.48	SI 363.52	
22.	24" HOPE	1279	LF	S73.70	$94,262.30	S71,298.00	S0.00	S0.00	$71,298.00	76%	S22 964.30	SJ 564.90	Yes	17.00%	Sil	120.66	$606.03	83.00%	559 177.34	$2 958.87	
23.	42" HOPE	106	LF	$246.26	S26,I0).56	$19,185.00		S0.00	Sl9,185.00	73o/.	56 918.56	$959.25	Yes	17.00%	SJ 261.45	Sl63.07	83.00%	SIS,923.55	57%.18	
24.	48" HOPE	691	Lf	5320.16	Slll.230.56	589,000.00	SJ,'l<I0.00	S0.00	S92.900.00	42¾	Sl28 330.56	S4,645.00	Yes	17.00%	SIS 793.00	S789.65	83. •	577107.00	S3,855.35	
25.	54"/60" HOPE	1462	LF	$360.14	S526 524.68	$0.00	5212 000.0<1		S212 000.00	40-.	$314.524.68	SI0,600.00	Yes	17.00%	S36 040.00	SI 802.00	83.00'/4	Sl7S 960.00	SS,798.00	
26.	60" HOPE	64	LF	$480.83	S30 773.12	$7 200.00		S0.00	S7 200.00	23%	S23 573.12	$360.00	Yes	17.00%	SI 22<.00	561.20	83.00%	ss 976.00	S298.80	
27.	36" HOPE	1394	LF	$ll4.98	$160,282.12	$103,000.00	S8 800.00	$0.00	SIi i 800.00	70%	$48 482.12	ss 590.00	Yes	17.00%	Sl9 006.00	$950.JO	83.00%	$92 794.00	S4.639.70	

Usc_Column I on Con1n1as where vanable rt11t1nagc (or hnc items may 11pply.

APPLICATION NO: APPLICATION DATE:
PERIOD TO: ARCHITECTS PROJECT NO·

3
8/1512024
8/1512024
,.

AIAOOCUM(Nt010J COf,ITINO'-tKlNSHEETFOAC702 1W2f01110N AJA 01'9::.'
THEAME.RICANINSIIIUTEOF.\ACHITECTS 1735N[WYOAKAVENUE NW WASHINGTON OC 20006-5232	G703-10ll2

CONTINUATION SHEET	A/A DOCUMENT G703	P.9•1M4P•••

AIADocumenc G702, APPLICATION AND CERTIFICATION FOR PAYMENT. containing
Contractor's signedcer11fication 1s auachC'd.

Use Column 1 on Contracts wh,¥H• >M•n blc rctamagc for line items may applv.

APPLICATION NO: APPLICATION DATE:
PERIOD TO:

A	ll	C	I)	I	F	G	II	I	J	K	L	M	N	0	p	
nl!M
NO.	

Dl:SCRD'TION OF WORK	SCIIEDUI.ED VAJ.IJI·	wuR	11'LE·I .:o	MAlF.RlALS
PRESENll.Y STOKED (NOT IN DORF)	lO Al.
COMPLETED
ANO STORED
TO OAff
(J}+E-tF)	•
(0 •CJ	
DAI.ANO'.. TOFINlSII (C-G)	
RETAINAGE (IFVARIAHLE RATEi	Considered '"Shared lmpn:l\'emenl''	
I\.-ra.,u Eligible for f►.t)111CUI DyCadl.-ncc	
1'olal C<inlpkh.-d And Stored lo Dale Flig1ble for l'a)Tlk!nt
OvCatk.,icc	
Total ca
Rt.1111nagc@s•;.	
Percent Eligible f<'lt Pa)'llk."nt OyCDD	
T(.'llal Completed And Stl'll'Cd roDatc Eligible For Pa)mcnt
UvCDD	
Tocalt'D0
Re1amag(:(tl s••	
			FROM l'REVK)lJS APPL.ICArlON (D+E)	'11115 l)Ek.K>D													
		Quan1i1y	IJnil	"'=	'IQUtl															
28.	72" HOPE	1381	LF	$747.54	Sl.032,352.74	S0.00	S0.00	SI 05,400.00	SIOS,400.00	l°''o	S926 952.74	SS,270.00	Yes	17.00"-	Sl7,918.00	S895.90	83.00%	S87,482.00	54,374.10	
29.	TYPE "P" MANHOLE	4	EA	$15 330.53	S61 322.12	Sl2600.00		SO.()(I	SI2,600.00	21•/4	S48 722.12	S6)0.00	y.,	17.00%	S2 142.00	S)07.IO	83.00%	S)0458.00	S522.90	
31.	TYPE P-5 WITH "J" BOTTOMS	11	EA	$12 400.26	S136,402.86	S29 100.00	Sl2 400.00	S63 200.00	SI04,700.00	77%	SJl.702.86	S5,235.00	Yes	17.(>0%	S)7,799.00	S889.95	83.00%	S86.901.00	S4.345.05	
32.	TYPE P-5 INLETS	2S	EA	$6 492.88	Sl62 322.00	S44 000.00	512 900.00	Sl7 300.00	S74.200.00	46''	S88 122.00	SJ 710.00	Yes	)7.()(1%	S12,614.tl0	S630.70	83.()0%	S61 586.00	SJ 079.JO	
33.	TYPE P-6 WITH "J" BOTTOMS	8	EA SJ4 844.13	Sl 18.753.04	S23 800.00	Sl4 800.00	S)4,000.00	S52,600.00	44%	S66 153.04	S2,630.00	Yes	17.00%	S8 942.00	$447.IO	83.00%	S43,658.00	S2 )82.90	
34.	TYPE P-6 INLETS	4	EA	7 220.65	S28,882.60	$4 400.00	S7 220.00	S2,000.00	SIJ,620.00	47,'o	SIS 262.60	$681.00	Yes	)7.00%	S2 315.40	$115.77	83.00%	Sl I 304.60	S565.2)	
35.	TYPE "J" BOTTOM WITH TYPE "A" MANHOLE	I	EA	$33 164.59	S33 164.59	Sl9.000.00		Sll.00	S)9,00II.OO	57%	$14,164.59	S950.00	Yes	17.00%	$3,230.00	S161.50	8).00%	SIS 770.00	S788.50	
36.	BOX CULVERT 5'Xl0'	280	LF	$1 319.81	S369 546.80	S228 005.00	SI I 0.(MI0.00		S338 005.00	91%	SJI 541.80	516900.25	Yes	17.00%	557,460.85	S2,873.04	83.00%	$280,544.15	$14 027.21	
37.	TV LINES	1	LS	$31 524.38	SJI,524.38	S0.00			S0.00	0%	SJI 524.38	S0.00	Yes	17.00%	so.oo	S0.00	83.00%	S0.00	SU.00	
38.	8" C-900	487	LF	$50.9"	$24,807.78	$9 300.00	S0.00	S0.00	S9 300.00	37%	SIS 507.78	$465.00	Yes	)7.00%	Sl.581.00	S79.05	8).00%	57 719.00	$385.lJS	
39.	16" DIP	2,581	LF	131.18	SJ)8 575.58	S241.576.00		SO.DO	S24 >.576.00	71%	$96,999.58	Sl2 078.80	Yes	17.00%	S41 067.92	S2 053.40	83.00%	S200 508.08	SlO 025.40	
40.	12"C-900	2,752	LF	$87.96	S242 065.92	S163,960.00		SO.()(l	Sl6J 960.00	68%	S78 105.92	S8 >98.00	Yes	l7.('t0%	S27 873.20	S1,393.66	83.00%	SIJ6.086.80	S6 804.34	
41.	6" C-900	816	LF	$37.07	SJO 249.12	S6 380.110		S0.00	S6,380.00	21•1o	S23 869.12	S319.00	Yes	17.00 0	Sl,084.60	S54.23	83.00%	S5,295.40	S264.77	
42.	12" GATE VALVE	13	EA	54.796.85	S62 359.05	S62 700.00		SO.DO	S62.700.00	101%	(Sl40.95l	Sl,135.00	Yes	)7.00%	Sl0,659.00	5532.95	83.00%	552 041.00	S2 602.05	
43.	6" GATE VALVE	13	EA	$1 903.55	S24 746.15	SO.DO			SO.OD	0%	S24 746.15	S0.00	Yes	17.00%	S0.00	S0.00	83.00%	S0.00	S0.00	
44.	16" GATE VALVE	18	EA	$8 950.47	Sl61,108.46	S0.00		sos 550.00	S68,550.00	43%	S92,558.46	SJ,427.50	Y,s	)7.00%	Sl 1.65).50	S582.68	83.00%	S56.896.50	S2,844.8J	
45.	8" GATE VALVE	17	EA	$2 648.89	S45 OJI.fl	S0.00		S9 600.00	S9,600.00	21%	Sl5 431.13	S480.00	Yes	17.00%	SI 632.00	S81.60	lt'U)0%	S7 968.00	S)98.40	
46.	RELOCATE FHA	I	EA	$3 474.50	Sl.474.50	SO.IX>			so.oo	0%	53474.50	S0.00	Yes	17.oo♦/4	S0.00	S0.00	83.00%	SO.DO	SO.()(l	
47.	FIRE HYDRANT ASSEMBLY	18	EA	$6 239.51	Sl 12,311.18	so.no	S39,000.00		$39,000.00	)5%	S7l.Jll.l8	Sl,950.00	Yes	)7.00%	S6,6JO.OO	SJJl.50	83.00%	S32,J70.00	Sl.618.50	
48.	ARV	1	EA	S7 426.58	S7 426.58	S0.00			S0.00	0"/4	S7 426.58	S0.00	Yes	17.00-/4	SO.DO	S0.00	83.00%	S0.00	S0.00	
49.	16"XJ2" WET TAP	I	EA	$JS 160.96	S>S 160.96	S7 500.00		S0.00	57 500.00	49%	S7 660.96	Sl75.00	Yes	17.00%	SI 275.00	S6l.75	83.00%	S6,225.00	SJ> l.25	
5D.	!6"XJ6" WET TAP	1	EA	$33 555.01	S33,555.0I	SO.()(\		S8 200.00	$8,200.00	24%	S25 355.01	$410.00	Yes	17.00%	SI 394.00	S69.70	83.00%	56.806.00	Sl40.30	
51.	14"01RECTIONAL DRILL	80	LF	$173.41	Sll.872.80	S7 200.00		S0.00	S7,200.00	52%	S6.672.80	5360.00	Yes	17.00%	SI 224.00	S61.20	83.00%	55 976.00	S298.80	
52.	JUMPER	2	EA	2 787.30	SS,574.60	S0.00			S0.00	0%	ss 574.60	S0.00	Yes	17.000/4	SO.DO	SO.OD	83.00%	S0.00	SIUlO	
53.	RESTORATION/MOT FOR OFFS\TE WORK	1	LS	$33 392.21	S33 392.21	S0.00			SO.()(l	0%	SJJ.392.21	S0.00	y.,	17.00%	S0.00	SO.DO	8).00-/4	S0.00	S0.00	
54.	WATER FITTING	I	LS	$122 471.75	$122,471.75	S90.700.00		S0.00	S90,700.00	74%	SJI 771.75	S4 535.00	Yes	17.00%	SI5 419.00	S770.95	83.00%	S75 281.00	$3 764.05	
55.	TESTING	1	LS	$11475.00	S11 475.00	S0.00			SO.DO	0%	SI 1,475.00	S0.00	Yes	>7.00%	S0.00	SO.DO	83.00°/4	SO.DO	S0.00	
56.	8" REUSE	5,392	LF	$49.11	S264 801.12	S12).480.00		S0.00	S12).480.()(1	47%	Sl4\ 321.12	56 174.00	y.,	17.00%	S20,991.60	Sl,049.58	83.00%	Sl02 488.40	S5 124.42	
57.	8" GATE VALVE	17	EA	$2 738.50	S46 554.50	SO.DO	SI I 000.00		Sl l.000.00	24%	SJS.554.50	S550.(l(J	Yes	>7.00%	Sl.870.00	59).50	8.1.00%	S9 130.00	S456.50	
58.	4" REUSE C-900	590	LF	$30.67	SIS 095.)0	S0.00			S0.00	0%	S\8.095.JO	SO.IIO	Yes	17.00%	S0.00	S0.00	10.00%	S0.00	S0.00	
59.	4" GATE VALVE	14	EA	$2 295.78	S.12, 140.92	SO.I)()	56,600.01)		S6,600.()(I	21%	515,540.92	S.130.00	Yes	17.000/4	Sl,121.00	S56.IO	83.00-/4	S5.478.ll0	S27J.90	
60.	30"X8" WET TAP	2	EA	$12 237.97	S24,475.94	S0.00			SO.DO	0%	$24,475.94	S0.00	Yes	17.00%	S0.00	so.oo	8).0()'/4	S0.00	S0.00	
61.	10" DIRECTIONAL DRILL	80	LF	S136.2S	SI0900.00	S2.400.00		S0.00	S2 400.00	22%	SS,500.00	Sl20.00	Yes	17.00%	S408.00	520.40	8.1.00%	Sl,992.00	599.60	
62.	REUSE JUMPER	2	EA	$2 737.14	S5 474.28	S4 600.00		SO.DO	S4600.00	84%	S874.28	S2JO.OO	Yes	17.00%	S782.00	!39.)0	83.00%	SJ,8!8.00	5190.90	
63.	REUSE FITTINGS	1	LS	541 221.83	S41 221.83	S23 000.00		S0.00	S23 000.tkl	56%	SIR,221.8)	Sl,1.50.CMI	Yes	17.00%	SJ,910.00	S195.50	83.00%	S19,090.00	S954.SO	
64.	REUSE TESTING	I	LS	9 750.38	S9 750.J8	S0.00			SO.DO	0%	59.750.38	S0.00	Yes	17.00%	S0.00	S0.00	83.00%	SO.()()	S0.00	
65.	TYPE "D" INLET	1,487	LF	$21.25	SJ) 598.75	SO.DO			S0.00	0%	SJl,598.75	S0.00	Yes	17.00%	SO.DO	S0.00	83.00"/4	S0.00	SO.<>O	
66.	TYPE "F" CURB	17,785	LF	$28.13	S500 292.05	SO.DO	$33 750.00		SJJ 750.00	7%	S466.542.05	SI 687.50	Yes	)7.00%	ss 737.50	S286.88	83.00%	S28.012.50	SI 400.63	
67.	JO' CONCRETE SIDEWALK	3,647	LF	$61.44	$224.071.68	S0.00			S0.00	0%	S224 071.68	S0.00	Yes	17.00%	S0.00	$0.00	83.00"/4	$0.00	SO.DO	
68.	JO' HCR	11	EA	s2 1so.oo	SJO 250.00	S\1.00			SO.()()	0%	SJO 250.IIO	S0.00	Yes	17.(K)0/4	S0.00	S0.00	8).110%	SO.DO	S0.00	
69.	S' SIDEWALK	6,S62	LF	$29.9"	S196,466.28	S0.00			SO.<K>	11%	$ 196 466.28	SO.DO	Yes	17.00%	SO.DO	S0.0(1	83.00%	SO.<IO	S0.00	
70.	S' HCR	14	EA	$1 481.25	S20 737.50	SO.DO			SO.DO	0%	!20 737.50	S0.00	y.,	17.00%	SO.DO	S0.00	83.00%	SO.OD	Sll.00	
71.	12" STABILIZATION	25,301	SY	SS.42	S\37 131.42	S0.00	$47,600.00		S47,600.00	35%	S89.5Jl.42	S2 380.00	Yes	)7.00%	$8 092.00	$404.60	83.00%	SJ9,508.00	S>.975.40	
72.	1" SP 12.5 !ST LIFT	21,349	SY	$13.81	S294.829.69	$11.00			S0.00	0%	S294 829.69	S0.00	Yes	17.00%	S0.00	S0.00	8).00-/4	S0.00	S0.00	

,,	ARCHITECTS PROJECT NO·

)
8115/2024
8115/2024

...."DOCUMENTG7nl CON1lNUATIONSHEETf:OAG7'02 1W'2[01T)()N AIA 01"2
THE -'MERICAN INSTllUT£ OF ARCHITECTS 1735 NEW YORK AVENUE NW WAStilNOTON DC 70006-,5?3;>	G703-1DD2

A/A DOCUMENTG703	l"-ci•lof'l"IOM

AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing
Conlractor's s1gnttl ccn.ificauon1s attached.

l)sc Column I on Contraas where-	1ble m.a1nage for hnc ncms may app\v.

APPLICATION NO: APPLICATION DATE:
PERIOD TO: ARCHITECT'S PROJECT NO·
•

J
s11sno24 s11sno24
,.

'	"	C

I)	I	F
WOK.1'1,. COMl' ..E11·u

Mt\'ll·Kll\LS

G
IUIAI.

II	I	'	K	I,

M	N	()

ffhM
NO

UES('RIPI K)N 01: WORK

QlYnllly Unit

Sl'lll'llUl,FD
VALUI·
Pmx

hllal

FM.OM l'Rl:VJOUS Al'l'UCAI ION (D+E)

l'RFSENlLY
nus 1•1=RK>1>  STORED
(NOrlN
DORI:.)

COMPt.Cl"ED ANDSl'()RH) TO DAU
tl>tE+F)

((i•C)

HAJ.J\NCI l'OFlNISII (C-Gl

RlnAINAGI! (B: VARlADJ.E RAU)

Considered
"Shared
hllJ')RW'CllK.'lll

l'cro.'111 Elisiblc For Paymcnl llyC.adcncc

roi1I Coo1pk1cd And Slortd To l.> IC Fhtibk For l'a)1ncnt HvC1d1,.,JCC

rotalCad1.'IK.'C
Rctamagc(n S..._

Pcm..-nt 1:lig1ble Por Plym(..-nl UyCDD

1 Nal Cornplclcd And Sltll'Cd T('I Dale Ph1itilchlfP1ynk..'tll ll·CDI>

IOlalC'DIJ
Rctllf\l{!C I •·

!" SP 9.S ASPHALT WITHIN 6 MONTHS OF CFC
I" SP 9.S ASPHALT
10" LIME ROCK
STAMPED ASPHALT
TEMP MARKING
PERMENATE MARKINGS

21,349 SY
21,349  SY
21,349  SY
1,680  SF
I	LS
I	LS

517.63
$13.71
$24.71
$13.75
SIS 402.S0
572 12S.00

SJ76 382.87 S292,694.79 5527,533.79 S23,l00.00 SIS 402.50
S72 125.00

S0.00 S0.00 S0.00 S0.00 S0.00 S0.00

so.no
S0.00
SO.Oil S0.00 S0.00
SO.Oil

0%
0%
0%
0%
00/4
0%

S376 382.87 S292,694.79 S527 533.79 S23.l00.00 Sl8,402.S0 S72 125.00

S0.00
SO.Oil S0.00 S0.00 S0.00 S0.00

Yes Y<S
y,.
Y,s
v..
Y,s

17.00%
)7.00%
)7.00%
17.00%
)7.00%
17.00%

S0.00
SO.Oil S0.00 S0.00 S0.00 S0.00

S0.00 S0.00 S0.00 S0.00
SO.Oil S0.00

83.00%
8J.00%
83.00% SJ.00% 8J.00% XJ.00%

S0.00 S0.00 S0.00
S0.00
so.oo
S0.00

SO.Oil S0.00 S0.00 S0.00
Sll.00 S0.ll(l

DRY UTILITIES
MOBILl2ATIONIGENERAL CONDITIONS

I	LS

YS 120.00

S45 120.00

S0.ll0

SJ.500.00

SJ.500.00	8%

S41,620.00

Sl75.00

Yes

17.00%

S595.00

S29.75

83.00%

S2,905.00

Sl45.25

PERFORMANCE BOND

I	LS

S60 768.oo

S60.768.00

S60 768.00

S60,768.00

100%

S0.00

S3.038.40

Y<S

11.00,.

SI0 330.56

S516.53

83.00%

S50 437.44

S2521.87

6" SCHEDULE 40 GREY
CONCRETE DUCT BANK
83. 2" SCHEDULE 40 GREY

60 S30 LF
S,490  LF
!S,212  LF

52S.17
514.97
SIS.10

Sl 523 540.l0
S82 185.30 S229.70l.20

S0.00 S0.00 S0.00

SJ6.000.IJO

S39 200.00

S36 000.00
S0.00 SJ9 200.00

2%
0%
1-r-•

Sl 487 540.10
S82 !85.30
Sl90 501.211

Sl 800.00 S0.00 Sl,960.00

Yes Yes Yes

)7.00%
17.00,'.
)7.00%

S6 120.00 S0.00
S6 664.00

\306.00
S0.00 S3JJ.20

8'.\.00"/4
8J.00%
8J.00%

S29.880.00
S0.00 SJ2 536.00

Sl,494.00
SO.Oil Sl 626.80

2" FITTINGS
4" SCHEDULE 40 GREY

I	LS
Sl,000  LF

S26 884.00
$20.31

S26,884.00 SI 035810.00

S0.00 S0.00

S2 600.00

S2,600.00 S0.00

10%
0%

S24 284.00
Sl 035 810.00

SIJ0.00
Sll.00

Y,s Y<S

)7.00%
)7.00%

S442.00 S0.00

S22.10
Sll.00

83.00%
83.00'/4

S2.158.00
S0.00

S107.90 S0.00

4"& 6" FITTINGS
30' TA·· LED SINGLE HEAD LIGHT

I	LS
22	EA

$64 118.00
$12 274.00

S64,118.00 S2711,028.00

so.on	S4 600.00
S0.00

S4 600.00	7%
S0.00	0%

S59,5l8.00 S270 028.00

S2JU.00 50.00

Yes Yes

)7.00%
17.0()o/.

S782.00
SO.Oil

SJ9.l0 S0.00

83.00%
83.00%

SJ 818.00
SO.Oil

Sl90.90
SO.Oil

30' TALL POLE WITH TWIN HEADS

24	EA 514 363.00

SJ44 712.00

S0.00

S0.00	0%

S344,712.00

S0.00

Y<S

17.00%

SO.Oil

S0.(Xl

8J.00"/4

S0.00

SO.Oil

ADD BLACKE DYETO CONCRETE POLES
SPLICE BOXES
LAYOUTIAS-BUILTS
HANDHOLES

46	EA
52	EA
1	LS
IS	EA

5909.00
5S 770.00
S!7 410.00 S3 !4S.OO

S4l,814.00 SJ00,040.00 Sl7,410.00 S47,17.S,00

S0.00 S0.00 S0.00 Sil.II()

S0.00
Sll.00 S0.00 SO.O<I

IWo (W. 0%
0%

S41,814.00 SJ00,040.00 517410.00
S47 175.00

Sil.Oil
S0.00
S0.ll0 S0.00

Yes Yes Yes Yes

17.00%
17.00%
17. /4
11.00,,

S0.00 S0.00 S0.00 50.00

S0.00 S0.00 S0.00 S0.00

83.00%
83.00%
83.00%
83.00%

S0.00 S0.00 S0.00 S0.00

S0.00 SO.I)() S0.00 S0.00

MAHOLES

LANDSCAPE/IRRIGATION

4	EA

$7 793.00

$3) 172.00

SCl.lH)

so.oo  0%

S3l.172.00

Sll.00

Yes

17.00%

S0.00

SO.DO

83.00%

S0.00

S0.00

MOBILIZATION/GENERAL CONDITIONS
PERFORMANCE BOND
SURVEY/LAYOUT
LANDSCAPE
IRRIGATION
MAINTENANCE
SQDIGROUND COVERING

Chamre Order #1Fire Access Rd
Install Fire Access Rd. 8'' Ume Rock with Prime
Install Two Extra Fire Hvtlrant Assemblv
Install Extra PVC with Fittinas
Extra Labor/Crew and Equipment to Facilitate Install

I I I I I I I

9,111
2
1
1

LS $29 S60.00
LS $22 693.00
LS $6 880.00 LS $421116.00 LS  $393 612.00
LS S73 440.00
LS  $141 212.00

SY	S!4.20
EA  $6,400.00
LS $ 3.200.00
LS S 69,800.00

529,560.00
S22 693.00
S6 880.00 S421 l l6.00 SJ93,6l2.00 S7J 440.00
$141 212.00

S129,)76.20
$12,80(1.00
SJ,200.011 S69,800.00

SO.II() 522,693.00
S0.00 S0.00 S0.00 S0.00 SO,()()

SO.OIi Sl2.8011.ll0 SJ,21IO.00 S42,000.00

SJ.500.00

SJJ 200.00

SII0000.00
so.oo
S0.00
SI! 000.IKl

SJ 51l(l.00 S22,693.00
S0.00 S0.00
S33 200.00
S0.00 S0.00

SI lO 000.00
Sl2 800.00
SJ 200.00
S60 llllll.00

12%
l00'/4
00/4
0%
8%
0%
0%

85%
100%
100,1
86%

S26 060.00
S0.00 S6,880.0ll S42l 116.00
S360.4 I 2.00 573,440.ll(l Sl4l 212.00

Sl9,J76.20
$0.CIO SO.OD S9.800.00

Sl75.00
St 134.65
SO.Oil S0.00 Sl,660.00 S0.00
SO.Oil

S5 501J.00 S640.00 5160.00 S3,000.00

Yes Yes Y,s Yes Yes Yes Yes

No No No No

11.00,.
17.00%
17.00%
17.00%
17.00'1
17.00'/4
17.00%

0.()()%
0.(,0-/o
0.00'/4
0.00%

5595.00
SJ,857.81
SO.Oil S0.00
$5,644.00
S0.00 S0.00

SO.Oil S0.00 S0.00 S0.00

S29.75 Sl92.89 S0.O(J S0.00 S282.20 S0.00 S0.00

S0.00 SU.00
so.oo
S0.00

83.00%
83.00%
83.00-/4
83.00%
8J.00'/4 SJ.00% 3.00%

IOOJI0% 100.00% l00.00% 100.()()%

S2 905.00
SIS 835.19
S0.00 S0.00 527,556.00
S0.00 S0.00

SII0 000.IIO Sl2 81IO.OO SJ 200.00 S60,000.00

Sl45.25 S941.76
Sil.Oil S0.00 Sl.377.81l
Sil.Oil
$0.(H}

SS.500.00 S640.00 Sl60.00 SJ 000.00

	SUDTOlAL					S14,420,382.69	S2,182,317.00	5893,970.00	SJ 12,950.00	SJ.J89,237.00	24%	Sl l,03l,l45.69 Sl69,461.85			5544,550.29	S27,227.SI		S2,844,686.71	S142,234.J4	
		GRAND TOTALS				S14.420,382.69	S2,182,Jl7.1Kl	S893.970.00	$312,950.00	S3.J89,237.IIO		SI l,0Jl,)45.69 Sl69,461.85			S544,S50.29	S27,227.51		S2.844,686.7 I	$142.234.34	
Users may obtain validation of this document by requeatlng of the license a completed AIA Document 0401 • CertlflcatJon of Document's Authenticity

MAOCICOMEl<'lG'l'OJ CONIINUATIONSHl:ETl'OA(H02 10021::0lll()N NA CIIOD?
lHEAtAESbCA.MINStlTVTEOFAACHITECtS ll'3$NEWvoi:tlCAVCNIJE HW WASHI..OtON OC	0703-1092

DEVELOPER'S REPRESENTATIVE CERTIFICATE FOR PAYMENT

Wyld Oaks- Infrastructure Pay Application #3 Pa Application Period Through 8/15/24

In accordance with the Contract Documents, based on on-site observations and the data comprising
this application, the Developer's Representative certifies to the Owner that to the best of the Developer's Representative's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.

AMOUNT CERTIFIED.	$1,146,574.00
(Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.)

By:

Name: 	 Timothy R. Dennard	 Title:'		President
This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.

THIRD PARTY BENEFICIARY'S ENGINEER CERTIFICATE FOR PAYMENT

In accordance with the Contract Documents, based on on-site observations and the data comprising this application, the Third Party Beneficiary's Engineer certifies to the Owner to the best of the Third Party Beneficiary Engineer's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.

AMOUNT CERTIFIED........................................................................	$
(Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.)

THIRD PARTY BENEFICIARY'S ENGINEER:

By:	Date:
Name: Title:`

This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.

WAIYER AND RELEASE OF LIEN UPON PROGRESS PAYMENT

The undersigned lienor, in consideration of the sum of$ 1,146,574.00	, hereby waives and releases its lien and right to claim a lien for labor, services, or materials furnished through 08/15/2024 to Double B Development and Kelly Park VB Development, LLC on the job of Wyld Oaks Infrastructure to the following property:
S of Kelly Park Rd & Effie Dr.
3620 W Kelly Park Rd.
Apopka, FL 32712, Orange County (description of property)

This waiver and release does not cover any retention or labor, services, or materials furnished after the date specified.

DATED on August 15, 2024.

Lienor RCS Construction Company, Inc. Address 295 E SR 50, Suite 1,

Prin	am : o	Bass ltsc ent

State of Florida
County of _L=a=k=e	
The foregoing instrument was acknowledged before me this 15th	day of August	, 20_1L, by, as of said company, who has presented as identification or is personally known to me.

		Victoria E Lauteria	 Print, Type or Stamp Commission

PROGRESS PAYMENT AFFIDAVIT

STATE OF FLORIDA COUNTY OF LAKE

BEFORE ME, the undersigned authority, duly qualified and authorized in the State and County aforesaid to administer oaths and take acknowledgements, this day, personally appeared	Jody Bass	, who being by me first duly sworn, deposes and says:

The facts and matters contained and recited in the Affidavit are based upon personal knowledge of the Affiant.
Affiant is the Owner of	RCS Construction Company, Inc.	, a North Dakota Corporation company (hereinafter the "Contractor")
Contractor and	Kelly Park VB Development, LLC	(hereinafter the "Owner") have executed, delivered and entered into that certain CONTRACT AND AGREEMENT dated	December 4, 2023	(hereinafter the "contract").
Affiant now requests partial payment under the Contract. In Consideration of Owner providing such partial payment, Contractor hereby provides this Affidavit upon which Owner intends to rely.
Contractor is not aware of any Claims that would require an adjustment of the Contract Time or the Contract Price except for any Change Order Requests or Change Order Proposals previously submitted in writing to Owner prior to execution of this Affidavit.
Contractor releases any Claims for an adjustment to the Contract Time or the Contract Price except for those previously made in writing and delivered to Owner prior to execution of this Affidavit.
Affiant states that all bills for labor, services or materials furnished, delivered, installed or performed on the job site through the date of this Affidavit have been FULLY paid and that no lien for such may properly be filed, recorded or enforced. Waiver and Release of Lien upon Progress Payment forms for every such potential lienors are provided herewith through 07/10/2024
Affiant states that, except as provided herein, all bills for labor, services or materials furnished, delivered, installed or performed on the job site through the date of this Affidavit have been FULLY paid and that no lien for such may properly be filed, recorded or enforced. Waiver and Release of Lien Upon Progress Payment forms for every such potential lienor are provided herewith, except as provided below:

Pagelof3

Name of Lienor	 Amount due for labor1 services or Or Potential Lienor		materials furnished1 delivered1
Installed or performed

1.  Atlantic Directional Drilling, Inc.	$0.00	
2. Central Florida Turf Pros	$3,500.00	
3. Dixie Lime & Stone	$0.00	
4. Florida Design Consultants	$9,250.25	
5.  Formasters Concrete Specialists	$32,950.00	
6. Fortiline, Inc.	$75,698.34	
7.  Oldcastle Infrastructure	$62,146.16	
8.  Quality Petroleum	$13,948.27	

FURTHER AFFIANT SAYETH NOT.

RCS Construction Company1 Inc.

L4 -c,	, ,   Affiant

Sworn to and subscribed before me this	15th	day of	August	,2024, by
	w, h(coheck one): [ X] is personally known to me, [ ] produced
a driver's license (issued by a state of the United States within the last five (5) years) as identification, or [ ] produced other identificati,		. Affiant did take an oath.

VICTORIA E. 1.AUTERIA
,	o"Notary Public
f	i  state of Florida
"-	comm# HH276625
"J'1Nce , 'l<o	Expires 6/19/2026

Print Name:	Victori	uteria 	 Notary Public, State of Florida
Commission No.:_....:..H:..;H...:2.=7.:.6.=6..;2-=5=.	
MCommyission Expires:	06/19/2026

JOINDER AND INDEMNIFY AGREEMENT

Contractor, joins in the execution of this Affidavit for the purpose of adopting all representations of fact contained therein. Contractor understands that this Affidavit will be relied upon by Owner for all purposes relating to the Contract. Contractor agrees to indemnify, hold harmless and defend the Owner from, against and with respect to any and all loss, cost, damage and expense, including reasonable attorneys' fees, arising out of any claims by laborers, subcontractors or materialmen who might claim that they have not been paid for labor, services or material.

B	

A Florida Corporation Company

 By:	
Name:	o3ass
Title:Vice President

(CORPORATE SEAL)[where applicable]

REQUISITION

The undersigned, an Authorized Officer of Golden Gem Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture between the District and U.S. Bank Trust Company, National Association, Fort Lauderdale, Florida, as trustee (the "Trustee"), dated as of June 1, 2024 (the "Master Indenture"), as amended and supplemented by the First Supplemental Trust Indenture between the District and the Trustee, dated as of June 1, 2024 (the Master Indenture as amended and supplemented is hereinafter referred to as the "Indenture") (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):
(A)	Requisition Number: 12

(B)

(C)

Name of Payee: Amount Payable:

RCS Construction Co. Inc.
$194,678.46

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance, if applicable):
Fund, Account and/or subaccount from which disbursement is to be made:
Series 2024 Acquisition and Construction Account
The undersigned hereby certifies that obligations in the stated amount set forth above have been incurred by the District, that each disbursement set forth above is a proper charge against the Series 2024 Acquisition and Construction Account and the subaccount, if any, referenced above, that each disbursement set forth above was incurred in connection with the acquisition and construction of the Phase 1 Project and each represents a Cost of the Phase 1 Project, and has not previously been paid.
The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate entitled to retain.

Originals or copies of the invoice(s) from the vendor of the property acquired or services rendered with respect to which disbursement is hereby requested are on file with the District.
GOLDEN GEM COMMUNITY DEVELOPMENT DISTRICT

Authorized Officer

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY
If this requisition is for a disbursement from other than the Costs of Issuance Account, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Phase 1 Project and is consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and specifications for the portion of the Phase 1 Project with respect to which such disbursement is being made; and (iii) the report of the Consulting Engineer attached as an Exhibit to the First Supplemental Trust Indenture, as such report shall have been amended or modified on the date hereof.

Consulting Engineer
Kevin M Roberson
Kimley-Horn and Associates, Inc

TO OWNER:	PROJECT: Wyld Oaks	APPLICATION NO:	8	Distribution to:	
Kelly Park VB Development, LLC		Revised 7/18/24		OWNER	
660 Beachland Blvd.				ARCHITECT	
Vero Beach, FL 32963		PERIOD TO:	8/1S/24	CONTRACTOR	
FROM CONTRACTOR:	VIA ARCHITECT:				
RCS CONSTUCTION CO. INC.
295 E. HWY 50 SUITE I		
PROJECT NOS:			
CLERMONT, FL3471I
CONTRACT FOR:		
CONTRACT DATE:			

APPLICATION AND CERTIFICATION FOR PAYMENT	A/A DOCUMENT G702	PAGE ONE OF	PAGES	3

CONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment. as shown below, io connection wilh the Contract. Continuation Sheet, AIA Document G703, is atlached.

.. «,.,IN". CON,R < , ',tlM
I  ct c:ai,nv..-tw I """ "Order,.

,. ---- ..

The undctsigned Conttactor ccnifie.s that to the best of the Contractor's knowledi;c, information and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by theContractor for Wori< for which previous Certificates for Payment were issued and payments received from the Owner. and that current payment shown herein is now due.

I "'NTn -.cT 'ii ..,, IP ll!\ ff ((Jne I  21
4	I l
DATE	(Column G on G703)
5. RETAINAGE:

\2t,ll.!4H'i

\	nJli'l. IH
\	,  tM. '·  m

B,. · _..-,.,,,....,,_.,.,i..,--; rlo.	,	 Date: 	"TVliiic1¥f'!o'1R'i!mIAt-iE='".

	5 % of Completed Work		 n		O +Eon G703)

State	AJ	Notary Public
Su	d !)Ad sworn toJef'!e me	State of Florida

	5 % of Stored Material nfonG703)

,oc.

Notary Pu ic: 1/J{tt.J2J..tv	.,.,...._  ,,.	Comm# HH27662
My Commissio/ p1rcs:	2026

Total Retainagc (Lines Sa Sb or
l

(Line 4 Less Line S Total)
7. LESS PREVIOUS CERTIFICATES FOR		
PAYMENT (Line 6 from prior Certificate)
ti
!, 'INl'	N('I.I ....... KL ,A ... I\CI
(Linc 3 less Line 6)

Total Completed and Stored To Onie That is Eligible For C'DD Paymcn( Total Retainage At 5%
Total Earned Which Is Eligible For CDO Payment, l.ess Rclainage Less Amounl Previously Paid By CDD
Current Paym 'llt Due By COD	---+

Total Completed and Stor -d To Date - Eligible For KPVBD Payment Total Rctainagc At 5%
Total Earned Which Is Eligibh: For KPVBO Payment, Less Retainage
Lc:,s Amount Previously Paid B>· KPVBD

	.	

S	4,749,112.48
\		'.147. ,.	••• I HI 

1,629,486.S'l
	81,474.34 
	I ,S48,012.5S 
	1.353,334.09 
194,678.41>

3. 735,462.11
	186,773.11 
	3.548,689.00 
3,395,778.39

In accordance with the Contract Documents, based on on-site observations and the data comprising the application, the Engineer certifies to the Owner that to the best of the Engineer's knowledge, information and belief the Work has progn:sscd as indicated.
the quality of the Won< is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED ........... S  347,589.07

(Allac/1 expfa11aIio11 i/'amo11111 certijied diDersfrom I/,e flmount applied. h1iri11f all Jig11res 011 this Application (Ind on/1,e Conlin11mio11 SJ,eel 1hat are changed10 co1!for111 wit/, the an,011111 certified.) ENGINEER:	,,...//	Kevin Roberson, Kimley-Horn and Assoc.
By:	/ffe.f\'I	Date:	9-20-24
This Cer1ificate is 1101 negotiable. The AMOUNT CERTIFIED is J)llyable only lo the Conttactor named herein. Issuance, payment and acceptance of payment are wilhout prejudice 10 any rights of the Owner or Contractor under this Contract.

Current Payment Due By KPVBD	..	152,910.61

CHANGE ORDER SUMMARY
fotal fungcs approved in previous months by Owner Total aPl)fovcd this Monlh
II
I

ADDITIONS
$69,787.00
S0.00 1>bq.7 7 J1,9.7M7_1

DEDUCTIONS
$0.00
S0.00
t ..

IAlA DOCUMENT G702 • APP\.ICATION AND CERTIFICATION FOR PAYMENT 1"192 EDITION· AIA 01W2	THE AMERICAN INSTITUTE OF AACHTECTS, 1135 NEW YORK AVE.. N.W, WASHINGTON, DC
Users may obtain validation of this document by requesting a completed AJA Document 0401 • Certification of Oocumenrs Authenticity from the Licensee.
..... ('m11rnc1or nr:r• t!.? :luu l)1n1t:r wil! Jlf'r w11J1 ,du,1 h111dinr! 1.v ,,,·ffif(lb/<• whi(h mm· not eq11al tlr.i c·urn:111 P41W11f!1tJ D,w. An,· Ull/)llid hnlmir<' will remnm nn nccnwll l<1rOw11er to 1u1,· l1.·1JI, ,,,,,,,.,. hmds
1'ote: Item• in RED FONT ar..- automaticall• calculated from tht G703 form ur from Items within thi:r. G702 form, Do NOT hand l'Otl'r thl'K itrms o, this shed.

	
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CONTINUATION SHEET

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$6_,S l,-1$07	$4.999,0(;:\'1'7 f SJU.,Jl.!l

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AIA DOCUMf.'NT G70J	.....J..1......

'

PPLICATIONNO: APPLICATION DATE:	K!l.5!20:?4

u .. rarn•  vllfdatfonaflNad04vnllftlb'/Nqu.stlngof1MN •c'"' AIAPocum.•tDM>f CertJftca15onctl •

AIA.DOCUUENTnlm ,OMr Tl(lN!IHll:tffQAOfW '911f.Ol NA	,
•H[.WH1tC'-"'"4f'ITV"OfN!'Cltll(CU t1ll!,l,(:,Wl'MllA'IIE.l«.IE.fllW W tOIIDC 2CIOOl,l:Ja	GlOJ-1ff%

DEVELOPER'S REPRESENTATIVE CERTIFICATE FOR PAYMENT
W\'ld Oaks- Mass Site Gradine.Application #8 Period Through 8/15/24 Revised 9/19/24
In accordance with the Contract Documents, based on on-site observations and the data comprising
this application, the Developer's Representative certifies to the Owner that to the best of the Developer's Representative's knowledge, infonnation and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED..........N.	$347.589.07
(Attach explanation if amount certified differs from the amount applied. Initial au figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.)
DEVE OPER'S REPRESENT	

:De ---	_

		Date:	9/19/24
N	• =--Thoo y
	e•:		President
This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.

WAIYER AND RELEASE OF LIEN UPON PROGRESS PAYMENT

The undersigned lienor, in consideration of the sum of$ 347,589.07	, hereby waives and releases its lien and right to claim a lien for labor, services, or materials furnished through 08/15/2024 to Double B Development and Kelly Park VB Development. LLC on the job of Wyld Oaks Mass Grading Improvements to the following property:
S of Kelly Park Rd & Effie Dr.
3620 W Kelly Park Rd.
Apopka. FL 32712. Orange County (description of property)

This waiver and release does not cover any retention or labor, services, or materials furnished after the date specified.

DATED on September 19, 2024.

Lienor RCS Construction Company, Inc. Address 295 E SR 50, Suite 1,

By:	'	 \.	C1-:?=
P•	t	: Jody Bass
It:: ident

State of Florida
County oLf =ak=e,  _
The foregoing instrument was acknowledged before me this 19th  day of September  , 20..lL, by, Jody Bass   as  Vice President	of said company, who has presented as identification or is personally known to me.

VICTORIA E. LAUTERIA
Notary Public State 0f Florida Comm# HH27662S Ex,::'rf1 /1.9/2026

Signature of	otary Public	- t
(Seal)	/	.,	,X ,,r	"1,//l

I	1Jf lftJ,i{ ((  '-(/	1 l l	/v

		Victoria E Lauteria	 Print, Type or Stamp Commission

PROGRESS PAYMENT AFFIDAVIT

STATE OF FLORIDA COUNTY OF LAKE

BEFORE ME, the undersigned authority, duly qualified and authorized in the State and County aforesaid to administer oaths and take acknowledgements, this day, personally appeared	Jody Bass	, who being by me first duly sworn, deposes and says:

The facts and matters contained and recited in the Affidavit are based upon personal knowledge of the Affiant.
Affiant is the Owner of	RCS Construction Company. Inc.	. a North Dakota Corporation company (hereinafter the "Contractor")
Contractor and	Kelly Park VB Development. LLC		(hereinafter the "Owner") have executed, delivered and entered into that certain CONTRACT AND AGREEMENT dated	December 4,2023	(hereinafter the "contract").
Affiant now requests partial payment under the Contract. In Consideration of Owner providing such partial payment, Contractor hereby provides this Affidavit upon which Owner intends to rely.
Contractor is not aware of any Claims that would require an adjustment of the Contract Time or the Contract Price except for any Change Order Requests or Change Order Proposals previously submitted in writing to Owner prior to execution of this Affidavit.
Contractor releases any Claims for an adjustment to the Contract Time or the Contract Price except for those previously made in writing and delivered to Owner prior to execution of this Affidavit.
Affiant states that all bills for labor, services or materials furnished, delivered, installed or performed on the job site through the date of this Affidavit have been FULLY paid and that no lien for such may properly be filed, recorded or enforced. Waiver and Release of Lien upon Progress Payment forms for every such potential lienors are provided herewith through 08/15/2024
Affiant states that, except as provided herein, all bills for labor, services or
materials furnished, delivered, installed or performed on the job site through the date of this Affidavit have been FULLY paid and that no lien for such may properly be filed, recorded or enforced. Waiver and Release of Lien Upon Progress Payment forms for every such potential lienor are provided herewith, except as provided below:

Name of lienor	Amount due for labor, services or Or Potential Lienor	materials furnished, delivered,
Installed or performed

1. Acme Barricades	$472.11	
2. Central Florida Turf Pros	$3,000.00	
3. Florida Design Consultants	$6,567.50	
4. Hanes Geo Components	$1,106.43	
5. Hull & Son Well	$9,300.00	
6. Koncept Carma, Inc.	$1,210.00	
7. Krane Development, Inc. dba ADS Services, Inc.	$0.00	
8. Mid Florida Materials Co.	$0.00	
9. Mobil Modular	$1,612.84	
10. National Trench Safety	$270.25	
11. Quality Petroleum Corporation	$41,605.68	
12. Ring Power Corporation	$34,731.24	
13. Sunbelt Rentals, Inc.	$0.00	

FURTHER AFFIANT SAYETH NOT.

  RCS Construction Company, Inc.	

----l<-1-1, 'b.....,. h-\ -----".-'-...,;		_	_,. Affiant

Sworn to and subscribed before me this	15th	day of  August	,2024, by

C

	, who (check one): [ X] is personally known to me, [ ) produced a driver's license (issued by a state of the United States within the last five (5) years) as identification, or [ ] produced other identification to wit-:	.-'---..--· Affiant

did take an oath.	/	{.(	7
----b-'---=--=.1...:......1::......< --,'-.j.i..;..:..::..::;.. ...:....--
Print Name:	Victoria e' au·eria ------

®

VICTORIA E. LAUTERIA
Notary Public State of Florida Commll HH276625

Notary Public, State of Florida
Commission No.:_-=-H=H.:..:2=7-"'6=6=25=--------
My Commission Expires:	06/19/2026

WCf , "	Expires 6/19/2026

JOINDER AND INDEMNIFY AGREEMENT

Contractor, joins in the execution of this Affidavit for the purpose of adopting all representations of fact contained therein. Contractor understands that this Affidavit will be relied upon by Owner for all purposes relating to the Contract. Contractor agrees to indemnify, hold harmless and defend the Owner from, against and with respect to any and all loss, cost, damage and expense, including reasonable attorneys' fees, arising out of any claims by laborers, subcontractors or materialmen who might claim that they have not been paid for labor, services or material.

 Ith

A Florida Corporation Company
tA.			
By:
Name:	od	as
Title:Vice President

(CORPORATE SEAL)[where applicable)

REQUISITION

The undersigned, an Authorized Officer of Golden Gem Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture between the District and U.S. Bank Trust Company, National Association, Fort Lauderdale, Florida, as trustee (the "Trustee"), dated as of June 1, 2024 (the "Master Indenture"), as amended and supplemented by the First Supplemental Trust Indenture between the District and the Trustee, dated as of June 1, 2024 (the Master Indenture as amended and supplemented is hereinafter referred to as the "Indenture") (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):
Requisition Number: 13

Name of Payee:	RCS Construction Co. Inc.

Amount Payable:	$81,495.47

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance, if applicable):
Fund, Account and/or subaccount from which disbursement is to be made:
Series 2024 Acquisition and Construction Account

The undersigned hereby certifies that obligations in the stated amount set forth above have been incurred by the District, that each disbursement set forth above is a proper charge against the Series 2024 Acquisition and Construction Account and the subaccount, if any, referenced above, that each disbursement set forth above was incurred in connection with the acquisition and construction of the Phase 1 Project and each represents a Cost of the Phase 1 Project, and has not previously been paid.
The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate entitled to retain.

A-1

Originals or copies of the invoice(s) from the vendor of the property acquired or services rendered with respect to which disbursement is hereby requested are on file with the District.
GOLDEN GEM COMMUNITY DEVELOPMENT DISTRICT

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY
If this requisition is for a disbursement from other than the Costs of Issuance Account, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Phase 1 Project and is consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and specifications for the portion of the Phase 1 Project with respect to which such disbursement is being made; and (iii) the report of the Consulting Engineer attached as an Exhibit to the First Supplemental Trust Indenture, as such report shall have been amended or modified on the date hereof.

Consulting Engineer
Kevin M Roberson
Kimley-Horn and Associates, Inc

A-2

APPLICATION AND CERTIFICATION FOR PAYMENT	A/A DOCUMENT G702	PAGE ONE OF	PAGES	3	

TO OWNER:	PROJECT: Wyld Oaks
Golden Gem Community Development District	
APPLICATION NO:	
9	Dist	
ribution to: OWNER	
660 Beachland Blvd.			ARCHITECT	
Vero Beach, FL 32963	PERIOD TO:	9/16/	24	CONTRACTOR	
FROM CONTRACTOR:	VIA ARCHITECT:				
RCS CONSTUCTION CO. INC.				
295 E. HWY 50 SUITE I	PROJECT NOS:			
CLERMONT, FL3471I				
CONTRACT FOR:	CONTRACT DATE:			
CONTRACTOR'S APPLICATION FOR PAYMENT	 The undersigned Contraclor certifies that to the best of the Contractor's knowledge, information and Application is made for payment. as shown below. in conn -ction with the Contract.	 belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet, AJA Document G703, is altached.	Contract Documents, that all amounts have been paid by the Contractor for Work for which previous
Certificates for Payment were issued and payments received from the Owner, and that current payment
ORIGINAL CONI RAC'T SUM	s	6.520,0 fi 07	shown herein is now due.
Net change by Change Orders	$	397.126 2]
CONl RAC I SUM IO DATE (Linc I :t- 2)	s	6,917,154.29
l O rtd COMPI f 11 D &c S roRr D ro	$ 	5.533.750.65 
DATE	(Column G on G703)	By:	/ l  '  v-   I'	• - 	C	

§

	

RETAINAGE:

$276,687.53

VICTORIAE.

5_% of Completed Work		
(Column D +Eon G703)

Notary Public

5 % of Stored Material

S0.00

State of Florida

(Column Fon G703)		

Total Rctainage (Lines Sa+ Sb or

"'A g'.lu
ENGINEER'S CERTIFICATE FOR PAYMENT

Comm# HH27
XUIIES 6/119/2\.¥-6

Ioral ,n Column I of G703 i
6 IO rAI I f\RNI D L rss Rn'f\lNM,L (Line 4 Less Line 5 Total)
7. LESS PREVIOUS CERTWICATES FOR		
PAYMENT (Line 6 ti-om prior Certificate)
H CURRFNf PA YM[Nl DUL
9 flALANCI ro FINISH, INC'I.UDING RI rAINA(il
(Linc 3 less Line 6)

Total Completed and Slored To Date That is Elib ble For COD Paymen Total Retainage Al 5%
Total Earned Which Is Eligible For COD Payment. Less Retainage Less Amount Previously Paid By COD
Current Payment Due By COD

Total Completed and Stored To Date - Eligible For KPVBD Payment Total Retainage Al 5%
Total Earned Which Is Eligible For KPVBD Payment. Less Retainage Less Amount Previously Paid By KPVBD
Current Payment Due By K.PVBD

s	276.687.51	

State o,.

. LAKE
y /f Septcrpber, 2024

'" , ,

,	I  ,'CX r.,v

s	5.257.063.12	

$	5,096,701.55	
s	160,161.57 ••• 
.s   1.660.091.17	

  1,715,271.60	
	85,763.58	
  1,629,508.02	
  1,548,012.55	
81,495.47

  3,818,479.05	
	190,923.95	
  3,627,555.10	
  3,548,689.00	
78,866.10

In accordance with the Contract Documents. based on on-site observations and the data comprising the application, lhe Engineer certifies to the Owner that lo the best of the Engineer's knowledge, information and belief the Work has prob>ressed as indicaled.
the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED ........... $	160,361.57

(Allaclr explanation ifamo,111I certified differsfrom tire amormt applied. Initial all figures on tlris Application and 0111/re Co11tinuatio11Slreet that are changed to conform with the amou111certified.)
ENGINEER:	_	_/I	Kevin Rooerson, Kimley-Horn and Assoc.
By:	lW  •	Date:	9-26-24
This Certificate is not negotiable. The AMOUNT CERTWIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.

CHANGE ORDER SUMMARY	ADDITIONS	DEDUCTIONS	
Total changes approved in previous months by Owner	$69,787.00	$0.00	
Total approved this Month	$327,339.22	$0.00	
TOTAIS	$397.126.22	$0.00	
NI l CIIANGl·S by Change Order	$397.126.12		

iAIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA • @1992	THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW., WASHINGTON, DC 20006-5292
Users may obtain validation of this document by requesting a completed AIA Document 0401 - Certification of Document's Authenticity from the Licensee.
••• Co111rac1or agrees tlrat Owner will pav wrth wlrat l1111d111 rs amilable which mm·11m eq11al the Current Parme11I Due. A11r 1111µ(1/d balance will re111a111 011 acco11111 for Owner to pm·with /11I11re f1111ds.
Note: Items in RED FONT arc automatically calculated from the G703 form or from items within this G702 Form. Do NOT hand enter these items on this sheet.

DEVELOPER'S REPRESENTATIVE CERTIFICATE FOR PAYMENT

Wyld Oaks- Mass Site Grading Application #9 Period Through 9/16/24

In accordance with the Contract Documents, based on on-site observations and the data comprising
this application, the Developer's Representative certifies to the Owner that to the best of the Developer's Representative's knowledge,
information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents,
and the Contractor is entitled to payment of the AMOUNT CERTIFIED.

AMOUNT CERTIFIED		
(Attach explanation if amount Application and on the Contin

DEVELOPER'S REPRESENTATIVE:

By:
Name: 	 Timothy R. Dennard Title:'		President---

  	........................_$160,361.57	_
amount applied. Initial all figures on this nged to conform with the amount certified.)

Date:	9/26/2024

This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.

CONTINUATION SHEET	A/A DOCUMENTG703	Pao•Jof] ......

AIA Docwnclll G702. APPLICATION ANDCER'l1FICA'110N FOR PAYMENl.oom.aining
Contractor'!. SJJ!'.IK:d ca11fic.ition 15 attached

APPLICATION NO: APPLICATION DATE:
PERIOD TO:

9
9/1612024
9/1612024

Use t'olumn I on ConlracL,; where ,-anahlc rclama •c ror line items ma •arml •.	ARCHITECTS PROJECT NO:
A	B	C	I)	I	E	F	G	II	I	J	K	I.	M	N	0	I	
f"ffM NO.	
l>l:S<'IUl'llON OF \l.'ORK	SCIIFIJUI FD
VALi.IF	WOk.K COMl'U. I l;U	MAll;RIAl-'i
PRESENlLY STORED (NOTIN
DOR El	IOIAL
COMPLETED ANDSfORED TOOATE
(D+E<1-F)	%

(G•(')	BALANCE TO l·TNISII
(C-G)	RETAINAGI,
('alcula1edatl¾	(.'JJDl·h1biht•	KJ>VIII) l!llR:1i.bty	
			FKOM PREVIOUS
APl'LICA'IION
(Dt E)	IIIIS Pl·RIOD						v.1-:haiblc hw 1'1)1llrnl UyCDD	lotal Con.,lcted An1
S10«.'d 'Io Date Eligible For l'aynrtl D COD	11.llll COD Re11ir111rtt
@w.	%BtStiblctor
1'1)1ntt1 lly
KPVDI)	loial Compktod An.I
S1on:d To Date l,li.iiNe I-or l'ayn-.en
IJyKPVHI)	Total Kl'VDU
Rt1.11111J(lc"1 s•.		
		Qua1111y	u.•	Pri<:,	Toal															
	t'ner• onml ons, 'lon111.-t on.un·t'																			
1. MOBILIZATION	I	LS	$250 000.00	S:?50.000.00	S2.SO.OOO.OO	S0.00		S2.S0.000.00	100-/4	S0.00	512.500.00	9.97'/4	$24.925.00	S1.246.25	90.03',	S:?25.075 00	SI 1.-.:!53 75		
2. ATTORNEY FEE	I	LS	$95 000.00	$95.000.00	595.000.00	S0.00		$95.000.00	l	·'i	S0.00	54.7.SO.OO	9.97'1	S9.471 50	5473.58	90.03'·•	S85.5:?8 50	S4.:?76.43		
3. GENERAL CONDITIONS	I	LS	s21 457.44	S:?1.457.44	S19.500.00	S1.957.44		521.4S7.44	100%	sooo	51.07:!.IP	9.97''..	S2.139.31	510697	9003,.,	519.118 13	S96591		
4. PERFORMANCE BOND	I	LS	$80 494.S0	SW.494.50	Stt0.49-'.SO			580,494.SO	l 'i	S0.00	54,024.73	9.97''..	SS.025 30	S401.27	9003•,	S72.469.10	SJ.623 46		
5. LAYOUT/ASBUILTS	I	LS	$48 391.25	S-'11.391.:?5	S17.:?00.00	55.500.0fl		S42.700.00	88''•	SS.69125	S2.115.00	9.97',-	S4.257.19	S:?12 86	90.03',	538.44:?.81	51.9:?2 14		
6. SWWWP	1	LS	s10 003.75	S10.003.75	S9 300.00	5703.75		SI0.003.75	100''i	sooo	S500.19	9.97',	SIJ97 37	$49.87	9003'0	$9.006.38	S450.32		
7. Sil T FENCE	I	LS	$38 618.08	SJK.61808	S38.611t.08			538,618.08	100'11	S0.00	Sl.910.90	9.97''1	S3Jl.S0.22	$192.51	90.03'•	534,76786	S1,738 39		
8. TREE PROTECTION	I	LS	$19 718.90	S19.718.90	$17.000.00	S2.71ft90		S19.718.90	100•-•	sooo	S985.95	9.97'/,	Sl.965.97	S98.30	90.0J'/•	$17,75293	$887 65		
9. CONSTRUCTION ENTRY	2	EA	$12 461.65	S24.923.30	S:!0.70000	$4.:?23.30		$:?4.9:?J.JO	100',,	S0.00	S1.24617	9.91',	$2.-184.85	Sl:?4.24	90.03',	S22.43845	S1.121 92		
10.	CLEAR SfTEIWVLD OAKS	I	LS	$52 000.00	S52.000.00	$52.000.00	S0.00		$52.000.00	l(){)'/4	S0.00	S2,(,()(),00	9.97',	S5.184.40	$259.:?2	90 OJ •	S46.815.60	S2.34'>78		
11.	DEMO STRUCTURES -WYLD OAKS	I	LS	$34 500.00	S34.500.00	S34.500 00	S0.00		S34.500.00	I	·,	S0.00	S1,725.00	99?-·•	SJ,439.65	S171.98	9003,,.	SJl.060.35	Sl.553.02		
12.	DEMO PAVEMENT	3658	SY	$5.92	$21.655.36	SI8.800.00	S0.00		S18.80000	87",	S2.k5536	$9-IO.OII	9.97'.	Sl.874.36	S93.72	900J''o	S16.925.64	S846 28		
13.	DEMO CONCRETE	960	SY	$9.S6	$9.177.60	S9.177.60	S0.00		$9.177.60	100%	S0.00	S4S8.88	9.9-r.,	$915.01	S4S.75	90.03'·•	stt.262.59	S◄IJ1'		
14.	MASS GRADE	1273657	CY	$2.42	SJ.082.249.94	$2.964.)08.00	S0.00		S:?.964.308.00	96%	SI 17.941.94	Sl4jt215.40	9.97',	$295.541.51	514.77708	90.0J,-,	$2,668.766 49	Sl13AJ8.J:?		
15.	DEMO GOLDEN GEM PROPERlY	1	LS	55	333.23	S55.JJJ.23	$55.333.::?J	S0.00		S55.333.2J	100%	S0.00	$2.766.66	9.91''•	SS.516.72	S:?75.84	90.0J',	$49,816 SI	$2.490 81		
16.	DOUBLE SILT FENCE FOR STOCK PILE AREA	3800	LF	$4.35	$16.530.00	S0.00			S0.00	0%	S\6.530.00	S0.00	9.9-r.·•	S0.00	S0.00	9003,,	sooo	S0.00		
17.	HYDRO SEED STOCK PILE AREA	57000	SY	s1.00	$57.000.00	S0.00			S000	O'-	$57.00000	S0.00	9.97'/,	S0.00	S000	9003':.	S0.00	sooo		
18.	OVER EXCAVATE SOILS AREAS S' IN DEPTH	47682	CY	$5.52	$263.204.64	$256.112 UO	$7,091.64		$263.104.64	100%	S0.00	S13.160.23	9.97,,	S26,241 50	Sl.312.08	9003',	5236.963.14	SI I.K48 16		
19.	GRADE SITE	1	LS	$42	707.00	S42.707.00	S:!2.800.00	S15,000.00		$37,800.00	89',i,	$4,907.00	Sl.890.00	9.97',.	SJ.768 66	S188 43	9003''..	S34,031.34	Sl.701.57		
20	EROSION BLANKET	1	LS	$25	851.20	S25,K51.20	S0.00			S0.00	0%	S:?5,851.20	S0.00	9.9-r,'o	S0.00	S0.00	9003'•	S0.00	S0.00		
21.	WELL ABONOONMENT • WYLO/GOLOEN GlM	4	EA	$9 700.00	$38.800.00	S:?5,000.00	$9,500.00		$34,500.00	89''.	$4,300.00	Sl,725.00	9.97'/4	53.439.65	$171.98	9(1.03':.	SJl.060.35	Sl,553.0::?		
22.	CLEAR SITE/GOLDEN GEM	1	LS	$51000.00	SSl,000.00	543.500.00	S6.000.00		S49.500.00	97'1o	S1.500.00	S2.475 00	9.97',	$4.935.15	S:?46.76	90.0J'·'i	$44.564.85	S:?.2:?8 24		
23.	SOD PONDS	67270	SY	$4.81	S3:?3.568.70	sooo			S0.00	o,.	S32.3.568.70	S0.00	99'79.	S0.00	S0.00	90.03'1-	S000	sooo		
24.	PONO LINER 30 Mill	20645	SF	$3.57	573,702.65	S0.00			S0.00	o••	$73.702.65	S0.00	9.9-r.,	so.oo	S0.00	90.03''i	S0.00	S0.00		
25.	HYDRO SEED BOTTOM OF PONDS	72900	SY	$1.00	SJ:!.900.00	S0.00			S0.00	0•1.	$72.900.00	SO.DO	997'·'i	S0.00	S0.00	90.0JS.	S0.00	sooo		
26.	DEWATERING	1	LS	$30 000.00	S30,000.00	SJ0.000.00	SO.DO		SJ0.000.00	100%	S0.00	SI.500.00	9.97'·'i	52.991.00	$149.55	9003'"	$27.009.00	Sl,350 45		
27.	SEED/MULCH	1	LS	$3S4 813.60	5354.813.60	S01)()			S0.00	0%	5354.813 60	S0.00	9.97''.	S000	S0.00	90.03'·•	S0.00	S000		
28.	60" HOPE	1414	LF	S274.81	$311.8. 1.34	S357.JS 72	S31.198.62	SOIJO	SJSK.581.34	100%	sooo	$19,429.07	100 -.	$)88.58134	S19.429.07	000'·•	S000	S000		

