Okaloosa County BOCC — August 6, 2013 — contract renewal — reading text

CONTRACT/LEASE RENEWAL FORM September 3, 2013 Mr. Michael R. Koran 801 Beach Drive Destin, FL 32540 RE: Lease Renewal Mr. Koran: The Okaloosa County Airports agrees to renew the subject lease, #LO9-0358-AP for an additional term. The contract renewal period will be December 1, 2013 to November 30, 2014. The annual budgeted amount for this lease is $14,400.00. If you are in agreement, please sign below and return this form along with a current Certificate of Insurance listing Okaloosa County as co-insured (if applicable). AUTHORIZED COMPANY REPRESENTATIVE Contractor: MN (hack £ Koc BY Approved LA COUNTY REPRESENTATIVES Dept. Director Me Signature: z H Approved By (as prescribed below gh item 1) Approved By: Title: Que (as prescribed below on item 1) Date: Date: St Lr. (ob Zo13 County Depariment Instructions: 1) Obtain signatures from Department Director, authorized Company Representative and then 2) 3) Purchasing Director <$25K and less, County Administrator <$50K and less or Board >$50K, as necessary. If Board approval is required, the Chairman and County Administrator's signatures are required. Make sure the company provides a current Certificate of Insurance. (if applicable). Keep a copy of this form for your records. Send original to Purchasing Services Coordinator. If you have any questions please contact the Purchasing Director at 850-689-5960, Fax: 850- 689-5998. "CERTIFICATE OF COVERAGE _ ISSUED ON: 1ore/2013 | COVERAGE PROVIDED BY: PREFERRED GOVERNMENTAL INSURANCE TRUST PACKAGE AGREEMENT NUMBER: PX FUL 0461046 13- 04 : COVERAGE. PERIOD: 10/1/2013 TO 10/1/2014 12: 01 AM COVERAGES: This i is to certify that the agreement below has been issued to the designated member for the coverage period indicated. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the coverage afforded by the : agreement described herein subject to all the terms, exclusions and conditions of such agreement. Mail to: Certificate Holder Designated Member 1 Michael R. Koran Okaloosa County BOCC 801 Beach Drive 601-A North Pear! Street Destin, FL 32540. : Crestview, FL 32526 | LIABILITY COVERAGE WORKERS’ COMPENSATION COVERAGE. X Comprehensive General Liability, Bodily Injury, Property Damage ‘ and Personal Injury Limit $1,000,000 $100,000 SIR X Self I 1 Workers’ C 4 : os soa elf Insured Workers' Compensation ae Officials Liability $500,000 Self Insured Retention imit ; oo. X Statutory Workers' Compensation Employment Practices Liability | Limit X Employers Liability X Employee Benefits Liability $1,000,000 Each Accident 4 Limit $1,000,000 $100,000 SIR $1,000,000 By Disease X Law Enforcement Liability $1,000,000 Aggregate Disease Limit $1, 000, 000 _ $100, 000 SIR PROPERTY COVERAGE AUTOMOBILE. COVERAGE : Buildings & Personal Property Automobile Liability Limit Limit $1,000,000 $50,000 SIR Note: See coverage agreement for details on wind, flood, and other X All Owned deductibles. ; Specifically Described Autos Rented, Borrowed and Leased Equipment ; X Hired Autos Limit X Non-Owned Autos All other Inland Marine | Automobile Physical Damage Limit ; X Comprehensive See Schedule for Deductible X Collision See Schedule for Deductible X Hired Auto with limit of $35,000 1 Garage Keepers Liability Limit Liability Deductible Comprehensive Deductible Collision Deductible : NOTE: The most we will pay is further limited by the limitations set forth ir in Section 768. 28(5), Florida Statutes (2010) or ‘the equivalent limitations of successor law which are re applicable a at the time of the loss. ' 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 section completed by member's agent, who bears complete responsibility and liability for its accuracy. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage | afforded by the agreement above. “Administrator | CANCELLATIONS A SHOULD ANY PART OF THE ABOVE DESCRIBED AGREEMENT BE CANCELLED BEFORE THE EXPIRATION DATE _ Public Risk Underwriters® THEREOF, PREFERRED GOVERNMENTAL INSURANCE TRUST WILL ENDEAVOR TO MAIL 60 DAYS WRITTEN : P.O. Box 958455 NOTICE, OR 10 DAYS WRITTEN NOTICE FOR NON-PAYMENT OF PREMIUM, TO THE CERTIFICATE HOLDER Lake Mary, FL 32795-8455 NAMED ABOVE, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE PROGRAM, ITS AGENTS OR REPRESENTATIVES. ‘Producer — a ~ ~ © Public Risk Insurance Agency . Yeon i ae 1 P. O. Box 2416 - Daytona Beach, FL 32115 SS SS SS SS SSeS : AUTHORIZED REPRESENTATIVE { PGIT-CERT (11/09) PRINT FORM 10/8/2013 PUBLIC ENTITY AUTOMATIC ADDITIONAL COVERED PARTIES THIS ENDORSEMENT CHANGES THE AGREEMENT. PLEASE READ IT CAREFULLY. This endorsement modifies coverage provided under the AUTOMOBILE COVERAGE FORM, PGIT 300, the GENERAL LIABILITY COVERAGE FORM, PGIT 200 and the PROPERTY