Okaloosa County BOCC — April 21, 2015 — L15-0418-FM.pdf Internal Coordination for Opportunity Inc. — reading text

CONTRACT & LEASE INTERNAL COORDINATION SHEET Contract/Lease Number: L[]S —=p-HB=F11) Tracking Number:_/ 33 7—*%5 Grant Funded: YES NO Contractor/Lessee Name:_@g_&-m« %d@h\cfimfl C)Bh‘f‘MD{aAL Purpose%bcfi aap U Date/Term: /O/ lr/w ~ 9/30 /J-+ 1. [] GREATER THAN $50,000 Amount: ¥l0o / Ldm) 2. [] GReATER THAN $25,000 Department:__ M\ 3. [] $25,000 OR LESS 7 Dept. Monitor Name: Dwotytf Document has been reviewed and includes any attachments or exhibits. Purchasing Review Procurement requiremenfzz; /%t // Date: "/ '/3 //S P/drchasing Q)irector or Defigne‘ca/ V" \_ Joanne Kublik or Sunnie Estes \ Risk Management Review Approved gs written: FW% Date: /76/ /\S‘://d— Risk M@/nager orkde/signee Laura Porter or Krystal King County Attorney Review Approved as written: Date: Gregory T. Stewart or Lynn Hoshihara_ Cour)l;yAttomey i oa (AL L Sdon L] N2l (P RAC A AT o 3 T I / e NS Following Okaloosa County approvallz Contracts & Grants Document has been received: Date: Contracts & Grants Manager Joanne Kublik From: Lynn Hoshihara Sent: Tuesday, April 14, 2015 9:45 AM To: Joanne Kublik; Parsons, Kerry; Laura Porter Cc: James Puckett; hstokley@ngnlaw.com Subject: RE: 1338-15 AND 1339-15 These leases are approved as to legal. It's my understanding James Puckett is working on the revised exhibit. Lynn M. Hoshihara Please note: Due to Florida's very broad public records laws, most written communications to or from County employees regarding County business are public records, available to the public and media upon request. Therefore, this written e-mail communication, including your e-mail address, may be subject to public disclosure. From: Joanne Kublik Sent: Monday, April 13, 2015 3:02 PM To: Parsons, Kerry; Laura Porter Cc: Lynn Hoshihara Subject: 1338-15 AND 1339-15 These leases are being put through coordination review again. I’m told the Exhibits are forthcoming. I’m also told Heath Stokely wrote these documents. Lynn, if you remember, these went through a couple weeks ago. I guess they were not accepted. Also, I’ve requested COIs for both documents. With that said, these need your attention to be placed on the April 21st agenda - deadline is Wednesday at noon. Thanks and let me know if you have any questions. Thanks, Jo http://www.co.okaloosa.fl.us/sites/default/files/contracts/contra pdf/L14-0405-FM.pdf http://www.co.okaloosa.fl.us/sites/default/Files/contracts/contra pdf/L15-0418-FM.pdf Joanne Kublik, Contracts and Lease Coordinator Okaloosa County Purchasing Department 602-C North Pearl Street Crestview, Florida 32536 (850) 689-5960 jkublik@co.okaloosa.fl.us<mailto:jkublik@co.okaloosa.fl.us> Please note: Due to Florida's very broad public records laws, most written communications to or from County employees regarding County business are public records, available to the public and media upon request. Therefore, this written e-mail communication, including your e-mail address, may be subject to public disclosure. Common Policy Declarations RENEWAL DECLARATION [ e e e e ) NAME AND ADDRESS OF AGENCY INSURANCE COMPANY Illinois National Insurance Co. Irwin S8iegel Agency, Inc. 25 Laké Louise Marie Road 175 Water Street - 18th Floor. Rock Hill NY 12775 New York NY 10038 AGENCY 0000096397 NAME AND MAILING ADDRESS OF INSURED POLLCY NUMBER RENEWAL OF ORALCOSA WALTON HOMELESS CONTINUUM 06-1X -027564138-3/000 06-LX-027564138-2 OF CARE OPPORTUNITY POLICY PERIOD 305 LOVEJOY RD FROM: 10-19-14 TO: 10-19-15 FORT WALTON BEACH FI, 32548 at 12:01 A.M. standard time at the mailing address shouwn. ) . /[ ! ' ! ' [ | -/ [ [ ! | J [ | ! | | | THE NAMED INSURED IS : CORPORATION BUSINESS DESC : SOCIAL SERVICE/OCC IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. PREMIUM COMMERCIAL PROPERTY COVERAGE PART NOT COVERED COMMERCIAL GENERAL LIABILITY COVERAGE PART ) 7,342 COMMERCIAL CRIME COVERAGE PART NOT COVERED COMMERCIAL INLAND MARINE COVERAGE PART NOT COVERED COMMERCIAL AUTO COVERAGE PART ' NOT COVERED GARAGE COVERAGE PART NOT COVERED MISCELLANEOUS PROFESSIONAL LIABILITY 2,578 ESTIMATED TOTAL PREMIUM $9,920 FLORIDA HURRICANE CATASTROPHE FUND SURCHARGE 95.45 CITIZENS' PROP INS CORP EMERGENCY ASSESSMENT 73.42 GRAND TOTAL . $10,088.87 THE POLICY WRITING NONREFUNDABLE MINIMUM PREMIUM IS $100 FORMS AND ENDORSEMENTS APPLICABLE TO ALL COVERAGE PARTS 89644 (06-13) IL0017 (11-98) 76105 (02-09) 90231 (12-05) 74825 (08-09) PRG7003(11-09) 96556 (02-08) 10-20-14 Page 1 of 10 Common Policy Dleclarations RENEWAL DECLARATICN ! [ | | | [ | ' | [ | | | | | | | | [ [} INSURANCE COMPANY NAME AND ADDRESS OF AGENCY Illinecis National Insurance Co. Irwin Siegel Agency, Inc. 25 Lake Loulse Marie Road 175 Water Street - 18th Floor. Rock Hill NY 12775 New York NY 10038 AGENCY 00000956397 POLICY NUMBER RENEWAL OF 06-LX -027564138-3/000 06-LX-027564138-2 POLICY PERIOD NAME AND MAILING ADDRESS OF INSURED OKALOOSA WALTON HOMELESS CONTINUUM OF CARE OPPORTUNITY 305 LOVEJOY RD FROM: 10-19-14 TO: 10-19-15 FORT WALTON BEACH FL 32548 . at 12:01 A.M. standard time at the mailing address shown. THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, LF APPLICABLE, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, LF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. Etef sl BY: AUTHORIZED REPRESENTATIVE o e 10~20~14 Page 2of 10 C5;7JT-5¥Ffiéffif%::32“-___""—“ -~ NAME AND ADDRESS OF AGENCY Irwin Siegel Agency, Commercial Property RENEWAL DECLARATION A O M e S R Inc. 25 Lake Loulse Marie Road INSURANCE COMPANY Illinoilg National Insurance Co. 175 Water Street - 18th Floor. Rock Hill NY 12775 New York NY 10038 AGENCY 0000096397 NAME AND MAILING ADDRESS OF INSURED POLIGCY NUMBER RENEWAL OF OKALOOSA WALTON HOMELESS CONTINUUM OF CARE OPPORTUNITY 305 LOVEJOY