A1-'00CUMENTG103 CONTINUAftONS Elf"ORG?W 19-0?EOlllON AJA 0111'ili
THE AMERtCAN INSTITUTE OF ARCHITECT$ 17JSN(W 'l'O'IKA\11:J«<JE NW Wot.S,HINQTON OC ;,oooe. 32	G70J.1992

CONTINUATION SHEET	A/A DOCUMENT G703	P-lofl ......

/\IA Document G70:!, Al'PIJC',\TION AND (T l lFICATION l·OR PAYMENT. cmtammg Cootr.1ctor's s•	cet11fica11on 1 aoachoJ

APPLICATION NO: APPLICATION DATE:
PERIOD TO:

9
9116/2024
911612024

U
•

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ARCIIITECTS PROJECT NO·
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CDl>l-k1ubt.111v lotalCtlnt,lctcdAm
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1- ibk.ForPaynn
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$7,13182
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$813.138 13
sooo

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Users may obtain valldatlon of this document by requesting of the license a completed AJA Document 0401 - Certification of Document's Authenticity

NAOOCUM(Hl0103 CONTINUII.TIOH!H(£1f OJW 1N1EDITIOH .-.iA 0119? TH(AMf:RICANll•<SllTUU:OfAJ!CltllECTS l735NEW '!'()qKA\'ENUI! ... w WASHIN010H DC 1000&-

G703•1H2

WAIYER AND RELEASE OF LIEN UPON PROGRESS PAYMENT

The undersigned lienor, in consideration of the sum of$ 160,361.57	, hereby waives and releases its lien and right to claim a lien for labor, services, or materials furnished through 09/16/2024 to Double B Development and Kel1y Park VB Development, LLC on the job of Wyld Oaks Mass Grading Improvements to the following property:
S of Kelly Park Rd & Effie Dr.
3620 W Kelly Park Rd.
Apopka, FL 32712, Orange County (description of property)

This waiver and release does not cover any retention or labor, services, or materials furnished after the date specified.

DATED on September 16, 2024.

Lienor RCS Construction Company, Inc. Address 295 E SR 50, Suite 1,

Print

Clermont FL 34711   By:_...,c:;:v..i.	...;L	­

State of Florida
County of _L=ak=e'----
The foregoing instrument was acknowledged before me this 16th	day of  September
20_l±  , by, as of said company, who has presented as identification or is personally known to me.

		Victoria E Lauteria	 Print, Type or Stamp Commission

PROGRESS PAYMENT AFFIDAVIT

STATE OF FLORIDA COUNTY OF LAKE

BEFORE ME, the undersigned authority, duly qualified and authorized in the State and County aforesaid to administer oaths and take acknowledgements, this day, personally appeared	Jody Bass	, who being by me first duly sworn, deposes and says:

The facts and matters contained and recited in the Affidavit are based upon personal knowledge of the Affiant.
Affiant is the Owner of	RCS Construction Company, Inc.	. a North Dakota Corporation company (hereinafter the "Contractor")
Contractor and	Kelly Park VB Development, LLC		(hereinafter the "Owner") have executed, delivered and entered into that certain CONTRACT AND AGREEMENT dated	December 4, 2023	(hereinafter the "contract").
Affiant now requests partial payment under the Contract. In Consideration of Owner providing such partial payment, Contractor hereby provides this Affidavit upon which Owner intends to rely.
Contractor is not aware of any Claims that would require an adjustment of the Contract Time or the Contract Price except for any Change Order Requests or Change Order Proposals previously submitted in writing to Owner prior to execution of this Affidavit.
Contractor releases any Claims for an adjustment to the Contract Time or the Contract Price except for those previously made in writing and delivered to Owner prior to execution of this Affidavit.
Affiant states that all bills for labor, services or materials furnished, delivered, installed or performed on the job site through the date of this Affidavit have been FULLY paid and that no lien for such may properly be filed, recorded or enforced. Waiver and Release of Lien upon Progress Payment forms for every such potential lienors are provided herewith through	09/16/2024
Affiant states that, except as provided herein, all bills for labor, services or materials furnished, delivered, installed or performed on the job site through the date of this Affidavit have been FULLY paid and that no lien for such may properly be filed, recorded or enforced. Waiver and Release of Lien Upon Progress Payment forms for every such potential lienor are provided herewith, except as provided below:

Name of Lienor	Amount due for labor, services or Or Potential Lienor	materials furnished, delivered,

Installed or performed

1.  Acme Barricades	$472.11	
2. Florida Design Consultants	$7,744.00	
3. Fortiline Inc	$0.00	
4. Koncept Carma, Inc.	$715.00	
5. Krane Development, Inc. dba ADS Services, Inc.	$0.00	
6.  Mid Florida Materials Co.	$0.00	
7.  Oldcastle Infrastructure	$8,252.10	
8.  Quality Petroleum Corporation	$29,928.42	
9. Sunbelt Rentals, Inc.	$0.00	

FURTHER AFFIANT SAYETH NOT.

Sworn to and subscribed before me this	16th	day of September	,2024, by	Jody Bass	, who (check one): [ X] is personally known to me, [ ] produced a driver's license (issued by a state of the United States within the last five (5) years) as identification, or [ ] produced other identi•
Affiant did take an oath.

VICTORIA E. LAUTERIA
Notary Public State of Florida Comm# HH276625
Expires 6/19/2026

I
Print Name:	Viet	a	Lauteria 	 Notary Public, State of Florida
Commission No.:--HH-27-66-25-------
MComymission Expires:	06/19/2026

JOINDER AND INDEMNIFY AGREEMENT

Contractor, joins in the execution of this Affidavit for the purpose of adopting all representations of fact contained therein. Contractor understands that this Affidavit will be relied upon by Owner for all purposes relating to the Contract. Contractor agrees to indemnify, hold harmless and defend the Owner from, against and with respect to any and all loss, cost, damage and expense, including reasonable attorneys' fees, arising out of any claims by laborers, subcontractors or materialmen who might claim that they have not been paid for labor, services or material.

By: ---...,.......,1'-<:b:7'""--t --------------

A Florida Coq: oration Company

(CORPORATE SEAL)[where applicable]

REQUISITION

The undersigned, an Authorized Officer of Golden Gem Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture between the District and U.S. Bank Trust Company, National Association, Fort Lauderdale, Florida, as trustee (the "Trustee"), dated as of June 1, 2024 (the "Master Indenture"), as amended and supplemented by the First Supplemental Trust Indenture between the District and the Trustee, dated as of June 1, 2024 (the Master Indenture as amended and supplemented is hereinafter referred to as the "Indenture") (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):
Requisition Number: 14

Name of Payee:	Kutak Rock LLP

Amount Payable:	$1,351.00

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance, if applicable):
Fund, Account and/or subaccount from which disbursement is to be made:
Series 2024 Acquisition and Construction Account

The undersigned hereby certifies that obligations in the stated amount set forth above have been incurred by the District, that each disbursement set forth above is a proper charge against the Series 2024 Acquisition and Construction Account and the subaccount, if any, referenced above, that each disbursement set forth above was incurred in connection with the acquisition and construction of the Phase 1 Project and each represents a Cost of the Phase 1 Project, and has not previously been paid.
The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate entitled to retain.

A-1

Originals or copies of the invoice(s) from the vendor of the property acquired or services rendered with respect to which disbursement is hereby requested are on file with the District.
GOLDEN GEM COMMUNITY DEVELOPMENT DISTRICT

Autho.ilie:	

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY
If this requisition is for a disbursement from other than the Costs of Issuance Account, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Phase 1 Project and is consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and specifications for the portion of the Phase 1 Project with respect to which such disbursement is being made; and (iii) the report of the Consulting Engineer attached as an Exhibit to the First Supplemental Trust Indenture, as such report shall have been amended or modified on the date hereof.

Consulting Engineer
Kevin M Roberson
Kimley-Horn and Associates, Inc

A-2

A-3

K U T A K  R O C K  L L P
TALLAHASSEE, FLORIDA
Telephone 404-222-4600
Facsimile 404-222-4654

Federal ID 47-0597598

August 26, 2024

Check Remit To: Kutak Rock LLP PO Box 30057
Omaha, NE 68103-1157

ACH/Wire Transfer Remit To:
ABA #104000016
First National Bank of Omaha
Kutak Rock LLP A/C # 24690470
Reference: Invoice No. 3439070 Client Matter No. 47123-4
Notification Email: eftgroup@kutakrock.com

Mr. George Flint Golden Gem CDD
c/o Governmental Management Services 219 East Livingston Street
Orlando, FL 32801	Invoice No. 3439070
47123-4

Re:	Series 2024 Construction
For Professional Legal Services Rendered

07/01/24	A. Willson	0.30	94.50	Confer	with	Edwards	regarding
	payment letter; review and revise
same	
07/10/24	A. Willson	0.30	94.50	Review	change	orders	regarding
mass grading and infrastructure site work	agreements;	confer	with	
07/11/24

07/22/24	A. Willson

A. Willson	0.40

0.30	126.00

94.50	Edwards and Flint regarding same Confer	with	Edwards	regarding change		order	and		contact assignments
Confer	with	Walda	regarding	

07/25/24	
J. Gillis	
0.70	
122.50	contractor payment process; review items regarding same
Receive and review notice to owner	

07/25/24	

A. Willson	

0.20	

63.00	received from Dixie Lime and Stone Company; draft response to same;
confer with staff regarding same Review and revise response to notice	
07/30/24	A. Willson	0.30	94.50	to owner
Confer with Murray regarding title	
				insurance policy; review of same	

KUTAK ROCK LLP
Golden Gem CDD August 26, 2024
Client Matter No. 47123-4 Invoice No. 3439070
Page 2

07/31/24	A. Willson	0.20	63.00	Confer  with  Roberson  and  Flint
regarding district maintenance items
TOTAL HOURS	2.70
TOTAL FOR SERVICES RENDERED	$752.50
TOTAL CURRENT AMOUNT DUE	$752.50

K U T A K  R O C K  L L P
TALLAHASSEE, FLORIDA
Telephone 404-222-4600
Facsimile 404-222-4654

Federal ID 47-0597598

September 30, 2024

Check Remit To: Kutak Rock LLP PO Box 30057
Omaha, NE 68103-1157

ACH/Wire Transfer Remit To:
ABA #104000016
First National Bank of Omaha
Kutak Rock LLP A/C # 24690470
Reference: Invoice No. 3454612 Client Matter No. 47123-4
Notification Email: eftgroup@kutakrock.com

Mr. George Flint Golden Gem CDD
c/o Governmental Management Services 219 East Livingston Street
Orlando, FL 32801	Invoice No. 3454612
47123-4

Re:	Series 2024 Construction
For Professional Legal Services Rendered

08/02/24	A. Willson	0.70	220.50	Confer	with	Edwards	regarding
ongoing items
08/06/24	A. Willson	1.20	378.00	Review direct purchase of materials
requirements; confer with Edwards regarding same
TOTAL HOURS	1.90
TOTAL FOR SERVICES RENDERED	$598.50
TOTAL CURRENT AMOUNT DUE	$598.50

REQUISITION

The undersigned, an Authorized Officer of Golden Gem Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture between the District and U.S. Bank Trust Company, National Association, Fort Lauderdale, Florida, as trustee (the "Trustee"), dated as of June 1, 2024 (the "Master Indenture"), as amended and supplemented by the First Supplemental Trust Indenture between the District and the Trustee, dated as of June 1, 2024 (the Master Indenture as amended and supplemented is hereinafter referred to as the "Indenture") (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):
Requisition Number: 15

Name of Payee:	Golden Gem Community Development District

Amount Payable:	$2,660.00

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance, if applicable):
Fund, Account and/or subaccount from which disbursement is to be made:
Series 2024 Acquisition and Construction Account

The undersigned hereby certifies that obligations in the stated amount set forth above have been incurred by the District, that each disbursement set forth above is a proper charge against the Series 2024 Acquisition and Construction Account and the subaccount, if any, referenced above, that each disbursement set forth above was incurred in connection with the acquisition and construction of the Phase 1 Project and each represents a Cost of the Phase 1 Project, and has not previously been paid.
The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate entitled to retain.

Originals or copies of the invoice(s) from the vendor of the property acquired or services rendered with respect to which disbursement is hereby requested are on file with the District.
GOLDEN GEM COMMUNITY DEVELOPMENT DISTRICT

AuthorizeG;:			

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY
If this requisition is for a disbursement from other than the Costs of Issuance Account, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Phase 1 Project and is consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and specifications for the portion of the Phase 1 Project with respect to which such disbursement is being made; and (iii) the report of the Consulting Engineer attached as an Exhibit to the First Supplemental Trust Indenture, as such report shall have been amended or modified on the date hereof.

Consulting Engineer
Kevin M Roberson
Kimley-Horn and Associates, Inc

	
Please remit payment electronically to:	If paying by check, please remit to:	
Account Name:	KIMLEY-HORN AND ASSOCIATES, INC.
Bank Name and Address:	WELLS FARGO BANK, N.A., SAN FRANCISCO, CA 94104
Account Number:	2073089159554
ABA#:	121000248	KIMLEY-HORN AND ASSOCIATES, INC.
P.O. BOX 932520
ATLANTA, GA 31193-2520	
Please send remittance	payments@kimley-horn.com information to:		

GOLDEN GEM CDD
C/O GOVERNMENTAL MANAGEMENT SERVICES 219 EAST LIVINGSTON ST
ORLANDO, FL 32801

Invoice Amount: $2,660.00
Invoice No:	28699678 Invoice Date:	Jun 30, 2024
Project No:	147968000.3

Federal Tax Id: 56-0885615
For Services Rendered through Jun 30, 2024

Project Name: Project Manager:
Client Reference:

GOLDEN GEM CDD INTERIM ROBERSON, KEVIN
RESOLUTION 2024-05

COST PLUS MAX

2,660.00

Total COST PLUS MAX

2,660.00

5,687.50

8,347.50

25,000.00

Subtotal

2,660.00

5,687.50

8,347.50

25,000.00

INTERIM ENGINEERING

Current Amount Due

Previous Amount Billed

Amount Billed to Date

Contract Value

Description

Total Invoice: $2,660.00
Description of Services:
Normal operations tasks
Sign and return engineer certification for PLUM
Efforts for coordination of plat language for CDD ownership and CDD’s purchase of the pond property
Meeting with Taylor on splitting up past invoices for CDD related activities
Review of Final Engineering agreement with CDD
Attend June CDD board meeting
CDD weekly call with development team
Assist Mike Gibbons for response to RCS’s attorney on CDD boundaries, and CDD responsibility of mass grading project
Sign Requisite closing cost and closing fees
Construction related efforts
Meeting with attorney to discuss construction pay app process with CDD
Review pay requisites for mass grading pay apps

If you have any questions, please contact Zach.Reuther at 561-234-4519 or Zach.Reuther@kimley-horn.com.	31ZSR

GOLDEN GEM CDD
C/O GOVERNMENTAL MANAGEMENT SERVICES 219 EAST LIVINGSTON ST
ORLANDO, FL 32801

COST PLUS MAX		

Invoice No: Invoice Dat
Project No: Project Nam Project Man	

Task	
Description	
Hrs/Qty	
Rate	Current Amount Due	
01INTERIM ENGINEERING	SENIOR PROFESSIONAL II	7.0	380.00	2,660.00	
TOTAL 01INTERIM ENGINEERING	7.0		2,660.00	
TOTAL LABOR AND EXPENSE DETAIL			2,660.00	

e:

e: ager:

28699678
Jun 30, 2024
147968000.3
GOLDEN GEM CDD INTERIM ROBERSON, KEVIN

This page is for informational purposes only. Please pay amount shown on cover page.

31ZSR

10/2/24, 10:39 AM	about:blank

about:blank	1/1

REQUISITION

The undersigned, an Authorized Officer of Golden Gem Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture between the District and U.S. Bank Trust Company, National Association, Fort Lauderdale, Florida, as trustee (the "Trustee"), dated as of June 1, 2024 (the "Master Indenture"), as amended and supplemented by the First Supplemental Trust Indenture between the District and the Trustee, dated as of June 1, 2024 (the Master Indenture as amended and supplemented is hereinafter referred to as the "Indenture") (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):
Requisition Number: 16

Name of Payee:	RCS Construction Co. Inc.