AND INLAND MARINE COVERAGE FORM, PGIT 104 Where indicated by (x) below, coverage applies to the person(s) or organization(s) as their interest may appear. The provisions in this endorsement do not supersede Florida Statute 768.28, Article 10 § 13 of the Florida Constitution, or any other Statute or law limiting whom a Public Entity can indemnify. _X ADDITIONAL COVERED PARTY - BY CONTRACT, AGREEMENT OR PERMIT SECTION I - WHO IS A COVERED PARTY is amended to include any person(s) or organization(s) (hereinafter called Additional Covered Party) with whom you agree in a written “insured contract” to name as a Covered Party, but only with respect to liability arising, in whole or in part, out of your operations, “your work” or facilities owned or used by you. The coverage afforded to the Additional Covered Party does not apply: (1) Unless the written “insured contract’, agreement or permit was executed prior to the “bodily injury,” “property damage,” “personal injury” or “advertising injury;” (2) To any person(s) or organization(s) included as a Covered Party under this coverage agreement or by an endorsement made part of this coverage agreement. xX ADDITIONAL COVERED PARTY - OWNERS OF LEASED EQUIPMENT SECTION Il - WHO IS A COVERED PARTY is amended to include any person(s) or organization(s) (hereinafter called Additional Covered Party) with whom you agree in a written equipment lease or rental agreement to name as a Covered Party, but only with respect to liability arising out of the sole negligence of the Covered Party, and only while such equipment is in the care, custody or control of the Covered Party, or any employee or agent of the Covered Party. The coverage afforded to the Additional Covered Party does not apply to: (1) “Bodily injury” or “property damage” occurring after you cease to lease or rent the equipment; (2) “Bodily injury” or “property damage” arising out of any negligence of the Additional Covered Party; (3) Structural alterations, new construction or demolition operations performed by or on behalf of the Additional Covered Party; (4) Liability assumed by the Additional Covered Party under any contract or agreement; (5) “Property damage” to: (a) Property owned, used, occupied by, or rented to the Additional Covered Party; (b) Property in the care, custody or control of the Additional Covered Party or its employees or agents, or of which the Additional Covered Party, its employees or agents are for any purpose exercising physical control. PGIT 902 (10 09) Page 1 x ADDITIONAL COVERED PARTY - MANAGERS OR LESSORS OF PREMISES SECTION II - WHO IS A COVERED PARTY is amended to include any person(s) or organization(s) (hereinafter called Additional Covered Party) with whom you agree in a written agreement to name as a Covered Party, but only with respect to liability arising, in whole or in part, out of the “premises” leased to you by such person(s) or organization(s). The coverage afforded to the Additional Covered Party does not apply to: (1) “Bodily injury” or “property damage” occurring after you cease to be a tenant in that “premises”; (2) “Bodily injury” or “property damage” arising out of any negligence of the Additional Covered Party; (3) Structural alterations, new construction or demolition operations performed by or on behalf of the Additional Covered Party; (4) Liability assumed by the Additional Covered Party under any contract or agreement; (5) “Property damage” to: (a) Property owned, used, occupied by, or rented to the Additional Covered Party; (b) Property in the care, custody or control of the Additional Covered Party or its employees or agents, or of which the Additional Covered Party, its employees or agents are for any purpose exercising physical control. Notwithstanding any other provision of this agreement, nothing in this agreement shall be construed as a waiver of the Covered Party’s sovereign immunity nor shall any provision of this agreement increase the liability of the covered party, or the sums for which the covered party may be liable, beyond the limits provided in §768.28, Florida Statutes. PGIT 902 (10 09) Page 2 —_ ‘Date/erm: all RECEIVED cro o . | SEP 4 ot 12h CONTRACT & LEASE INTERNAL COORDINATION SHEET Contract/Leose Number: £ OF- Q 358 HP Tracking Number: ay of ‘i Conircictor/Lessoe Nome: 216 Mjehiol Ke Oran _ Grantfunded: YES NOx Last Gilet rier Purpose: . <4, [) GREATER THAN $50,000 7 “Amount Fit, Wooo - 2, [1] GREATER THAN $25,000 Deparment Hepert _ 3, EA-§25.000 OR LESS Dept. Monitor Nome: Document hos beer reviewed: and includes any attachments or exhibits. Purchasing Review County AHorney Review | Date: County - Atlorney ~ Following Okaloosa County approval: Contracts & Grants Document has been teceived: Date: Contracts & Grants Manager