Okaloosa County BOCC — 2013 meeting #1140 (date undetermined) — Kimley_Horn and Associates Internal Coordination Sheet_Contract Renewal_Certificate of Insurance — reading text

- repbee rd Gh oS _ CONTRACTS 2 LEASE INTERNAL COORDINAT conttaciheaie Romnbe C 04- ul 3g-AP — ~ ~ tracking Number 0-1 : hn ley Harn. 3 ‘Assoc. | |necrant Funded: YES_ NO coniractortese® Name: eee f wal \ ot. lonb rack tor Consul tervp Seev i ees | Purpose, bate/term: ") ne: 13. ~ was IU . Nok | Os Ger cade. schedule. 20 GREATER THAN $25,000 GREATER THAN $50.0 000 Amount: Ax pos}. _ 8. 3 $25,000 OR LESS beperiment: Dept. Monitor Name: _] DNal le qT. Shae t.. a Document has been reviewed and includes any tachment or exhibits. Sa Purchasing Review Se a . eet wee en Se — - _ Procurement requirements are mek — - Us <7) vain thls | patching Dt Director Grdesianes | a Sik. Risk eraser OF FUesignee County, Alforney Review Date: Following Okaloosa County approval: ~ er Contracts & Grants Document has been received: Date: Contracts & Granis Manager CONTRACT/LEASE RENEWAL FORM May 28, 2013 Kimley-Horn and Associates, Inc. Attn: Mr. David R Barat 1920 Wekiva Way, Suite 200 West Palm Beach, FL 3341] RE: Contract Renewal Dear Mr. Barat: The Okaloosa County Airports agrees to renew the subject contract, #CO9-1738-AP for an additional term. Tne contract renewal period will be July 9, 2013 to July 8, 2014. The annual budgeted amount for this contract is $50,000.00. 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). COUNTY REPRESENTATIVES AUTHORIZED COMPANY REPRESENTATIVE Dept. DeCtor Z y Contractor:_ky on \eu~ oen a9 NeeeesorES, le Signature: m wher ( ~~ Approved By: SOR SS | Title: 2. Nhu “Rene : Approved By: (as prescribed below on item 1) Approved By: (as prescribed below on item 1) Date: Date: , ull (2 County Department Instructions: S 1) Obtain signatures from Department Director, authorized Company Representative and then 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. (lf applicable). 2) Keep a copy of this form for your records. 3) Send original to Purchasing Services Coordinator. If you have any questions please contact the Purchasing Director at 850-689-5960, Fax: 850- 689-5998. ® ACCORD | CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 5/30/2013 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED certificate holder in lieu of such endorsement(s). IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy{ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the PRODUCER Greyling Insurance Brokerage CONTACT Jerry Noyola PHONE ext. (770) 552-4225 FAX i), (866) 550-4082 450 Northridge Parkway E-MAIL... jerry .noyola@greyling.com Suite 102 INSURER(S) AFFORDING COVERAGE NAIC # Atlanta GA 30350 INSURERA:‘National Union Fire Ins. Co. 19445 INSURED INSURERB:Commerce & Industry Insurance 19410 Kimley-Horn and Associates, Inc. insuRERC ‘New Hampshire Insurance Company (23841 P.O. Box 33068 INSURERD :Lexington Insurance Company 19437 INSURER E : Raleigh NC 27636 INSURER FE: COVERAGES CERTIFICATE NUMBER:13-14 (Kimley Sharda) REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNSR ADDL|SUBRI POLICY EFF | POLICY EXP LIR TYPE OF INSURANCE INSR | WyD POLICY NUMBER (MM/DDIYYYY) | (MM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X | COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)_| $ 500,000 A | CLAIMS-MADE OCCUR GL 9645227 4/1/2013 4/1/2014 | wep exp (Any one person) _| $ 25,000 X | Contractual Liability PERSONAL & ADV INJURY _| $ 1,000,000 — GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG | $ 2,000,000 pouicy | X | FEO | x | Loc $ COMBINED SINGLE LIMIT | AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000 A X | any AUTO BODILY INJURY (Per person) | $ ALL OWNED | | SCHEDULED ICA 4982985 4/1/2013 4/1/2014 | BopILy INJURY (Per accident)! $ NON-OWNED PROPERTY DAMAGE Xi pirepautos | * | autos (Per accident) 8 $ X | uMBRELLALIAB «| X | occur EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 peo | X | RETENTION S 10,000 BE 016395110 4/1/2013 |4/1/2014 5 C_ | WORKERS COMPENSATION x | WC STATU OTH- AND EMPLOYERS’ LIABILITY YIN TORY LIMITS ER ANY GROPRIETORIPARTNER/EXECUTIVE NIA E.L. EACH ACCIDENT $ 1,000,000 R/MEMBER EXCLUDED? (Mandatory in NH) Wo 018112556 4/1/2013 4/1/2014 | 1 pigease - EA EMPLOYEX $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ 1,000,000 D | Professional Tiabilit 016017332 2/1/2012 [4/1/2014 | perciaim $2,000,000 Y , ! Aggregate $2,000,000 Re: Commissioners, Okaloosa County, DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 104, Additional Remarks Schedule, if more space is required) Okaloosa County Airports; KHA Project Mgr. Dave Bardt. The Okaloosa County Board of. County its respective agents, consultants, Additional Insureds on the above referenced liability policies with the exception of workers compensation & professional liability where required by written contract. The above referenced liability policies with the exception of professional liability are primary & non-contributory where required by written contract. Waiver of Subrogation is applicable where required by written contract & allowed by law. servants & employees are named as CERTIFICATE HOLDER CANCELLATION Okaloosa County Board of County Commissioners 602C North Pearl Street Crestwood, FL 32536 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE David Collings/JERRY eof EO a ee ACORD 25 (2010/05) INSAIS rontnnay m4 © 1988-2010 ACORD CORPORATION. All rights reserved. Tha ACORN nama and Inada ara ranictarod marke af ACMDN