Amount Payable:	$973,944.06

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance, if applicable):
Fund, Account and/or subaccount from which disbursement is to be made:
Series 2024 Acquisition and Construction Account

The undersigned hereby certifies that obligations in the stated amount set forth above have been incurred by the District, that each disbursement set forth above is a proper charge against the Series 2024 Acquisition and Construction Account and the subaccount, if any, referenced above, that each disbursement set forth above was incurred in connection with the acquisition and construction of the Phase 1 Project and each represents a Cost of the Phase 1 Project, and has not previously been paid.
The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate entitled to retain.

A-1

Originals or copies of the invoice(s) from the vendor of the property acquired or services rendered with respect to which disbursement is hereby requested are on file with the District.
GOLDEN GEM COMMUNITY DEVELOPMENT DISTRICT

Authorized Officer

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY
If this requisition is for a disbursement from other than the Costs of Issuance Account, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Phase 1 Project and is consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and specifications for the portion of the Phase 1 Project with respect to which such disbursement is being made; and (iii) the report of the Consulting Engineer attached as an Exhibit to the First Supplemental Trust Indenture, as such report shall have been amended or modified on the date hereof.

Consulting Engineer
Kevin M Roberson
Kimley-Horn and Associates, Inc

A-2

CONSTRUCTING PARTY'S APPLICATION FOR PROGRESS PAYMENT

TO:	Fidelity National Title
Attn: Sam Sobering (sam.sobering@fnf.com) 2400 Maitland Center Parkway, Suite 110
Maitland, FL 32751

FROM:

CC:

Golden Gem Community Development District ("CDD")
c/o Governmental Management Services - Central Florida, LLC 219 East Livingston Street
Orlando, Florida 32801

LIT Cadence West Kelly Phase I, LLC ("LIT Cadence") Attn: Todd Watson (todd@cadencepartnersllc.com)
617 Virginia Drive
Orlando, FL 32803

Application is made for a Progress Payment from the Escrow Funds pursuant to Section 9(c) of the Development Agreement between Developer and LIT Cadence.

Total Amount Due Contractor under Contractor's Application For Payment

Amount of Escrowed Funds Equal to 17% of Shared Infrastructure Being Requested for Release

$1,167,749.52

$193,805.46

Check Payment made Payable to: RCS Construction Co. Inc., 295 Hwy. 50, Suite 1, Clermont, FL 34711.

Attachments:

Contractor's Application for Payment Contractor Progress Payment Affidavit Contractor Waiver and Release of Lien

The Developer or COD, as applicable, acting as Constructing Party, certifies to the best of its knowledge, infonnation and belief, that the Work covered by this Application for Progress Payment has been completed in accordance with the Construction Contract, and that the current amount shown herein is now due.

Page I of2

CONSTRUCTING PARTY:

Golden Gem Community Development District,
A Community Development District created pursuant to the Uniform Community Development District Act of 1980, Chapter 190, Florida Statutes, the Florida Constitution, and other applicable provisions of law, and established by Ordinance No. 3041, enacted by the City Council of the City of Apopka, Florida, on January 3, 2024

By:	Date:		

Name: H.M. Ridgely Title:	Vice Chainnan

State of Florida		
County of-:;t..-oC'an 	\\!'t<

,L-u. e 

Subscribed and sworn to before me by means ofr/4hysical presence or LJ on-line notarization, H- Y\- A¥, t\A	'the		u.i'sroan of the Golden Gem Community Development District, this  4  day(;f  (!		 , 2024.

Notary Public, State of Florida

Name: .$¥A:Nl'{Qfi: C...OMN
My Commission expires:	Io-a l.J-o>ruR

Page 2 of 2

APPLICATION AND CERTIFICATION FOR PAYMENT	AJA DOCUMENT G702	PAGE ONE OF	PAGES	4		

TO OWNER:	PROJECT: Infrastructure- Wyld Oaks	APPLICATION NO:	4	§Distribution to: Kelly Park VB Development, LLC					OWNER
660 Beachland Blvd.	ARCHITECT
Vero Beach, FL 32963		PERIOD TO:	9/16/24	CONTRACTOR FROM CONTRACTOR:	VIA ARCHITECT:
RCS CONSTUCTION CO. INC.
295 E. HWY 50 SUITE I	PROJECT NOS:
CLERMONT, FL347l l
CONTRACT FOR:	CONTRACT DATE		
CONTRACTOR'S APPLICATION FOR PAYMENT	 The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Application is made for payment, as shown below, in connection with the Contract.	Work covered by this Application for Payment has been completed in accordance with the Contract Documents,
Continuation Sheet, AJA Document G703, is attached.	that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were
issued and payments received from the Owner, and that current payment shown herein is now due.
I  ORIGINAL CONl R.\CI SL M	$	14,205,20(>.4'1
Net change by Change Orders	$	215,176.20	CONTRACTOR:	RCS CONSTRUCTION CO., INC.
CONTRACT SUM TO DATF (I me I  2)	$	14,420,3 2.6()	t../
TO rAL COMPLFTFD & SlORLD I 0	$	4,618,447.02
DATE	(Column G on G703)	•	i	9/16/2024
RETAINAGE:	II"	Date:	VICTORIA el
5_% of Completed Work		S230,922.35 	By,fj'-1'-;!- I	Nota,v Pub!;
(Column D +Eon G703)
5 % of Stored Material		$0.00 	I ,	State of Flon
(Column Fon G703)	Comm# HH2
Total Retainage (Lines 5a + 5b or	\ v ff l/(,C	'<fAJ ·	Expires 6/19
fotal m Column I of G703)	S	230.922 35	
6 IO I Al f'ARNFD IFSS RrTAINAC,F	$	4.387,524.67	 In accordance with the Contract Documents, based on on-site observations and the data (Line 4 Less Line 5 Total)			comprising the application, the Engineer certifies lo the Owner that 10 the best of the
LESS PREVIOUS CERTIFICATES FOR					 Engineer's knowledge, information and belief the Work has progressed as indicated, PAYMENT (Line 6 from prior Certificate)			$	3,219,775.15	the quality of the Work is in accordance with the Contract Documents, and the Contractor
CURIH"Nf PAYMINI DUE----------	1.167.749.52 •••	is entitled to payment of the AMOUNT CERTIFIED.
<l. l3ALANCF IO l lNISII. INCi UOING RFTAINAGF	$	I 0.032.858.02	1,167,749.52
(Line 3 less Linc 6)	AMOUNT CERTIFIED	$

Total Completed and Stored To Date Allocated To Cadence		$748,556.04 	(Allach expla11ario11ifa11101111r certified differsJi-om the amount applied. lnirial all.figures 011rhis
Total Retainage At 5%	$37,427.80	Applicarion and nnth r:n111in11ntinn Sheet thar are cha11ged to conform with the a111011111 cerrijied.)
Total Allocated To Cadence, Less Retainage		$711,128.24 	ENGINEER:  1 /J f\'\	Kevin Roberson, Kimley-Horn and Assoc.
Less Balances Due By Cadence On Previous Payment Applications	$517,322.78
Payment Due By Cadence This Payment Application	$193,805.46	By: 	 Date:	10-3-24

Total Completed and Stored To Dale Allocated To COD		$3,869,890.98 	 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Total Retainage At 5%			$193,494.55 	Contractor named herein. Issuance, payment and acceptance of payment are without
Total Allocated To COD, Less Retainage			$3,676,396.43 	prejudice 10 any rights ofthc Owner or Contractor under this Contract. Less Balances Due By COD On Previous Payment Applications		g  702,j52.37
Payment Due By COD This Payment Application	$973,944.06	
CHANGE ORDER SUMMARY	ADDITIONS	DEDUCTIONS		
Total changes approved in previous months by Owner
Total approved this Month	$2 I 5,176.20			
fOTALS	$215.176.20	I	so.oo		
NET Cl1/\NGFS by Change Order	$215,176.20		
	
IAtA DOCUMENT G702 • APPLICATION ANO CERTIFICATION FOR PAYMENT· 1992 EDITION· AIA • ©1992	THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292
Users may obtain validation of this document by requesting a completed AIA Document D401 - Certification of Document's Authenticity from the Licensee.
•••  Conrracror agrees rhat Owner will pm· witl1 wha, funding,s amilable w/11ch mar 1101equal the C11rre111Pa),111e111Due. ,for 1111paid balance will remain 011 account (or Owner 10 pay with f11111re /1111ds.
Note: Items itt_RED FONT arc automaticall)' calculated from the C703 form or from items within this C702 Form. Do NOT hand enter these items on this sheet.		

LAUTERIA

af
6625

2026

I

•

CONTINUATION SHEET	AJA DOCUM£NTG703	,. :r.,.......
AL-\ l}ocunl\.,1\ G702. APPLIC'ATK>N ANIJ (ER"IU:IC'ArK>N 1:oR PAYMENI'. comainin	APPLICATION NO,
funtracton s1in1.-.d ccr11fica1mn 1s llttachcd.	APPLICATION DATE:	9/1612024
PERIOD TO,	9/1612024

..

"

IJseColunm lon(',,rnncts lk."h: ,.arfahk rc1111na for lmc it1-,11s ma annly	ARCHITECT'S PROJECT NO

"

C	1:
WORK COMJ'l.171:D

F
MAfCRIAl.S

G
IOTAL

II	J	K
c.-.-.,.

L	M	N	<>

1 11

Dl:SCRll'TION OF WORK

.ondlllon,. MobillJII on. :-.un

SCIIEOl.11..ED

,_	,_,

VAi.UL
o.-  l'•t

FltO t l'REVIOLTS
APPUCATIO!>l
(0. l'l

flHSPER.100

PRES0'.TLY STORl'O (NOTIN DORI:)

CO'-fPUll:0 ANOSTORl'O TODATF..
1D•F. 1-1

(0 •C)

HALAl'.CP. TOFINISII (C,G)

Rh-YAINAGE (IFVARl,\HLE RATEi

,.,
lrt'4)RJWm11tnt0

l'fl'CICntf.li.f!;ibic 1-·o.-P1ymmt BrC■dc:,n,;,c

1 ou1C lded Ard Sk>RJTo0.11:
Ehg,ble-Forl'1ym,:ni Rv(:1,k,u,

Tui..l
Rcw,-iic(615%

l"cn.'cnlFJ1pblt fi,rP1)'malt OyCDD

Toll.ll.'on-.,lctcdA..!

I

SIOmlToD11k	TOYlc..,>D
D ble-fo,Pa)'fflt'III  Rei.,rai:c{- 5'4 UyCl>O

MOBILIZATION
GENERAL CONDITIONS

1	LS  13 750.00
1	LS < 221250.00

Sil 750.00
S22J.250.00

SIJ,75000
$105000.00

Sil 750.00 SIOS.000.00

100'•
4 ,

SOJIO Sll6,250.00

s6g1..so
55 :?50.00

Yes
fo

17.00'f
17. -

S2 337.50 Sl7.8.SOOO

Sll6.88 5892 SO

83 00',.
noo-,

SI I 412 50
S87 15000

S57061 S4,l.S7..SO

PERFORMANCE BONO

1	LS ! 103 750.00

SJOJ,750.00

SIOJ 750.00

SJOJ.750.00

100-ii

50.00

55.187..SO

Ye,

11.00-,.

Sl7 637.50

SSlll.118

83<Mr-:.	S86.ll:?.SO

54.'.\0563

LAYOUTIASBUILTS

1	LS  96 518.75

596518.75

S32 420.00

SI I 000.00

S4J.420.00

45"-

S5J098.75

S:?.171.00	v«

17. .

S7311l.40

S)69.07

8).00,;,

S.M 038.60

SJ 1101 9l

SWWWP

1	LS  28 750.00

S.!8750.00

59000.00

SI 20000

SI0,200.00

3s,.

SIS 550.00

5510.00

Ye,

17lX>'.

Sl,734.00

1116.70

83.009'.

Sk 46600

5423.lO

SILT FENCE

21818 Lf	Sl.81

SJ9 490.58

$33100.00

SJJ.10000

84,.

56 390.58

SI 655.00

Yes

1100-;.

5562700

5211135

83 -

s21473 no

SI 37165

TREE PROTECTION

2930  lf

S6.73

S19,718.90

S0.00

Sl9718.90

$197111.90

100-,

S0.00

S9S5.95	Yo

11.00,.

SJ 352.21

516761

83 ()()'.

516 3661'19

SSIII.H

8. CONSTRUCTION ENTRY

2	EA SJ2 647.28

S25 294.56

suoo.oo

Sii 800.00

Js•,

516.494.56

S.W0.1)0

Y<>

17.00".

SI 496.00

$7480

83 oo-•

S7 J0,1,00

5365 !O

o. MASS GRADING

31971 CY	2.81

SS91lJll.SI

5752.S0.00

575 250.00

84%

S14.S8S.51

SJ 762..50

Ye,

17,00,it	$1279:?..SO

$63963

KlOO';.

S624S7 50

SJ.1:?2811

"·

10. ROADWAY GRADING SOD BEHIND CURB
10" FORCE MAIN
10• PLUG VALVE
12"X10" WET TAP

1
10613
5244
14
2

l5  S97 182.84
SY	S3.69
LF	S70.72
EA  S5 619.75
EA S16 066.18

$971112.84 539161 97
S370,ll55.68 S78 676.50
S32 I.J2.J6

SJ9 200.00
S0.00 Sl75,700.00 S58 750.00
Sil J00.00

SK 500.00

$47,700.00
sooo
$175,70000 558.75000
$11,300.00

4cr,.
o"
47 .
,s,e
35•.

S49,482K4 SJ9 161.97 Sl95,155.68
$19926.50
S208.12.36

S2 Jll5.00 S0.00
S8 785.00
S2 917.50
1565.00

Ye, Yes Y«
Yes
Ye,

17.00%
17.00,f
11 cm.
17.00'.
17.()0%

S8 10900
sooo
$29 869 00
S9 987.50
SI 921.00

S405.45
sooo
SI 49)45 S499.lR
S96.05

8300---.
8).00-9
83 oo-, 8.l<Mr-:.
83 00-f

SJ9 591 00
,ooo
Sl458JI.OO
$43 762 .SO
S9 379.00

Sl,97955
sooo
S7 291 55
S24'11 n
$468 95

6" FORCE MAIN
6" PLUG VALVE
4" FORCE MAIN
4" PLUG VALVE

648
12
20
1

Lf	S50.13
EA S3 905.17
LF	<36.17
EA  S2 366.34

SJ248424 S4f,862.04 S72J.40 S:? 36634

$12800.00
S14 154.00
!0.00
5690.00

S12800.00
$14.154.00
S0.00 5690.00

39"'/4
30".
O,;,
29'c9

519684.24
Sl:?708.04
$72].40
$1,676.34

1640 00
S707.70 S0.00
$)450

Yes Yes Ye, Yes

1700"9
17.00'J:.
17()( -
1100,e

S2 17600
$2 406.18
SO 00 SJ 17.JO

SIOUO
$12031
,ooo
SS!l7

ucm,
8J.oo,,
83.00".
8HXJ%

S1062400
$11747.8!
!000
5572,70

S5JI 20 SS87,J9
!000
528.64

10 FORCE MAIN FITTINGS

1	LS

<78184.45

S78.184.45

S66952.00

566952.00

86·•

SIi 23245

SJ 347.60

Ye,

17. -

SIi38184

S569.09	n •

S55 570.16

$2,778 51

TESTING
18" HOPE

I 931

LS ,;,12 278.2S
lf	50.28

5122711.25
S46,810.68

S?,100.00 S32 856.00

S2 100.00
$32,856.00

1'7'.
70%

SJ0,17fl.25 513954.M

SIOS.00 SI 642.80

Ye,
Yt.--s

11.00-•
17.oo-,

5357.00
$558552

$1785 5279.28

111.00-,
noo-e

$1,743.00
S:?7 270411

$87 IS SI 36' 52

24• HOPE

1279  lf

73.70

S94,262.JO	$71,298.00

$71,298.00

76'•

$22964.30

SJ 564.90	Yn

cxr..

$12120.66

S6060J

113.00,;.

SS9.177.J4

S2 958Jl7

42" HOPE
48" HOPE
54"/60" HOPE
60" HOP[
36" HOPE

106
691
1462
64
094

Lf lf LF
lF
_l,_F

246.26
320.16
360.14
80.83
114.98

S26 IOJ 56 S221.2J0.56 S5265H.611 S30 77?- 12
$160 282,12

Sl9 JIIS.00 S92,900.00 S212000.00
$7,200.00
$111800.00

Sl4600000
s:n5n.12

$19111500
$92,900.00 1358 000.00
SJ0,773.12 S111.800.00

13,.
42'•
68·•
100,;,
7°'

56.Y\8.56 S128.330.56 Sl68,524.68
S0.00 548482.12

S959.25 S4 645.00 Sl7.90000 SI 538.66
$5 59000

Yes Yes Yes Y<>
Ye,

17 00-f
m•
11.r.m,
17.00-.
1100,.

SJ.261.-45
$1579).00
$60,860.00
S5231.43
$19006.00

Sl63.07 57119.65 S304J.OO S261 57
5950)0

83.00,;.
SJ.cm,
83.0(r,;,
83.oo-,
8J.oo,e

SIS 9:?J 55
$77 10700
S:?97.140.00 S:?5 541.69
S92 79400

S79618 SJ 855.35 Sl4,85700 Sl,277.08 S4,6VJ70

.t1AOOOIP,IE"1GJG3 CONTMJA.Tl()l,j$HE£HOAG102 1""2EOITlON •111- «11091
™£.tMERIC.tN'NSfflU'lEOF.tRCHITECTS.11Jl!iN(WV(lf!K,tVE NW Wit.SMNGTo,,1.0C. 2000&6l'32

0703-1992

CONTINUATION SHEET	A/A DOCUMENTG703	P• .. 2.,4P•IM

J\IA Doamleflt G702, 1\Pl'LICATlON ANDCflfflMCATION l{)k l'AYMFN"l, oornaini11g	APPLICATION NO,	4
Cootnclor' si11,1k..'d nT11lica1mn 1s anacht."tl	APPLICATION DATE,	9/16/2024
PERIOD TO,	9/16/2024

0	I	E
WORK L"OMPLl'"I I: )
ROM Pllf.\-10LTS

Al'l'UCA nm.:	TIIISM IOD
CD• El

F Ml\11.kJAIS PRfSE.VTLY STORFD
{ OTIN DORE)

G

II

I

J

K

L

SIOS,400.00 $790000.00 512,60000	$15000.00 SI0-1,700.00
$74,20000
$52 60000

IOIAJ, CO!l,U'LElED At."l)STORFD TODA1E
(D•F.•f)
$895 400.00
527,600.00
S104,700.00 574,200.00
$52.60000

10•C1
,,.,
45•;,
77".
◄6,.
44!:0
,,r,m.,
IO(r,,
O"lo
37%
1m
68'•
21¾
101•.
O"o
430,,
21•• O"

"

RAI.J\NCl:. 10t1NISII (C,G)

Rl:"lAINAGE (lfV/\RIAIII.E RAH.)

.,,.,.,,
lt11PIUYmw:nl•

c,.	,

PM.'CIIIEhpble forP•ymml llyC-

"
roa.1c...ic.- Rcu1ni1 (,ilS%

N

0

S4◄770.00 Sl,38000 S5 :?35.00
SJ 710.00
52,630.00
5681.00
$95000 518,477.)4
S0.00
$465.00
S12078.80 S8 19800 S3l9.00 53,135.()0 S0.00 53427.50
$480.00
S0.00 S1.950.00 50.00
5)75.00
S4IO.OO S360.00

Y<S
Yes
Y<S
Ye<
Ye,
Ye,
y"
v..
Ye,
Y<>
Y.:s.
Ye, Vos y"
Ye,
Ye,
v,
Ye,
y.,,
Yes Ye,
Ye,
Ye,

T0WCOff¥11ckJAnJ Sk>reJTo0.1e l:.hJJbk ror Paymmi ffvC1-denllt
11. •	SIS:? 218.00
11cm,	$4,69200
17.00-•	517 79900
17.00-i	Sl:?614.00
17. -	58942.00
11.cm•	S2,Jl5.40
17. •	$)23000
11.00-,	56:?.8:!2.96
1700%	!000
17.0IJ'.	SI 581 00
11. ,	S41,06792
17. -	S27 873 20
11.cm•	Sl,084.60
17.M•	$1065900
1700'!♦	50.00
11cm.	SI 1 65' 50
1700'/4	SI 6'2.00
17,00,e,	S0.00
1700"	56.630.00
1700'!•	1000
17 00-'.	Sl,275.00
11,00,,	SI 3'>400
17.0<r.•	SI 224.00

S7,610.90
$2>◄60
$SX9,95
563070
5447.10
S115.77 5161 50 SJ,1◄115
!000
57905
$205140
SI 39J66 55423 S532.95 50.00 S582.68
$8160
sooo
SJJ\ 50
5000
563 75
S69.70 561.20

Pm.>mtl:.l11t1hk
ForPaymmt
IJyCDD
n .
s,.cxr.,
81cm• 83.00"•
83.00I,
8JOO-•
83 oo-•
83.
8H>O%
83.00"♦
83.00'!.
8)00,e,
83. •
83.00%
8J.OO"•
8J.OO-•
83.00-/4
83.00,o
8300'!:0
83 cm•
83.00":0
81.(1()%
83.im•

Total C-.,1.da! AnJ
SlonJToDlte	fotalt'L)l)
Eligjbleto,Paymm  RN,111  5
llvCDO
$743,182.00
$22 908 00
$86901.00
$61 58600
543658.00
SIi :u)4.60
$1577000
S306723.84
!000
57 719.00
S200 508.08
5116,08680
SS,295.-40 552041 00
10.00
S56R9650
$7,96800 1000
532,HOOO
50.00
56 225.00
5680600
55,97600

$136 952.74
$3372212
$3170286 588122.00
566153.04
$15.262(,()
$14 16-1.59
!0.00 53152◄.38
515507,711
596999.51!
S78 !05.92
S23 869.12 1S340.95)
S24 74615
592,558 46
SJ5431.13
$347◄.50
S73311.18 57 426.58
$7,660.96
$25 355.01
$6,672.80

S0.00

,O,"...
2410
52"•
"O'"·.

JSO,•

56,600.00

.2.1,,•,

.".".

S}7,151J.10 Sl,14540 54 34505
$1079 JO
$2,182.90
$56521 571t850
S15,JJ614:I
1000
S38595 SI0025.◄o
5680-I ]4
S264 77 S2.60205 50.00 S28448.1 539840
5000
Sl.611!50 1000
531125
Sl4030
5298 80
sooo
sooo
$376405
sooo
5512442
$456.50
,ooo
$27' 90
S0.00 19960
Sl90 90
5954 SO
1000
1000
S7Al8 13
1000
1000
sooo
sooo
S2,32K 15
1000

lJsc ft'lunm I on Cv111racts wt.en: \'3nabk n.'1a11U1Pt: ft'lf hnt: 111..-nb mav annl .	ARCHITECTS PROJECT NO:
A I	ll	C

ITf.MII	SClll::DlTLf.O

,o	DESCRll'1IONOt' WORK	VAi.Or
OtMlnbl)'  \1191	•=

,...,

72" RCP	1381  lf	$747.54	SI.OJ:! J52.74
lYPE MP" MANHOLE	4	EA  sis 330.53	S6132212
T't'PE P-5 WITH "J" BOTTOMS	11  EA  C:12 400.26	SIJ6402.86
T't'PE P-5 INLITS	25  EA  $6492.38	516:? l:?200

34. T't'PE P-6 INLfl5	4	EA	S7 220.65		S281!1!2.W	SL\62000		SJJ 62000	
35. TYPE "r BOTTOM WITH TYPE "A" MANHOLE	1	EA	S33 164.S9		SJJ 164.59	5191Xkl00		$19000.00	
36. BOX CULVERT S'XlO'	280	lf	Sl 319.81		S369546-80	s.rn, 00500	5)1 541.80	5369,546.80	
37. 1V LINES	1	LS	531524.38		531 524.)8	50.00		S0.00	
38. 8" C-900	487	lf	SS0.94		S24 8077X	$9 300.00		59,300.00	
39. 16" DIP	2,581	LF	S131.18		5338 575.58	5241 576.00		S241,576.00	
40. 12" C·900	2,752	lf	C:87.96		5242065.92	516396000		Sl6'960.00	
41. 6" C-900	816	lf	S37.07		530 249.12	S6 38000		S6.J80.00	
42. 12" GATE VALVE	13	EA	S-4.796.85		$62359.05	S62,700.00		S62.700.00	
43. 6" GATE VALVE	13	EA	S1 903.55		$24746 15	sooo		S0.00	
44. 16" GATE VALVE	18	EA	S8 9S0.47		5161.108.46	S68,550.00		168 55000	
45. 8" GATE VALVE	17	EA	S2 648.89		S45.0JI.IJ	$9 60000		S9,60000	
RELOCATE FHA
FIRE HYDRANT ASSEM8LY	1
18	EA
EA	S3 474.SO
S6 239.51	-	SJ 474.50
5112,311.18	S0.00
S39000.00		50.00
53900000	
48. ARV	1	EA	57 426.58		57.42658	S0.00		S0.00	
49. 16"X12" WET TAP	1	EA	SJS 160.96		SIS 160.96	57 500 00		$7,.SOO.OO	
50. 16"X16" WET TAP	1	EA	S33 55S.01		SJJ.555.01	SR,200.00		58,200.00	
51. 14"DIRECTIONAL DRILL	80	lf	5173.41		SlJ,87:! 1IO	57,20000		$7,200.00	

T't'PE P-6 WITH "J" BOTTOMS	8	EA  Sl4844.13	$118.75).0-I

52. JUMPER	2	EA	52 787.30	$5 574.60	S0.00		50.00	5557◄60	50.00	Ye,	17.00':0	1000	sooo	8J 00'!•	sooo	
53. RESTORATION/MOT FOR OFFSITE WORK	I	LS	S33 392.21	$33 392.21	$0.00			S)J }92.21	S0.00	Ye,	17.1:>0,,	S0.00	sooo	8300'!♦	sooo	
54. WATER FITTING	1	LS	S122471.75	S\22471.75	S90 700.00		590,700.00	74•0	S31 771.75	$4 535.00	Yes	IH i,	51541900	S770.95	83,00,:,	S75 281 00	
55. TESTING	1	LS	SU 475.00	SIi 475.00	sooo		S0.00	<r-•	SI 1,47500	50.00	Yes	17.00'"•	1000	S0.00	8JW-•	5000	
56. 8" REUSE	5,392	lf	49.11	S264,801 12	5123,480.00		Sl23,a&80.00	-rr-;.	5141,321.12	56,17400	fo	1700,•	$20,991 60	Sl().;1958	8300'!•	510:?a&88.40	
57. 8" GATE VALVE	17	EA	S2 738.SO	S46 554 50	s11 ooaoo		Sll,00000	24 -	SJS.554.50	S550.00	Yo,	11.IXJ'e	Sl.870.00	593.50	83.()()".	S9,IJOOO	
58. 4" REUSE C-900	590	lf	S30.67	Sl8095.30	$0.00		10.00	....	$18,095.30	S0.00	Yes	17,00,e,	10.00	sooo	83.00-/4	sooo	
59. 4" GATE VALVE	14	EA	2 29S.78	532 140.92	56 60000			$25,540.92	SJJ0.00	Yes	17.00-.	Sl,122.00	$56.10	83.ocr.•	SS47R.OO	
60. 30")(8" WET TAP	2	EA	12 237.97	S24,47S.9◄	sooo		S0.00	S24475.94	S0.00	Yes	11.om•	S0.00	,ooo	830()":0	S0.00	
61. 10" DIRECTIONAL DRILL	80	LF	,;,136.25	510 900.00	S2 40000		S2 400.00	22•:.	58,500.00	5120.00	Yes	17.00',	5408.00	520 40	81,(l(r,:,	Sl,99200	
62. REUSE JUMPER	2	EA	2 737.14	S5474.2!t	$4,600.00		S◄,600.00	84•;,	$874.28	S2JO.OO	y,.	17.()()'"	5782.00	S39,IO	83.00'.	5381800	
63. REUSE FITTINGS	1	LS	141221.83	$4122183	523.00000		S2300000	i,;•.	518 221.83	SI 1.50.00	Y,s	11.(l(r,e	5391000	5195 50	8J_(l(r,,	$1909000	
64. REUSE TESTING	1	LS	97S0.38	59,750.38	S0.00		S0.00	S97.S0.3K	S0.00	fo	17.00%	sooo	sooo	ucm,	1000	
65. TYPE "D" INLET	1487	lf	S21.25	SJl.598.75	sooo		50.00	531 598.75	S0.00	Yes	17.ocr.9	S0.00	50.00	8J.ocr..	,ooo	
66. TYPE "F" CURB	17 785	lf	528.13	5500 292.05	$33 750.00	$145000.00	5178 750.00	36'e	S321,54205	,$8,937.50	Yes	17.00-•	530,J87 SO	SI 519311	83.00-o	$148.362.50	
67. 10' CONCRETE SIO(WAlk	3,647	lf	,;,61.44	5224071.AA	S0.00		50.00	er,:,	5224071.68	50.00	Y0<	17,0()"/4	1000	1000	83.ocr.•	S0.00	
66. 10' HCR	11	EA	S2 7S0.00	530.250.00	1000		1000	cr.e	SJO 2.5000	S0.00	Yt.."i	17.ClO':O	50.00	1000	83.ocr.:.	1000	
69. S'SIDEWALk	6 S62	lf	S29.94	S 196 ◄66.28	,ooo		1000	o,;	5196466.28	50.00	Ye,	17C)()".	S0.00	S0.00	83_()()".	1000	
70. S' HCR	14	EA	S1481.2S	$20 7)7.50	1000		S0.00	0,-	$20,7}7,50	50.00	Ye,	17.00'.	50.00	50.00	83.00-•	S0.00	
71. 12" STABILIZATION	25301	SY	C:S,42	5137 131.42	$47,6()1100	$8 500.00	556 100.00	-lt"i,	$81.031 42	S2,805.00	Yts	1700%	59 53700	5476R5	8300-i	546 56\,00	
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A/A DOCUMENTG70J

APPLICATION NO: APPLICATION DATE:

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PERJODTO:

9/161202'4
9/16121)24

74.	1" SP 9.5 ASPHALT	21349	SY	S13.71	S292 694 79	S0.00			S0.00		$291694 79	sooo	Yes	1700%	S0.00	sooo	
75.	10" LIME ROCK	21.349	SY	S24.71	5527,533 79	sooo			sooo		S527,533 79	sooo	Yes	17 .	sooo	sooo	
76.	STAMPED ASPHALT	1680	SF	<13.7S	$2110000	sooo			sooo		S!l,10000	sooo	fo	1700',	!000	5000	
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Uaers may obUlln validation of lhls document by requesting of the license a completed AJA Document 0401 - Certification of Document's Authenticity

A&o\000.HEHT070l 00N'Tll'IUATIOffS>t££TFCl'IG,O, IOO':lf:0rtlOH Aloll 91982
ft€ .t.M[,nc.t,HMTTl\JT£0f'ARQ41£CTS, 1136'EWVORl'.•YEM.E NW W•514HGlOfol OC :zooot.6n1	070l-HKl2

DEVELOPER'S REPRESENTATIVE CERTIFICATE FOR PAYMENT

Wyld Oaks- Infrastructure Application #4 Period Through 9/16/24

In accordance with the Contract Documents, based on on-site observations and the data comprising
this application, the Developer’s Representative certifies to the Owner that to the best of the Developer's Representative’s knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED	$1,167,749.52
(Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.)

DEVELOPER'S REPRESENTATIVE:

By:					Date:	10/1/2024 Name: 		Timothy R. Dennard					 Title:` 		President			
This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.

THIRD PARTY BENEFICIARY'S ENGINEER CERTIFICATE FOR PAYMENT

In accordance with the Contract Documents, based on on-site observations and the data comprising this application, the Third Party Beneficiary's Engineer certifies to the Owner to the best of the Third Party Beneficiary Engineer's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.

AMOUNT CERTIFIED........................................................................	$	
(Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.)

THIRD PARTY BENEFICIARY'S ENGINEER:

By:		Date:			 Name:				
Title:`		

This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.

WAIYER AND RELEASE OF LIEN UPON PROGRESS PAYMENT

The undersigned lienor, in consideration of the sum of$ 1,167,749.52	, hereby waives and releases its lien and right to claim a lien for labor, services, or materials furnished through 09/16/2024 to Double B Development and Kelly Park VB Development, LLC on the job of Wyld Oaks Infrastructure to the following property:
S of Kelly Park Rd & Effie Dr.
3620 W Kelly Park Rd.
Apopka, FL 32712, Orange County (description of property)

This waiver and release does not cover any retention or labor, services, or materials furnished after the date specified.

DATED on September 16, 2024.

Lienor RCS Construction Company, Inc. Address 295 E SR 50 Suite 1
Cl rmont FL 34711	

State of Florida
County of _L=ak=ec.	 _
The foregoing instrument was acknowledged before me this 16th	day of September 20_1.±_, by , as of said company, who has presented as identification or is personally known to me.

		Victoria E Lauteria	 Print, Type or Stamp Commission

PROGRESS PAYMENT AFFIDAVIT

STATE OF FLORIDA COUNTY OF LAKE

BEFORE ME, the undersigned authority, duly qualified and authorized in the State and County aforesaid to administer oaths and take acknowledgements, this day, personally appeared	Jody Bass	, who being by me first duly sworn, deposes and says:

The facts and matters contained and recited in the Affidavit are based upon personal knowledge of the Affiant.
Affiant is the Owner of	RCS Construction Company, Inc.	, a North Dakota Corporation company (hereinafter the "Contractor")
Contractor and	Kelly Park VB Development, LLC		(hereinafter the "Owner") have executed, delivered and entered into that certain CONTRACT AND AGREEMENT dated	December 4, 2023	(hereinafter the "contract").
Affiant now requests partial payment under the Contract. In Consideration of Owner providing such partial payment, Contractor hereby provides this Affidavit upon which Owner intends to rely.
Contractor is not aware of any Claims that would require an adjustment of the Contract Time or the Contract Price except for any Change Order Requests or Change Order Proposals previously submitted in writing to Owner prior to execution of this Affidavit.
Contractor releases any Claims for an adjustment to the Contract Time or the Contract Price except for those previously made in writing and delivered to Owner prior to execution of this Affidavit.
Affiant states that all bills for labor, services or materials furnished, delivered, installed or performed on the job site through the date of this Affidavit have been FULLY paid and that no lien for such may properly be filed, recorded or enforced. Waiver and Release of lien upon Progress Payment forms for every such potential lienors are provided herewith through	09/16/2024
Affiant states that, except as provided herein, all bills for labor, services or materials furnished, delivered, installed or performed on the job site through the date of this Affidavit have been FULLY paid and that no lien for such may properly be filed, recorded or enforced. Waiver and Release of Lien Upon Progress Payment forms for every such potential lienor are provided herewith, except as provided below:

Name of Lienor Or Potential Lienor

Amount due for labor, services or materials furnished, delivered, Installed or performed

1.  Atlantic Directional Drilling, Inc.	$0.00	
2. Central Florida Turf Pros	$1,000.56	
3.  County Materials Corporation	$695,491.19	
4. Dixie Lime & Stone	$0.00	
5. Florida Design Consultants	$25,101.25	
6.  Formasters Concrete Specialists	$101,550.00	
7. Fortiline, Inc.	$47,840.39	
8. Oldcastle Infrastructure	$17,457.48	
9.  Quality Petroleum	$635.57	
10. T&C Well & Pump LLC	$3,411.00	
11. Volusia General Contractors &	$0.00	
Trinity Construction Products, Inc.

FURTHER AFFIANT SAYETH NOT.

  RCS Construction Company, Inc.	

+---V-+'-00"'-+--t------,,,,,	- 	-	· Affiant

Sworn to and subscribed before me this	16th	day of September	,2024, by Jody Bass	, who (check one): [ X] is personally known to me, [ ] produced a driver's license (issued by a state of the United States within the last five (5) years) as identification, or [

] produced other identification, to wit:--- "	-· AffiaAt dj.01:ake
0	'!:I

VICTORlA E. LAUTERIA
Notarv Publlc
.... State of Florida
s	comm# HH276625
.	,	Expires 6/19/2026

Print Name:	Victoria E La Notary Public, State of Flori a
Commission No.:_-'H-'--H"-'-2=-7'"-'6"""'6"""2=5	
MCyommission Expires:	06/19/2026

JOINDER AND INDEMNIFY AGREEMENT

Contractor, joins in the execution of this Affidavit for the purpose of adopting all representations of fact contained therein. Contractor understands that this Affidavit will be relied upon by Owner for all purposes relating to the Contract. Contractor agrees to indemnify, hold harmless and defend the Owner from, against and with respect to any and all loss, cost, damage and expense, including reasonable attorneys' fees, arising out of any claims by laborers, subcontractors or materialmen who might claim that they have not been paid for labor, services or material.

::lorid		,i	 Name: Jo	 as
Title:ic  ident

(CORPORATE SEAL)[where applicable]

REQUISITION

The undersigned, an Authorized Officer of Golden Gem Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture between the District and U.S. Bank Trust Company, National Association, Fort Lauderdale, Florida, as trustee (the "Trustee"), dated as of June 1, 2024 (the "Master Indenture"), as amended and supplemented by the First Supplemental Trust Indenture between the District and the Trustee, dated as of June 1, 2024 (the Master Indenture as amended and supplemented is hereinafter referred to as the "Indenture") (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):
Requisition Number: 17

Name of Payee:	Kimley Horn

Amount Payable:	$975.00

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance, if applicable):
Fund, Account and/or subaccount from which disbursement is to be made:
Series 2024 Acquisition and Construction Account

The undersigned hereby certifies that obligations in the stated amount set forth above have been incurred by the District, that each disbursement set forth above is a proper charge against the Series 2024 Acquisition and Construction Account and the subaccount, if any, referenced above, that each disbursement set forth above was incurred in connection with the acquisition and construction of the Phase 1 Project and each represents a Cost of the Phase 1 Project, and has not previously been paid.
The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate entitled to retain.

Originals or copies of the invoice(s) from the vendor of the property acquired or services rendered with respect to which disbursement is hereby requested are on file with the District.
GOLDEN GEM COMMUNITY DEVELOPMENT DISTRICT

Authorized Officer

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY
If this requisition is for a disbursement from other than the Costs of Issuance Account, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Phase 1 Project and is consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and specifications for the portion of the Phase 1 Project with respect to which such disbursement is being made; and (iii) the report of the Consulting Engineer attached as an Exhibit to the First Supplemental Trust Indenture, as such report shall have been amended or modified on the date hereof.

Consulting Engineer
Kevin M Roberson
Kimley-Horn and Associates, Inc

	
Please remit payment electronically to:	If paying by check, please remit to:	
Account Name:	KIMLEY-HORN AND ASSOCIATES, INC.
Bank Name and Address:	WELLS FARGO BANK, N.A., SAN FRANCISCO, CA 94104
Account Number:	2073089159554
ABA#:	121000248	KIMLEY-HORN AND ASSOCIATES, INC.
P.O. BOX 932520
ATLANTA, GA 31193-2520	
Please send remittance	payments@kimley-horn.com information to:		

GOLDEN GEM CDD
C/O GOVERNMENTAL MANAGEMENT SERVICES 219 EAST LIVINGSTON ST
ORLANDO, FL 32801

Invoice Amount: $975.00
Invoice No:	29328859
Invoice Date:	Aug 31, 2024
Project No:	147968000.3

Federal Tax Id: 56-0885615
For Services Rendered through Aug 31, 2024

Project Name: Project Manager:
Client Reference:

GOLDEN GEM CDD INTERIM ROBERSON, KEVIN
RESOLUTION 2024-05

HOURLY NOT TO EXCEED

975.00

Total COST PLUS MAX

975.00

9,322.50

10,297.50

25,000.00

Subtotal

975.00

9,322.50

10,297.50

25,000.00

INTERIM ENGINEERING

Current Amount Due

Previous Amount Billed

Amount Billed to Date

Contract Value

Description

Total Invoice: $975.00

Description of Services:
Approve requisitions 8 and 9.
Review pay req 10. includes 300 pages of accounting back up for verification.