RD FORT WALTON BEACH FL. 32548 06-1X -027564138-3/000 06-LX-027564138-2 POL.ICY PERIOD FROM: 10-1¢2-14 TO: 10-19-15 At 12:01 A.M. standard time at the mailing address shown. BUILDING-1 305 LOVEJOY RD COVERAGES PROVIDED PREM. NO. 1 - BLDG. NO. 1 FORT WALTON BEACH INSURANCE AT THE DESCRIBED PREMISES APPLIES ONLY FOR COVERAGES FOR WHICH A LIMIT OF INSURANCE IS SHOWN COVERAGE CAUSE OF LOSS COINSURANCE LIMIT OF INSURANCE DED § - $ BUILDING-2 305 LOVEJOY RD COVERAGES PROVIDED PREM. NO. 1 BLDG. NO. 2 FORT WALTON BEACH INSURANCE AT THE DESCRIBED PREMISES APPLIES OMLY FOR COVERAGES FOR WHICH A LIMIT OF INSURANCE IS SHOWN COVERAGE CAUSE DF LOSS DED COINSURANCE LIMIT OF INSURANCE - $ S 10-20-14 Page 3 of 10 Commercial Property RENEWAL DECLARATION 0t T e 0 O T A N S S A S O O (S NAME AND ADDRESS OF AGENCY INSURANGCE COMPANY Illinois National Insurance Co. Irwin Siegel Agency, Inc. 25 Lake Loulise Marie Road 175 Water Street - 18th Floor. Rock H1ill NY 12775 New York NY 10038 AGENCY 0000096397 | NAME AND MAILING ADDRESS OF INSURED POLICY NUMBER RENEWAL OF OKALOOSA WALTON HOMELESS CONTINUUM 06-1LX —027564138~3/000 06-LX-027564138-2 OF CARE OPPORTUNITY POLICY PERIOD | 305 LOVEJOY RD FROM: 10-19-14 TO: 10-19-15 FORT WALTON BEACH FL 32548 At 12:01 A.M. standard time at the mailing address shown. - J ! 1 ' ‘' ' ' ' ! '/ ' | | [ ] BUILDING-3 1 i 1 | | PREM. NO. 1 BLDG. NO. 3 i 305 LOVEJOY RD ' FORT WALTON BEACH COVERAGES PROVIDED _ INSURANCE AT THE DESCRIBED PREMISES APPLIES ONLY FOR COVERAGES FOR WHICH A LIMIT OF INSURANCE IS SHOWN COVERAGE CAUSE OF LOSS DED COINSURANCE LIMIT OF INSURANCE & $ BUILDING-4 PREM. NO. 2 BLDG. NO. 1 203 CLOVERDALE BLVD FORT WALTON BEACH COVERAGES PROVIDED INSURANCE AT THE DESCRIBED PREMISES APPLIES ONLY FOR COVERAGES FOR WHICH A LIMIT OF INSURANCE IS SHOWN 1 | COVERAGE CAUSE OF LOSS DED COINSURANCE LIMIT OF INSURANCE $ 5 10-20-14 Page 4 of 10 Commercial Property RENEWAL DECLARATION ' P S N N Uomt USSR P NAME AND ADDRESS OF AGENCY INSURANCE COMPANY ’ Illinois National Insurance Co. Irwin Siegel Agency, Inc. 25 Lake Louise Marie Road 175 Water Street - 18th Floor. Rock Hill NY 12775 New York NY 10038 AGENCY 0000096397 NAME AND MAILING ADDRESS OF INSURED POLICY NUMBER RENEWAL OF OKALOOSA WALTON HOMELESS CONTINUUM 06-LX -027564138-3/000 06-LX-027564138-2 OF CARE OPPORTUNITY POLICY PERIOD 305 LOVEJOY RD FROM: 10-19-14 TO: 10-19-15 FORT WALTON BEACH FL 32548 At 12:01 A.M. standard time at the mailing address shown. .. ! ' /' ' [ [ [ [ [ /[ ./ ] [ [ [ [ [T BUILDING-5 PREM. NO. 3 BLDG. NC. 1 296 MARTIN LUTHER KENG CRESTVIEW COVERAGES PROVIDED INSURANCE AT THE DESCRIBED PREMISES APPLIES ONLY FOR GOVERAGES FOR WHICH A LIMLT OF INSURANCE IS SHOWN COVERAGE CAUSE OF LOSS DED COINSURANCE LIMIT OF LNSURANCE $ $ BUILDING-6 PREM. NO. 4 BLDG. NO. 1 171 NORTH 9TH ST DEFUNIAKI SPRINGS COVERAGES PROVIDED INSURANCE AT THE DESCRIBED PREMISES APPLIES ONLY FOR COVERAGES FOR WHICH A LIMLT OF INSURANCE IS SHOWN COVERAGE CAUSE OF LOSS DED COLNSURANCE LIMIT OF INSURANCE $ $ THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WLTH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, ILF ANY, ISSUED TO FORM A PART THERECF, COMPLETE THE ABOVE NUMBERED POLICY. e AUTHORIZED REPRESENTATIVE 10-20-14 Page 5 of 10 Commercial General Liability RENEWAL DECLARATION S S S O A O SN 5" MAME AND ADDRESS OF AGENCY INSURANCE COMPANY Illinois National Insurance Co. Trwin Siegel Agency, Inc. 25 Lake Loulse Marie Road 175 Water Street - 18th Floor. Rock Hill NY 12775 New York NY 10038 . AGENCY 0000096397 NAME AND MAILING ADDRESS OF INSURED POLICY NUMBER RENEWAL OF OKALOOSA WALTON HOMELESS CONTINUUM 06-1LX -027564138-3/000 06-1LX-027564138-2 OF CARE OPPORTUNITY POLICY PERIOD 305 LOVEJOY RD FROM: 10-19-14 TO: 10-19-15 FORT WALTON BEACH L 32548 At 12:01 A.M. standard time at the mailing address shown. . ! ! ! ./t /' /' [/ ‘(| '/ [ /' J [ J [ | LIMITS OF INSURANCE GENERAL AGGREGATE 5 3,000,000 PRODUCTS -COMPLETED OPERATIONS AGGREGATE| % 1,000,000 PERSONAL INJURY & ADVERTISING INJURY $ 1,000,000 EACH OCCURRENCE $ 1,000,000 DAMAGE- TO PREMISES RENTED TO YOU S 100,000 ANY ONE PREMISES MEDICAL EXPENSE S 10,000 ANY ONE PERSON STATE-1 LOCATION OF ALL PREMISES YOU OWN, RENT OR QCCUPY: Loc # 1: Br/1/N/36K 305 LOVEJOY RD, FT WALTON BEACH Lot # 1: B1/2/N/36K 305 LOVEJOY RD, FT WALTON BEACH Lot # 1: B1/3/N/36H 305 LOVEJOY RD, FT WALTON BEACH Lot &' 2: g2/1/Njo# 203 CLOVERDALE RD, FT WALTON BEA Loc # 3: #3/1/N/o# 296 MARTIN LUTHER KIING,CRESTVIEW Loc # &: BA[V/NJO# 177 NORTH 9TH ST, DEFUNIAKI SPRIN PMS PDTS LOC CLASSIFICATION CODE PREMIUM BASIS RATE RATE 1 SHELTERS, MISSION, SETTLEMENT OR HALFWAY HOUSE - NOTCHURCH OR 67017 AREA 1,872 OFFICE BUILDING PRODUCTS-COMPLETED OPERATIONS ARE SUBJECT TO THE GENERAL AGGREGATE LIMIT 1 SHELTERS, MISSION, SETTLEMENT OR HALFWAY HOUSE = MOTCHURCH OR 67017 AREA 1,872 OFFICE BUILDING ' PRODUCTS-COMPLETED OPERATIONS ARE SUBJECT TO THE GEMERAL AGGREGATE LIMLIT 10-20-14 Page 6of 10 Commercial General Liability RENEWAL DECLARATION ' ( ' ' ' /' ' ' ' ' [ (' [ [ | ' | | [ ]| NAME AND ADDRESS OF AGENCY INSURANCE COMPANY Illinois National Insurance Co. Irwin Siegel Agency, Inc. 25 Lake Loulse Marie Road 175 Water Street - 18th Floor. Reock Hill NY 12775 New York NY 10038 -AGENCY 0000096397 NAME AND MAILING ADDRESS OF INSURED POLICY NUMBER RENEWAL OF OKALOOSA WALTON HOMELESS CONTINUUM 06-LX -027564138-3/000 06-LX-027564138-2 OF CARE OPPORTUNITY POLICY PERIOD 305 LOVEJOY RD FROM: 10-19-14 TO: 10-19-15 FORT WALTON BEACH FL 32548 At 12:01 A.M, standard time at the mailing address shown. . ( | J /! /[ /! /' ' /' '/ [ ([ '/ [ [ -~ [ | PMS PDTS LOC CLASSIFICATION CODE PREMIUM BASIS RATE RATE 1 BOARDING OR ROOMING HOUSES 61000 UNITS 40 PRODUCTS-COMPLETED OPERATLONS ARE SUBJECT TO THE GENERAL AGGREGATE LIMIT 2" BUILDINGS OR PREMISES = BANKI