Okaloosa County BOCC — September 16, 2014 — The Advocacy Group Contract Renewal

CONTRACT/LEASE RENEWAL FORM Date: 8/27/2014 The Advocacy Group Attn: Slater W. Bayliss 215 South Monroe Street, Suite 602 Tallahassee, Florida 32301 RE: Contract Renewal Dear Mr. Bayliss: The Okaloosa County Board of County Commissioners wishes to renew the subject contract/lease, #C14-2122-BCC for an additional term. The contract renewal period will be October 1, 2014 to September 30, 2015. If you would like to review the previously accepted contract, please feel free to view on-line at http://www.co.okaloosa.fl.us/contracts/contra_pdf/C14-2122-BCC.pdf 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)to County Administrator's Office, 1804 Lewis Turner Blvd., Suite 400, Fort Walton Beach, FL 32547, COUNTY REPRESENTATIVES AUTHORIZED COMPANY REPRESENTATIVE Dept. Director Contractor: The Advocacy Group at a ¢ J Cardenas Partners LLC Signature,“ 2-yuner ‘ Approved By: Approved (as prescribed below on item 1) Approved By: Title: Partner (as prescribed below on item 1) Date: Date: S/z all [4- County Department 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. (lf 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. } Med ACORD Qo CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 09/03/2014 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 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 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 certificate holder in lieu of such endorsement(s). PRODUCER McKee Insurance Agency, LLC CONTACT patrick H. McKee PHONE xy, (850) 224-6055 "LEAR wo}: (850) 513-0646 1785 Thomasville Rd EMAL as: palrick@mckeeagency.com INSURER(S) AFFORDING COVERAGE NAIC # Tallahassee FL 32303 : - INSURERA: Depositors Insurance Company oo. 42587 INSURED insuRERB: Allied Property & Casualty 7 en The Advocacy Group Al Cardenas WsuRERC; BeazleyGroup) . - 215 S Monroe Street Ste 602 INSURER D: ee oe INSURERE: . oe ees Tallahassee FL 32301 INSURER F; COVERAGES CERTIFICATE NUMBER: 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. WSR ADDLSUBR] LTR TYPE OF INSURANCE WSR Ww POLICY NUMBER (aMOBIYYY (MMDDIVYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 Ne DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) {$8 300,000 _ claims-mape |< | occur MEO EXP (Anyone person) |S 5,000 A YX ACPBPOD5934994 157 07/01/2014 | 07/01/2015 | PERSONAL & ADV INJURY _| 1,000,000 ne GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $ __ 2,000,000 - | POLICY [| BR FRO: iB Loc $ AUTOMOBILE LIABILITY PeBINEO SINGLE LIMIT | 1,000,000 | any Auto BODILY INJURY (Per person) | $ Al jauros =? | | Soros ACPBPOD5934991157 07/01/2044 | 07/01/2015 | BODILY INJURY (Per accident) | § NON-OWNED XX wireo autos |<] Ruros = (ternectteny AoE s ee $ __ | UMBRELLALIAB =| | occur EACH OGCURRENCE $ __| EXCESS LIAB CLAIMS-MADE AGGREGATE s DED | | RETENTION $ $ WORKERS COMPENSATION x] WC STATU- OTH- AND EMPLOYERS’ LIABILITY YIN | 4s L TORY LIMITS ER 7000.00 ANY PROPRIETOR/PARTNER/EXECUTIVE LL DE 900,000 B OrtICERMEMBER EXCLUDED? NIA ACPWCP5934869495 02107/2014 | 02/07/2015 | =: =ACHACCIDENT $ (Mandatory ia NH} E.L. DISEASE - EA EMPLOYER $ 1,000,000 if yas, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ 4,000,000 E&O Aggregate $ 1,000,000 Cc W11C36130304 07/15/2014 | 07/15/2015 | Occurrence $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Certificate holder is also additional insurec CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Okaloosa County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1804 Lewis Turner Boulevard ACCORDANCE WITH THE POLICY PROVISIONS, Suite 400 aur ED REPRESENTATIVE Fort Walton Beach FL 32547 pati i. por i ACORD 25 (2010/05) 7 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD