Okaloosa County BOCC — September 2, 2014 — Koran Lease Final Payment Checklist

CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Purchasing Services Coordinator) DATE: 8-15-14 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Office SUBJECT: Contract No. LO09-0358-AP MANAGING DEPARTMENT: NWF Regional Airport CONTRACTOR'S NAME: MichaelR. Koran PROJECT TITLE: The attached has met the final payment contract requirement in subject contract. Yes 1. Final invoice WA/ See. Mhached Wie tt aqldad <a Teews Condcbions: a 2. Completed Contract/Lease Payment Approval Form 3. Close-Out Documents Yes No a. Signed Release of Lien CI C] b. Proof of Completion Advertisement C] [| c. Certificate of Insurance [ur C] d. Consent of Surety to Final Payment L | C] e. Proof of Performance/Payment Bond LJ L] Continuation 12 Months Following Final Payment ~< ® $s < 4, Agenda Request 5. Remarks Ll ¢ Wa? [Ll O €@ : << > Zo x Purchdsing Service# Coordinater DATE } CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT COMPLETED BY DEPARTMENT DATE: 8/26/2014 VENDOR NAME: MICHAEL R KORAN VENDOR #: 21000253 CONTRACT/LEASE#: L09-0358-AP VENDOR TASK COUNTY/FEMA BUDGET ACCOUNT # AMOUNT INVOICE # ORDER erat # | DEPARTMENT # $ 9-1-14 THRU 4210 544620 $ 3,600.00 11-30-14 TOTAL | $ 3,600.00 APPROVED FOR PROGRESS PAYMENT (lease sign, as applicable and date) CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT We A E DATE: COUNTY SUPERVISOR/PROJECT way MIKE (pdr DEPARTMENT DIRECTOR: ( ffir i) CONTRACTS & GRANT MANAG Up ZO COUNTY ADMINISTRATOR: (Payments>§25,000.) FINAL PAYMENT FINAL PAYMENT YES J NO (If "Yes", forward to Purchasing Services Coordinator for Close-Out) (Per Initial Agreement) DATE: £ Lb, -/f' Cf CONTRACTS & GRANTS MANAGER: Lille ZL, (All Contracts) DATE: & IE 26/1 Y COUNTY ADMINISTRATOR APPROVAL: = . fy rd (Per Initial Agreement) pate: ‘8/26 /i¢- PURCHASING DIRECTOR: has Shorak 2u Rdlovale t t t DATE: BOARD APPROVAL: (Per Initial Agreement} COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWED BY: PRINTED/ATTACHED BY: BCC FINANCE SECTION 3: TERM The term of this lease shall be for a period of one year commencing on December 1, 2009 and terminating on November 30, 2010. The lease will be extended automatically for one year periods upon mutual agreement of COUNTY and LESSOR. LESSOR or COUNTY may terminate this Lease with 60 days notice to other party. ae ee — =~ neice ame | SECTION 4: RENTAL FEES ee COUNTY agrees to pay to LESSOR for the privileges herein granted pex year for a total annual cost of FOURTEEN THOUSAND FOUR HUNDRED DOLLARS ($14,400.00). The fee will be paid quarterly in the amount\ of THREE THOUSAND SIX HUNDRED DOLLARS ($3,600.00) in advance|to Michael R. Koran, 801 Beach Drive, Destin, Florida 32540. If LESSOR decides to sell this building and property COUNTY shall have the first right of refusal and COUNTY and LESSOR agree that this agreement shall becofne a lease-to-own with all rents paid applied to the purchase of the building. The sale price shall be established by mutual consent based on an appraisal ocess satisfactory to both parties. SECTION 5: USE OF P ses COUNTY may use the building twenty four hours a day seven days a week for office space and storage of clean non hazardous materials and equipment. COUNTY shall comply with all present and future laws or ordinances applicable to the leased premises and shall not commit or suffer waste on the premises, or use or permit anything on the premises which may be illegal, or constitute a private or public nuisance. No construction, modification, or alterations shall be made without prior approval by LESSOR. SECTION 6: UTILITIES LESSOR will provide water and sewer service. COUNTY will be responsible for electrical, gas, telephone, and trash collection at its own expense. SECTION 7: MAINTENANCE LESSOR will be responsible, and make all necessary repairs, for air conditioning and heating, building exterior, lawn, pest control, and common area. COUNTY will be responsible and make all necessary repairs for building interior, and all appliances. Upon the expiration of or prior termination of this Lease, the COUNTY shall remove all property of the COUNTY from the premises, except leasehold improvements installed to the 2 REFERENCE: PURCHASING'S ONLINE CONTRACT REFERENCE: PURCHASING'S ONLINE CONTRACTS PRINTED/ATTACHED BY: BCC FINANCE CERTIFICATE OF COVERAGE “ISSUED ON: 10/8/2013 | : COVERAGE PROVIDED BY: sv: PREFERRED GOVERNMENTAL INSURANCE TRUST . COVE RAGE PERIOD: (0/1/2013 TO H/1/2614 12: 01 “AM ' 4 T NUMBER: PX FLI 0461046 13-04 “COVERAGE : certify that the agreement below has been issued to the designated member for the coverage period indicated. Notwithstanding any i requirement, term of condition of any contract or other dacument with respect te which this certificate may be issued or may pertain, the coverage afforded by the i - agreement described herein subject to all the terms, exclusions and conditions of such agreement. i Designated Member ' i Michael R. Koran Okaloosa Counfy BOCC 801 Beach Drive 601-A North Pearl Street . Destin, FL 32540, j : Crestview, FL 32526 { » Mail to: Certificate | Holder ML IABILE ry COVERAGE ix Comprehensive General Liability, Bodily Injury, Property Damage and Personal Injury WORKERS' COMPENSATION COVERAGE i Limit $1,000,000 $100,000 SIR x Sell 1 Workers’ C ' i dob ie Offteiate Chahily Self Insured Workers' Compensation | : ee Officials Liability $500,000 Self Insured Retention : . . Cage X Statutory Workers' Compensation Employment Practices Liability } - Limit X Employers Liability i X Employee Benefits Liability $1,000,000 Each Accident H > — Limit $1,000,000 $£00,000 SIR $1,000,000 By Disease i i X Law Enforcement Liability $1,000,000 Aguregate Disease ' Limit $1,000,000 $100,000 SIR r | PROPERTY COVERAGE AUTOMOBILE COVERAGE | Buildings & Personal Property Automobile Liability Limit Limit $1,000,000 $50,000 SIR i Note: Sev coverage agreement for details on wind, fload, and other X All Owned deductibles. Specifically Described Autos Rented, Borrowed and Leased Equipment Limit All other Inland Marine Limit j { X Hired Autos X Non-Owned Autos Automobile Physical Damage : X Comprehensive See Schedule for Deductible X Collision See Schedule for Deductible X Hired Auto with limit of $35,000 Garage Keepers Liability Limit Liability Deductible Comprehensive Deductible Collision Deductible i i i tee sete “4 t f 7 i NOTE:The most we @ will pay is further limited by th the ‘imitations set forth in Section 768.28(5), Florida Statutes (2040) or the equivalent limitations “of successor law which ; : are applicable al the time of the loss. " Description of Operations/ Locations/ Vehicles/Special items: Certificate holder is listed as an additional covered party per the PGIT 902 Form with respects to general liability insurance for the lease agreement between the insured : and certificate holder. This ction completed by member's 'y agen, who bears complete responsibility and liability for its accuracy. This cerlificate i is issued as a matter of information only and confers no rights upon the certificate holder. This certificale does Tot amend, “extend oF alter the coverage | ; afforded by the agreement 8 above. “Administrator Public Risk Underwriters® P.0, Box 958455 Laka Mary, FL 32796-8455 Producer . Public Risk Insurance Agency _P,O, Box 2416 Daytona Beach, FL 32915 CANCELLATIONS SHOULD ANY PART OF THE ABOVE DESCRIBED AGREEMENT BE CANCELLED BECORE THE EXMILATION DATE TREREOF, PREFERRED GOVERNMENTAL INSURANCE TRUST WILL EF: YOR TO MAIL 60 DAYS WRITTEN NOTICE, OR LO DAYS WRITTEN NOTICE FOR NON-PAYMENT OF PREMIUM, TO THE CERTIFICATE HOLDER NAMED ABOVE, HUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE PROGHAM, ITS AGENTS OR REPRESENTA TIVES. Wate aa re Por To c ERT H09) PRINT FORM