If you have any questions, please contact Zach.Reuther at 561-234-4519 or Zach.Reuther@kimley-horn.com.	31ZSR

GOLDEN GEM CDD
C/O GOVERNMENTAL MANAGEMENT SERVICES 219 EAST LIVINGSTON ST
ORLANDO, FL 32801

HOURLY NOT TO EXCEED		

Invoice No: Invoice Dat
Project No: Project Nam Project Man	

Task	
Description	
Hrs/Qty	
Rate	Current Amount Due	
01INTERIM ENGINEERING	SENIOR PROFESSIONAL II	2.5	390.00	975.00	
TOTAL 01INTERIM ENGINEERING	2.5		975.00	
TOTAL LABOR AND EXPENSE DETAIL			975.00	

e:

e: ager:

29328859
Aug 31, 2024
147968000.3
GOLDEN GEM CDD INTERIM ROBERSON, KEVIN

This page is for informational purposes only. Please pay amount shown on cover page.

31ZSR

REQUISITION

The undersigned, an Authorized Officer of Golden Gem Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture between the District and U.S. Bank Trust Company, National Association, Fort Lauderdale, Florida, as trustee (the "Trustee"), dated as of June 1, 2024 (the "Master Indenture"), as amended and supplemented by the First Supplemental Trust Indenture between the District and the Trustee, dated as of June 1, 2024 (the Master Indenture as amended and supplemented is hereinafter referred to as the "Indenture") (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):
Requisition Number: 18

Name of Payee:	Kimley Horn

Amount Payable:	$1,755.00

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance, if applicable):
Fund, Account and/or subaccount from which disbursement is to be made:
Series 2024 Acquisition and Construction Account

The undersigned hereby certifies that obligations in the stated amount set forth above have been incurred by the District, that each disbursement set forth above is a proper charge against the Series 2024 Acquisition and Construction Account and the subaccount, if any, referenced above, that each disbursement set forth above was incurred in connection with the acquisition and construction of the Phase 1 Project and each represents a Cost of the Phase 1 Project, and has not previously been paid.
The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate entitled to retain.

Originals or copies of the invoice(s) from the vendor of the property acquired or services rendered with respect to which disbursement is hereby requested are on file with the District.
GOLDEN GEM COMMUNITY DEVELOPMENT DISTRICT

Authorized Officer

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY
If this requisition is for a disbursement from other than the Costs of Issuance Account, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Phase 1 Project and is consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and specifications for the portion of the Phase 1 Project with respect to which such disbursement is being made; and (iii) the report of the Consulting Engineer attached as an Exhibit to the First Supplemental Trust Indenture, as such report shall have been amended or modified on the date hereof.

Consulting Engineer
Kevin M Roberson
Kimley-Horn and Associates, Inc

	
Please remit payment electronically to:	If paying by check, please remit to:	
Account Name:	KIMLEY-HORN AND ASSOCIATES, INC.
Bank Name and Address:	WELLS FARGO BANK, N.A., SAN FRANCISCO, CA 94104
Account Number:	2073089159554
ABA#:	121000248	KIMLEY-HORN AND ASSOCIATES, INC.
P.O. BOX 932520
ATLANTA, GA 31193-2520	
Please send remittance	payments@kimley-horn.com information to:		

GOLDEN GEM CDD
C/O GOVERNMENTAL MANAGEMENT SERVICES 219 EAST LIVINGSTON ST
ORLANDO, FL 32801

Invoice Amount: $1,755.00
Invoice No:	29595987
Invoice Date:	Sep 30, 2024
Project No:	147968000.3

Federal Tax Id: 56-0885615
For Services Rendered through Sep 30, 2024

Project Name: Project Manager:
Client Reference:

GOLDEN GEM CDD INTERIM ROBERSON, KEVIN
RESOLUTION 2024-05

HOURLY NOT TO EXCEED

1,755.00

Total HOURLY NOT TO EXCEED

1,755.00

10,297.50

12,052.50

25,000.00

Subtotal

1,755.00

10,297.50

12,052.50

25,000.00

INTERIM ENGINEERING

Current Amount Due

Previous Amount Billed

Amount Billed to Date

Contract Value

Description

Total Invoice: $1,755.00

Description of Services:
ENGINEERING
Coordination with team on adding change orders to agenda.
Download documents and preparation for Board meeting.
Attend September Board meeting.
Review and approve Pay Req 11.
Coordination with attorney on process procedures for construction change orders.
Review and approve Pay Req 12.

If you have any questions, please contact Zach.Reuther at 561-234-4519 or Zach.Reuther@kimley-horn.com.	31ZSR

GOLDEN GEM CDD
C/O GOVERNMENTAL MANAGEMENT SERVICES 219 EAST LIVINGSTON ST
ORLANDO, FL 32801

HOURLY NOT TO EXCEED		

Invoice No: Invoice Dat
Project No: Project Nam Project Man	

Task	
Description	
Hrs/Qty	
Rate	Current Amount Due	
01INTERIM ENGINEERING	SENIOR PROFESSIONAL II	4.5	390.00	1,755.00	
TOTAL 01INTERIM ENGINEERING	4.5		1,755.00	
TOTAL LABOR AND EXPENSE DETAIL			1,755.00	

e:

e: ager:

29595987
Sep 30, 2024
147968000.3
GOLDEN GEM CDD INTERIM ROBERSON, KEVIN

This page is for informational purposes only. Please pay amount shown on cover page.

31ZSR

REQUISITION

The undersigned, an Authorized Officer of Golden Gem Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture between the District and U.S. Bank Trust Company, National Association, Fort Lauderdale, Florida, as trustee (the "Trustee"), dated as of June 1, 2024 (the "Master Indenture"), as amended and supplemented by the First Supplemental Trust Indenture between the District and the Trustee, dated as of June 1, 2024 (the Master Indenture as amended and supplemented is hereinafter referred to as the "Indenture") (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):
Requisition Number: 19

Name of Payee:	Duke Energy

Amount Payable:	$143,583.71

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance, if applicable):
Fund, Account and/or subaccount from which disbursement is to be made:
Series 2024 Acquisition and Construction Account

The undersigned hereby certifies that obligations in the stated amount set forth above have been incurred by the District, that each disbursement set forth above is a proper charge against the Series 2024 Acquisition and Construction Account and the subaccount, if any, referenced above, that each disbursement set forth above was incurred in connection with the acquisition and construction of the Phase 1 Project and each represents a Cost of the Phase 1 Project, and has not previously been paid.
The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate entitled to retain.

Originals or copies of the invoice(s) from the vendor of the property acquired or services rendered with respect to which disbursement is hereby requested are on file with the District.
GOLDEN GEM COMMUNITY DEVELOPMENT DISTRICT

Authorized Officer

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY
If this requisition is for a disbursement from other than the Costs of Issuance Account, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Phase 1 Project and is consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and specifications for the portion of the Phase i Project with respect to which such disbursement is being made; and (iii) the report of the Consulting Engineer attached as an Exhibit to the First Supplemental Trust Indenture, as such report shall have been amended or modified on the date hereof.

Consulting Engineer
Kevin M Roberson
Kimley-Horn and Associates, Inc

	INVOICE

Email sent to customer on 09/17/2024	Invoice: Invoice Date:
Page:	F5418962404 9/17/2024
1 of 1	
Bill to:	GOLDEN GEM CDD
219 EAST LIVINGSTON STREET
C/O GOVERNMENTAL MANAGEMENT SERVICES ORLANDO FL 32801	Customer ID: PO / Contract No: Payment Terms:
Due Date:	000322580

Net 30 10/17/2024	
		Amount Due:	$143,583.71	
Invoice for work or services performed at:	4105 GOLDEN GEM RD	APOPKA FL

For questions about your invoice, please contact Thomas Hunt at 407/464-1267

Line	Date of Charge	Description	Net Amount

1	Customer contribution	$143,583.71
Amount Due:	$143,583.71

To pay electronically, please allow 24 hours from the time this invoice is received and
use website https://www.e-billexpress.com/ebpp/DukeEnergy. Enter your customer ID and billing zip code from above. TO AVOID SERVICE INTERRUPTION, PLEASE DO NOT SEND MONTHLY UTILITY ACCOUNT PAYMENTS TO THIS ADDRESS
i Please detach and return with your payment. Please indicate invoice number on check.	i

Payment Coupon
Please make check payable to:		ACH Instructions:	

Invoice Number:	F5418962404

Duke Energy PO Box 602880
Charlotte NC 28260-2880

Wells Fargo - Florida 121000248
Duke Energy 002062640508238

Corporation Code: Please Pay By: Customer ID: Total Amount Due:

50226
10/17/2024
000322580
$143,583.71

Fed Tax ID # 56-2155481
GOLDEN GEM CDD
219 EAST LIVINGSTON STREET
C/O GOVERNMENTAL MANAGEMENT SERVICES
ORLANDO FL 32801

1806353431383936323430340000000143583716

Amount Enclosed

Section VII

Section C

Section 1

Golden Gem
Community Development  District

Unaudited Financial Reporting
October 31, 2024

Table of Contents

	Balance Sheet

	General Fund

	Series 2024 Debt Service Fund

	Series 2024 Capital Projects Fund

	Month to Month

	Long Term Debt Report

Golden Gem	
Community Development District	
Combined Balance Sheet	
October 31, 2024	
General	Debt Service	Capital Projects	Total	
Fund	Fund	Fund	Governmental Funds	

Assets:	
Cash:	
Operating Account	
Investments	
Series 2024	
Revenue	
Interest	
Sinking Fund	
Prepayment	
Reserve	
Capitalized Interest	
Acquisition & Construction	
Cost of Issuance	
Due from Developer	
Due from Capital Projects Fund	
Due from General Fund	
Prepaid Expenditures	

$	-	
$	-	
$	-	
$	-	
$	-	
$	-	
$	-	
$	-	
$	798	
$	-	
$	-	
$	-	

$

Total Liabilites	$	4,320	$	-	$	-	$	4,320

Total Assets	$	8,702	$ 5,753,408	$  17,700,603	$	23,462,713	
Liabilities:	
Accounts Payable	$	4,320	$	-	$	-	$	4,320	
Accrued Expenses	$	-	$	-	$	-	$	-	
Contracts Payable	$	-	$	-	$	-	$	-	
Due to Capital	$	-	$	-	$	-	$	-	
Due to General Fund	$	-	$	-	$	-	$	-	

Fund Balance:	
Nonspendable:	
Deposits and Prepaid Items	
Assigned:	
Debt Service - Series 2024	
Capital Projects Fund	
Unassigned	

$

7,904

-

$

$	-	
$	-	
$	-	
$	-	
$  2,712,768	
$  3,040,640	
$	-	
$	-	
$	-	
$	-	
$	-	
$	-	

$

-

-

$

$	-	
$	-	
$	-	
$	-	
$	-	
$	-	
$	17,654,324	
$	46,279	
$	-	
$	-	
$	-	
$	-	

$

-

-

$

$	-	
$	-	
$	-	
$	-	
$	2,712,768	
$	3,040,640	
$	17,654,324	
$	46,279	
$	798	
$	-	
$	-	
$	-	

$

7,904

-

$	-	
$	-	
$	4,382	

	
$  5,753,408	
$	-	
$	-	

	
$	-	
$	17,700,603	
$	-	

 
$	5,753,408	
$	17,700,603	
$	4,382	

Total Fund Balances	$	4,382	$ 5,753,408	$  17,700,603	$	23,458,394	
					
Total Liabilities & Fund Balance	$	8,702	$  5,753,408	$	17,700,603	$	23,462,713	

Golden Gem	
Community Development District	
General Fund	
Statement of Revenues, Expenditures, and Changes in Fund Balance	
For The Period Ending October 31, 2024	

Adopted	Prorated Budget	Actual		
Budget	Thru 10/31/24	Thru 10/31/24	Variance	

Revenues:					
Developer Contributions	$	153,628	$	5,000	$	5,000	$	-	

Total Revenues	$	153,628	$	5,000	$	5,000	$	-	

Expenditures:					
General & Administrative:					
Supervisor Fees	$	12,000	$	1,000	$	-	$	1,000	
FICA Expenditures	$	918	$	77	$	-	$	77	
Engineering	$	15,000	$	1,250	$	-	$	1,250	
Attorney	$	25,000	$	2,083	$	-	$	2,083	
Annual Audit	$	5,000	$	-	$	-	$	-	
Assessment Administration	$	5,000	$	-	$	-	$	-	
Arbitrage	$	450	$	-	$	-	$	-	
Dissemination	$	5,000	$	417	$	417	$	(0)	
Trustee Fees	$	5,000	$	-	$	-	$	-	
Management Fees	$	37,500	$	3,125	$	3,125	$	-	
Information Technology	$	1,800	$	150	$	150	$	-	
Website Maintenance	$	1,200	$	100	$	100	$	-	
Telephone	$	300	$	25	$	-	$	25	
Postage & Delivery	$	1,000	$	83	$	1	$	82	
Insurance	$	6,000	$	6,000	$	5,000	$	1,000	
Printing & Binding	$	1,000	$	83	$	-	$	83	
Legal Advertising	$	15,000	$	1,250	$	-	$	1,250	
Contingency	$	5,000	$	417	$	38	$	379	
Office Supplies	$	625	$	52	$	0	$	52	
Travel Per Diem	$	660	$	55	$	-	$	55	
Dues, Licenses & Subscriptions	$	175	$	175	$	175	$	-	

Total Administrative Expenditures	$	143,628	$	16,342	$	9,006	$	7,336	

Contingency	$	10,000	$	833	$	-	$	833	

Total Field Expenditures	$	10,000	$	833	$	-	$	833	

Total Expenditures	$	153,628	$	17,175	$	9,006	$	8,169	

Excess (Deficiency) of Revenues over Expenditures	$	-	$	(12,175)	$	(4,006)	
				
Fund Balance - Beginning	$	-		$	8,389	
				
Fund Balance - Ending	$	-		$	4,382	

Golden Gem	
Community Development District	
Debt Service Fund Series 2024	
Statement of Revenues, Expenditures, and Changes in Fund Balance	
For The Period Ending October 31, 2024	

Adopted	Prorated Budge	Actual	
Budget	Thru 06/30/24	Thru 06/30/24	Variance	

Revenues:		
Assessments - Tax Roll	$	-	
Interest	$	-	

$	-	
$	-	

$	-	
$	23,691	

$	-	
$	23,691	

Total Revenues	$	-	$	-	$	23,691	$	23,691	

Expenditures:		
Interest - 11/1	$	-	$	-	$	-	$	-	
Principal - 5/1	$	-	$	-	$	-	$	-	
Interest - 5/1	$	-	$	-	$	-	$	-	
Total Expenditures	$	-	$	-	$	-	$	-	

Excess (Deficiency) of Revenues over Expenditures	$	-	$	23,691	

Other Financing Sources/(Uses):

Bond Proceeds	$	-	
Transfer In/(Out)	$	-	

$	-	
$	-	

$	-	
$	-	

$	-	
$	-	

Total Other Financing Sources/(Uses)	$	-	$	-	$	-	$	-	
		
Net Change in Fund Balance	$	-	$	-	$	23,691	$	-	
		
Fund Balance - Beginning	$	-	$	-	$ 5,729,717	$	-	
		
Fund Balance - Ending	$	-	$	-	$ 5,753,408	$	-	

Golden Gem	
Community Development District	
Capital Projects Fund	
Statement of Revenues, Expenditures, and Changes in Fund Balance	
For The Period Ending October 31, 2024	

Adopted	Prorated Budget	Actual	
Budget	Thru 10/31/24	Thru 10/31/24	Variance	

Revenues:		
Developer Advances	$	-	
Developer Contributions	$	-	
Interest	$	-	

$	-	
$	-	
$	-	

$	-	
$	-	
$	80,180	

$	-	
$	-	
$	80,180	

Total Revenues	$	-	$	-	$	80,180	$	80,180	

Expenditures:		
General & Administrative:		
Capital Outlay	$	-	$	-	$	-	$	-	
Capital Outlay - COI	$	-	$	-	$	-	$	-	

Total Expenditures	$	-	$	-	$	-	$	-	

Excess (Deficiency) of Revenues over Expenditures	$	-	$	80,180	

Other Financing Sources/(Uses):		

Bond Proceeds	$	-	
Bond Discount	$	-	
Transfer In/(Out)	$	-	

$	-	
$	-	
$	-	

$	-	
$	-	
$	-	

$	-	
$	-	
$	-	

Total Other Financing Sources/(Uses)	$	-	$	-	$	-	$	-	
		
Net Change in Fund Balance	$	-	$	-	$	80,180	$	-	

Fund Balance - Beginning	$	-	$	-	$ 17,620,423	$	-	
		
Fund Balance - Ending	$	-	$	-	$ 17,700,603	$	-	

Golden Gem	
Community Development District	
Month to Month	

Oct	Nov	Dec	Jan	Feb	March	April	May	June	July	Aug	Sept	Total	

Revenues:														
Developer Contributions	$	5,000	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	5,000	

Total Revenues	$  5,000	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$  5,000	

Expenditures:														
General & Administrative:														
Supervisor Fees	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	
FICA Expenditures	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	
Engineering	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	
Attorney	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	
Annual Audit	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	
Assessment Administration	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	
Arbitrage	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	
Dissemination	$	417	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	417	
Trustee Fees	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	
Management Fees	$	3,125	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	3,125	
Information Technology	$	150	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	150	
Website Maintenance	$	100	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	100	
Telephone	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	
Postage & Delivery	$	1	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	1	
Insurance	$	5,000	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	5,000	
Printing & Binding	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	
Legal Advertising	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	
Contingency	$	38	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	38	
Office Supplies	$	0	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	0	
Travel Per Diem	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	
Dues, Licenses & Subscriptions	$	175	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	175	
Total Administrative Expenditur	$  9,006	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$  9,006	

Contingency	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	
Total Field Expenditures	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	
														
Total Expenditures	$  9,006	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$  9,006	

Excess Revenues (Expenditures)	$  (4,006)	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$	-	$  (4,006)	

- 5 -

Golden Gem	
Community Development District	
Long Term Debt Report	

	

Series 2024 Special Assessment Revenue Bonds	
Interest Rate:	5.15% to 6.00%	
Maturity Date:	11/1/2055	
Optional Redemption Date:	On or After 5/1/2034

Reserve Fund Definition:	50% MADS After Release Conditions Reserve Fund Requirement:		$2,712,768
Reserve Fund Balance:	$2,712,768

Bonds outstanding - 5/31/2024	$36,550,000 Less: May 1, 2029 Principal		$0	
Current Bonds Outstanding	$36,550,000	

- 6 -

Section 2

Golden Gem	
Community Development District	

Funding Request #9	
September 12, 2024	

Bill to:	Wyld Oaks Development	

Payee	General Fund

1	Egis	
	Invoice # 24410 - FY25 Insurance	

$	5,000.00

2	GMS- Central Florida, LLC	
	Invoice # 10 - Management Fees September 2024	

$	3,791.67

3	Kimley-Horn and Associates	
	Invoice # 29017234 - Engineering Services July 2024	

$	975.00

4	Kutak Rock, LLP	
	Invoice # 3425115 - General Counsel June 2024	$	2,493.26	
	(Note invoice total is $3,246.83, $753.57 was accidentally requested on FR#8 so balance is needed).	

5	Supervisor Fees - 09/11/2024 Meeting	
	Craig Linton, Jr.	
	H.M. Ridgely, III	
	Taylor Edwards	
	George Hamner, Jr.	
	Duane "Rocky" Owen	

$	215.30	
$	215.30	
$	215.30	
$	215.30	
$	215.30	

$	13,336.43

Total:

$	13,336.43

Please make check payable to:

Golden Gem Community Development District	
4530 Eagle Falls Place	
Tampa, FL 33619	

Golden Gem Community Development District c/o GMS - Central
219 E Livingston St. Orlando, FL 32801

INVOICE

Customer

Acct #	Golden Gem Community Development District
1478	
Date	08/16/2024	
Customer Service	
Kristina Rudez	
Page	1 of 1	

Payment Information	
Invoice Summary	$	5,000.00	
Payment Amount		
Payment for:	Invoice#24410	
1001241119	
Thank You

Please detach and return with payment

Customer: Golden Gem Community Development District

Invoice	Effective	Transaction	Description	Amount	

24410	

10/01/2024	

Renew policy	Policy #1001241119 10/01/2024-10/01/2025
Florida Insurance Alliance

General Liability - Renew policy Due Date: 8/17/2024	

5,000.00	
	Total	
	$	5,000.00	
	Thank You	
FOR PAYMENTS SENT OVERNIGHT :
Bank of America Lockbox Services, Lockbox 748555, 6000 Feldwood Rd. College Park , GA 30349		

Remit Payment To: Egis Insurance Advisors	(321)233-9939
P.O. Box 748555
Atlanta, GA 30374-8555	sclimer@egisadvisors.com	Date	
	08/16/2024	

GMS-Central Florida, LLC
1001 Bradford Way
Kingston, TN 37763

Bill To:
Golden Gem CDD 219 E. Livingston St. Orlando, FL 32801

Invoice

Invoice #: 1O
Invoice Date: 9/1/24
Due Date: 9/1/24
Case:
P.O. Number:

Description	Hours/Qty	Rate	Amount

Management Fees - September 2024 Website Administration - September 2024 Information Technology - September 2024
Dissemination Agent Services - September 2024		3,125.00
100.00
150.00
416.67	3,125.00
100.00
150.00
1	416.67	

Total	$3,791.67	
Payments/Credits	$0.00	
Balance Due	$3,791.67	

	
Please remit payment electronically to:	If paying by check, please remit to:	
Account Name:	KIMLEY-HORN AND ASSOCIATES, INC.
Bank Name and Address:	WELLS FARGO BANK, N.A., SAN FRANCISCO, CA 94104
Account Number:	2073089159554
ABA#:	121000248	KIMLEY-HORN AND ASSOCIATES, INC.
P.O. BOX 932520
ATLANTA, GA 31193-2520	
Please send remittance	payments@kimley-horn.com information to:		

GOLDEN GEM CDD
C/O GOVERNMENTAL MANAGEMENT SERVICES 219 EAST LIVINGSTON ST
ORLANDO, FL 32801

Invoice Amount: $975.00
Invoice No:	29017234
Invoice Date:	Jul 31, 2024
Project No:	147968000.3

Federal Tax Id: 56-0885615
For Services Rendered through Jul 31, 2024

Project Name: Project Manager:
Client Reference:

GOLDEN GEM CDD INTERIM ROBERSON, KEVIN
RESOLUTION 2024-05

HOURLY NOT TO EXCEED

975.00

Total COST PLUS MAX

975.00

8,347.50

9,322.50

25,000.00

Subtotal

975.00

8,347.50

9,322.50

25,000.00

INTERIM ENGINEERING

Current Amount Due

Previous Amount Billed

Amount Billed to Date

Contract Value

Description

DESCRIPTION OF SERVICES PERFORMED:
REVIEW AND APPROVE REQUISITION 4
REVIEW PAY REQ 5, SIGN AND RETURN
REVIEW AND APPROVE REQUISITION 6
	REVIEW LANDSCAPE MATERIALS REQUISITON

Total Invoice: $975.00

If you have any questions, please contact Zach.Reuther at 561-234-4519 or Zach.Reuther@kimley-horn.com.	31ZSR

GOLDEN GEM CDD
C/O GOVERNMENTAL MANAGEMENT SERVICES 219 EAST LIVINGSTON ST
ORLANDO, FL 32801

HOURLY NOT TO EXCEED		

Invoice No: Invoice Dat
Project No: Project Nam Project Man	

Task	
Description	
Hrs/Qty	
Rate	Current Amount Due	
01INTERIM ENGINEERING	SENIOR PROFESSIONAL II	2.5	390.00	975.00	
TOTAL 01INTERIM ENGINEERING	2.5		975.00	
TOTAL LABOR AND EXPENSE DETAIL			975.00	

e:

e: ager:

29017234
Jul 31, 2024
147968000.3
GOLDEN GEM CDD INTERIM ROBERSON, KEVIN

This page is for informational purposes only. Please pay amount shown on cover page.

31ZSR

K U T A K  R O C K  L L P
TALLAHASSEE, FLORIDA
Telephone 404-222-4600
Facsimile 404-222-4654

Federal ID 47-0597598

July 25, 2024

Check Remit To: Kutak Rock LLP PO Box 30057
Omaha, NE 68103-1157

ACH/Wire Transfer Remit To:
ABA #104000016
First National Bank of Omaha
Kutak Rock LLP A/C # 24690470
Reference: Invoice No. 3425115 Client Matter No. 47123-1
Notification Email: eftgroup@kutakrock.com

Golden Gem CDD
c/o Governmental Management Services 219 East Livingston Street
Orlando, FL 32801	Invoice No. 3425115
47123-1

Re:	General Counsel
For Professional Legal Services Rendered

06/05/24    A. Willson	1.10	346.50	Review  and  revise  landowner
funding agreement; confer with Vanderbilt and Flint regarding meeting agenda; review and revise same; review and revise engineering agreement; confer with Roberson regarding same
06/11/24    A. Willson	2.30	724.50	Prepare  resolutions  for  board
meeting; confer with Flint and Vanderbilt regarding same; review comments regarding engineering agreement
06/12/24    J. Gillis	0.20	35.00	Review  comments  received  on
	agreement for engineering services
with Kimley-Horn; confer with staff regarding same	
06/12/24	A. Willson	5.60	1,764.00	Travel to and attend board meeting;	
				post meeting follow up	

TOTAL HOURS	9.20

KUTAK ROCK LLP
Golden Gem CDD July 25, 2024
Client Matter No. 47123-1 Invoice No. 3425115
Page 2		
TOTAL FOR SERVICES RENDERED		$2,870.00	
DISBURSEMENTS			
Meals	31.78		
Travel Expenses	345.05		
TOTAL DISBURSEMENTS		376.83	
TOTAL CURRENT AMOUNT DUE		$3,246.83	

Attendance Confirmation
for
BOARD OF SUPERVISORS

District Name:		Golden Gem CDD	 Board Meeting Date:			September 11, 2024		

Name	In Attendance
Please	Fee Involved Yes/No	

1	
Craig Linton, Jr.		
Yes ($200)	

2	
H.M. Ridgely, III	./	
Yes ($200)	

3	
Taylor Edwards	v'	
Yes ($200)	

4	
George Hamner, Jr.	t/'	
Yes ($200)	

5	
Duane "Rocky" Owen		
Yes ($200)
-	

The supervisors present at the above referenced meeting should be compensated accordingly.

Approved for Payment:

DistictManager Signature

**RETURN SIGNED DOCUMENT TO DISTRICT ACCOUNTANT**

Golden Gem	
Community Development District	

1	GMS- Central Florida, LLC	
	Invoice # 11 - Management Fees October 2024	

2	Kutak Rock, LLP	
	Invoice # 3439068 - General Counsel July 2024	

4	Kutak Rock, LLP	
	Invoice # 3454613 - General Counsel August 2024	

5	Orlando Sentinel	
	Invoice # 101621131000 - Classified Listings September 2024	

6	Florida Commerce	
	Invoice # 91696 - Annual Fee	

Funding Request #10	
October 21, 2024	

Bill to:	Wyld Oaks Development	

Payee		General Fund	
			
		$	3,793.12	
			
		$	277.00	
			
		$	249.50	
			
		$	271.93	
			
		$	175.00	
		$	4,766.55	

Total:	
$	4,766.55	

Please make check payable to:			

Golden Gem Community Development District	
4530 Eagle Falls Place	
Tampa, FL 33619	

GMS-Central Florida, LLC
1001 Bradford Way
Kingston, TN 37763

Invoice

Bill To:
Golden Gem CDD 219 E. Livingston St. Orlando, FL 32801

Invoice#: 11
Invoice Date: 10/1/24
Due Date: 10/1/24
Case:
P.O. Number:

Description	Hours/Qty	Rate	Amount

Management Fees - October 2024 Website Administration - October 2024 Information Technology - October 2024
Dissemination Agent Services - October 2024 Office Supplies
Postage		3,125.00
100.00
150.00
416.67
0.06
1.39	3,125.00
100.00
150.00
416.67
0.06
1.39	

Total	$3,793.12	
Payments/Credits	$0.00	
Balance Due	$3,793.12	

K U T A K  R O C K  L L P
TALLAHASSEE, FLORIDA
Telephone 404-222-4600
Facsimile 404-222-4654

Federal ID 47-0597598

August 26, 2024

Check Remit To: Kutak Rock LLP PO Box 30057
Omaha, NE 68103-1157

ACH/Wire Transfer Remit To:
ABA #104000016
First National Bank of Omaha
Kutak Rock LLP A/C # 24690470
Reference: Invoice No. 3439068 Client Matter No. 47123-1
Notification Email: eftgroup@kutakrock.com

Golden Gem CDD
c/o Governmental Management Services 219 East Livingston Street
Orlando, FL 32801	Invoice No. 3439068
47123-1

Re:	General Counsel
For Professional Legal Services Rendered

07/08/24	A. Willson	0.20	63.00	Review meeting agenda; confer with
Flint	and	Vanderbilt	regarding
07/10/24	A. Willson	whether meeting necessary
0.40	126.00	Confer with Barry regarding CDD	
		description; review and revise same;
confer	with	Edwards	regarding	

07/12/24	
A. Willson	
0.20	
63.00	sunshine law requirements and best practices
Confer with Barry regarding audit	
07/15/24	G. Lovett	0.10	25.00	items
Research matters relating to district	
				rules of procedure and incorporation
of new legislation	

TOTAL HOURS	0.90
TOTAL FOR SERVICES RENDERED	$277.00
TOTAL CURRENT AMOUNT DUE	$277.00

K U T A K  R O C K  L L P
TALLAHASSEE, FLORIDA
Telephone 404-222-4600
Facsimile 404-222-4654

Federal ID 47-0597598

September 30, 2024

Check Remit To: Kutak Rock LLP PO Box 30057
Omaha, NE 68103-1157

ACH/Wire Transfer Remit To:
ABA #104000016
First National Bank of Omaha
Kutak Rock LLP A/C # 24690470
Reference: Invoice No. 3454613 Client Matter No. 47123-1
Notification Email: eftgroup@kutakrock.com

Golden Gem CDD
c/o Governmental Management Services 219 East Livingston Street
Orlando, FL 32801	Invoice No. 3454613
47123-1

Re:	General Counsel
For Professional Legal Services Rendered

08/12/24	M. Rigoni	0.10	29.00	Confer with Flint regarding August	
				meeting	
08/12/24	A. Willson	0.20	63.00	Confer with Flint and  Vanderbilt	
				regarding upcoming meeting	
08/19/24	A. Willson	0.20	63.00	Confer	with	Ridgely	and	Flint	
				regarding upcoming board meeting	
				items	
08/30/24	A. Willson	0.30	94.50	Confer	with	Tedrow	regarding	
eligibility for state grants
TOTAL HOURS	0.80

KUTAK ROCK LLP
Golden Gem CDD September 30, 2024
Client Matter No. 47123-1 Invoice No. 3454613
Page 2		
TOTAL FOR SERVICES RENDERED	$249.50	
TOTAL CURRENT AMOUNT DUE	$249.50	
UNPAID INVOICES:		
July 25, 2024	Invoice No. 3425115	3,246.83	
August 26, 2024	Invoice No. 3439068	277.00	
TOTAL DUE	$3,773.33	

Orlando Sentinel
-	MEDIA GROUP

INVOICE

PO Box8023
Willoughby, OH 44096

adbilling@tribpub.com 844-348-2445

Invoice Details
Billed Account Name: Billed Account Number: Invoice Number: Invoice Amount:
Billing Period: Due Date:

Golden Gem Cdd CU80173779 101621131000
$271.93 09/30/24 - 10/06/24
11/05/24

Page 1 of 2
Invoice Details

Date

tronc Reference#

Description	Ad Size/  Rate
Units

Gross
Amount

Total

9/30/24 OSC101621131 Classified Listings, Online
--		Public Hearling/Bid/Misc_Legal 7704080

271.93

OCT 1 5 2024

Account Summary

iirh·IMNM    -·tii&I

Current	1-30	31-60	61-90	91+	Unappiied
Amount	
271.93	0.00	0.00	0.00	0.00	0.00	

Please detach and return this porlion with your payment.

Orlando Sentinel
-	MEDIA GROUP

PO Box 8023
Willoughby, OH 44096

Remittance Section
Billed Period:
Billed Account Name: Billed Account Number: Invoice Number:

09/30/24 - 10/06/24
Golden Gem Cdd CU80173779 101621131000

Return Service Requested
b 45 4 0□□092	PRESORT PBPS001 <B>
11••1111111111111•111••11•11••11h111•11•II•11111hIIhi'I' 11I11•
GOLDEN GEM CDD STACIE VANDERBILT 219 E LIVINGSTON ST ORLANDO FL 32801-1508

For questions regarding this billing, or change of address notification, please contact Customer Care:

Orlando Sentinel PO Box 8023
Willoughby, OH 44096
..,.1111,.,.11.1.11,..,,..,,,,,  ,..1,,,.,,,,,,,,,,,,,,,,,,,,,,

Orlando Sentinel
-	MEDIA GROUP

Sold To:

Published Daily in
Orange, Seminole, Lake, Osceola & Volusia Counties, Florida

Golden Gem CDD - CU80173779 219 E Livingston St
Orlando, FL 32801

Bill To:
Golden Gem CDD - CU80173779 219 E Livingston St
Orlando, FL 32801

State Of Florida County Of Orange
Before the undersigned authority personally appeared
Rose Williams, who on oath says that he or she is a duly authorized representative of the
ORLANDO SENTINEL, a DAILY
newspaper published in ORANGE County, Florida; that the attached copy of advertisement, being a Legal Notice in:
The matter of 11150-Public Hearing Notice Was published in said newspaper by print in the issues of, or by publication on the newspaper's website, if authorized on Sep 30, 2024.

Affiant further says that the newspaper complies with all legal requirements for publication in Chapter 50, Florida Statutes.

Rose Williams

Signature of Affiant	Name of Affiant

Sworn to and subscribed before me on this l day of October, 2024,
by above Affiant, who is personally known to me (X) or who has produced identification ( ).

Signature of Notary Public

Name of Notary, Typed, Printed, or Stamped

7704080

Orlando Sentinel
MEDIA GROUP

BOARD OFSUPERVISORS MEETING DATES

ms

GOLDEN GEM COMMUNrrY DEVELOPMENT
DISTRICT FISC.AL YEAR
The Board of Supervisors of the Golden Gem Community Development District will hold their regular meetings for Fl cal Year 2025 at 10:30 AM, at the offices of GMS-CF, LLC, 219 E. Livingston Street, Orlando, FL 32801, on ttie second Wednesday of the month, unless otherwise Indicated, as follows:
October 9, 202.4
November 13, 202.4
December 11, .20U
January 8, 2025
February 12, .2025
March 12, 2025
Aprll 9, 2025
May U, 2025
June 11, 2025
July 9, 2025
August 13; 2025
September 10, 2025
The meetings are open to the publlc and will be conducted In accordance with the provision of Florid.a Law for Community Development Districts. The meetings may be continued to a date, time, and place to be specified on the record at the meeting. A copy of the agenda for these meetings may be obtained from the Dlstrlct Manager, Governmental Management Services - Central Florrda, LLC, 219 E. Livingston Street, Orlando, FL 32801 or by caUlng
(407) 841-552.d.
There may be occasions when one or more Supervisors or staff wm PQrtrclpate by speaker telephone. Punuanttoprovlslons of the Americans with OlsablHtles Ad, any person requiring special accommodations at this meeting because of a dl::.abJllty or physical Impairment should contact the District Office at {407) 841-552' at least 48 hours prior to the meetrng. If you are hearing or speech lmfJ(llred, please contact the Florida Relay Service by dlallng 7-1-1, or l-800-955- 8771 (TTY) / 1-800-955-8.770 (Voice), for
aid In contacting the Dh,trlct Office.
A person who decides to appeal any decision made at ftle meeting with respect to any matter considered at the meeting Is advised that person wlll need a record of the proceedings and that accordingly, the peroon may need to em,ure that a verbatim record of the proceedings ls made, Including the testimony and evidence up0n which such appeal ls to be based.
George S. Fllnt Olstrlct Manager
Governmental Management Services - Central Florida, LLC
9f.n/2024 7704080

7704080

1 IVll\,IQVVIIIIIU,"•G, .. G...ICII Ul::tUUil Al.1.ourn:a.u1111y l"'rogram Fiscal Year 2024 - 2025 Special District State Fee Invoice and Profile Update
Required by sections 189.064 and 189.018, Florida Statutes, and Chapter 73C-24, Florida Administrative Code
Date Invoiced: 10/01/2024				Invoice No: 91695	
Annual Fee: $175.00	1st Late Fee: $0.00	2nd Late Fee: $0.00	Received: $0.00	Total Due, Postmarked by 12/02/2024:
$175.00	
STEP 1: Review the following profile and make any needed changes.
Special District's Name, Registered Agent's Name and Registered Office Address:

000678
Golden Gem Community Development District
Mr. George S. Flint GMS- CF
219 East Livingston Street Orlando, Florida 32801

.:'\FLORIDA
..,-,COMMERCE

Telephone:
Fax:
Email:
Status:
Governing Body:
Website Address:
County(ies):
Special Purpose(s):
Boundary Map on File:
Creation Document on File:
Date Established:
Creation Method:
Local Governing Authority:
Creation Document{s):
Statutory Authority:
Authority to Issue Bonds:
Revenue Source(s):

407-841-5524 Ext:

gflint@gmscfl.com Independent Elected goldengemcdd .com Orange
Community Development 02/06/2024
02/06/2024
01/03/2024
Local Ordinance City of Apopka
City Ordinance 3041
Chapter 190, Florida Statutes Yes
Assessments

STEP 2: Sign and date to certify accuracy and completeness.
By signing and dating below, I do hereby certify that the profile above (changes noted if necessary) is accurate and complete: Registered Agent's Signature:			\i.		....		Date	l • I•'1 \ 1-  '1.
STEP 3: Pay the annual state fee or certify eligibility for zero annual fee.
Pay the Annual Fee: Pay the annual fee by following the instructions at www.FloridaJobs.org/SpecialDistrictFee.
Or, Certify Eligibility for the Zero Fee: By initialing both of the following items, I, the above signed registered agent, do hereby certify that to the best of my knowledge and belief, BOTH of the following statements and those on any submissions to the Department are true, correct, complete, and made in good faith. I understand that any information I give may be verified.
_	This special district is not a component unit of a general purpose local government as determined by the special district and its Certified Public Accountant; and,
_	This special district is in compliance with its Fiscal Year 2022 - 2023 Annual Financial Report (AFR) filing requirement with the Florida Department of Financial Services (DFS) and that AFR reflects $3,000 or less in annual revenues or, is a special district not required to file a Fiscal Year 2022 - 2023 AFR with DFS and has included an income statement with this document verifying $3,000 or less in revenues for the current fiscal year.
Department Use Only: Approved:  	Denied:   	Reason:	 _

STEP 4: Make a copy of this document for your records.
STEP 5: Email this document to SpecialDistricts@Commerce.fl.gov or mail it to FloridaCommerce, Bureau of Budget Management, 107 East Madison Street, MSC #120, Tallahassee, FL 32399-4124. Direct questions to 850.717.8430.