Okaloosa County BOCC — May 6, 2014 — Verizon Agreement Destin Airport — reading text

Communications LP d/b/a Verizon Wireless ~ LICENSEE kn Luck eli Pintle A N \Otynne Carlisle ame: Name: Aparna Khurjekar Title: Area Vice President Network Date: 21lay|QoOIN Exhibit A IBRD System components/design principles One (1) repeater to be installed in a closet in the “Regal building”, one (1) repeater to be installed in a closet in the “Destin Jet building” Exhibit B Licensor’s construction and contractors’ rules (N/A) AC OQ ke ~~ DATE(MMI/DD/YYYY) co CERTIFICATE OF LIABILITY INSURANCE owormot4 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 CONTACT 3 Aon Risk Services Northeast, Inc. PHONE 7 FAX = . Morristown Nj Office (AIG. No. Ext): (866) 283-7122 (NG. No): (800) 363-0105 g 44 whippany Road, Suite 220 E-MAIL ro Morristown NJ 07960 USA ADDRESS: = INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: National Union Fire Ins Co of Pittsburgh |19445 cellco Partnership dba Verizon wireless INSURER B; New Hampshire Ins Co 23841 Basking. Ridge Na 07920 USA INSURER C: Illinois National Insurance Co 23817 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570052580411 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. Limits shown are as requested NSE TYPE OF INSURANCE Aer SR POLICY NUMBER nee) | doen LIMITS A | GENERAL LIABILITY 2094699 06/30/ 2013 072014] Each OCCURRENCE $1,000,000 X | COMMERCIAL GENERAL LIABILITY PREMISES (ca oveurene 2) $1,000,000 CLAIMS-MADE OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000] = GENERAL AGGREGATE $2,000,000 3 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 a |x| pouicy [| ine [| Loc 3 A | AUTOMOBILE LIABILITY 5196456 06/30/2013/06/30/2014] COMBINED SINGLE LIMIT $1,000,000 at AOS (Ea accident) , , - a [x | ANYAUTO 5196458 06/30/2013|06/30/2014] BODILY INJURY ( Per person) 8 [|] ALL OWNED SCHEDULED MA BODILY INJURY (Per accident) 2 A |__| autos 5196457 06/30/2013}06/30/2014 | GRopERTY DAMAGE & |__| HIRED AUTOS we NED VA (Per accident) e 5 UMBRELLA LIAB OCCUR EACH OCCURRENCE o | | exckss Liss CLAIMS-MADE AGGREGATE DED] [RETENTION B [| WORKERS COMPENSATION AND 049901115 06/30/2013/06/30/2014 x | WS STATU- [oat EMPLOYERS’ LIABILITY YIN AOS TORY LIMITS ER B | QrriceRMEMBeREXcLUDED? [N |wval [049902117 06/30/2013/06/30/2014| + EACH ACCIDENT 51,000,000 (Mandatory in NH) IL KY NC NH VT E.L. DISEASE-EA EMPLOYEE $1,000,000 lf yes, describe under DESCRIPTION OF OPERATIONS below EL. DISEASE-POLICY LIMIT $1,000 ,000)/__ = = DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: VZW Site: Destin Airport Das, Location Code: 274869, Site: Site ID: Site Address: 1001 Airport Rd., Destin, FL 32541. = 5 contract. Okaloosa County is included as Additional Insured with respect to the General Liability policy under required by written CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Okaloosa County 602-c North Pearl Street Crestview FL 32536 USA AUTHORIZED REPRESENTATIVE OA EER a ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000035381 —~ » LOC #: acon, ADDITIONAL REMARKS SCHEDULE Page _ of _ Aon Risk Services Northeast, Inc. POLICY NUMBER See Certificate Number: 570052580411 CARRIER NAIC CODE See Certificate Number: 570052580411 Cellco Partnership dba Verizon Wireless EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES Ifa policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. POLICY POLICY “we TYPE OF INSURANCE ano eR POLICY NUMBER clei aoeaa LIMITS (MMI/DD/YYYY) | (MM/DD/YYYY) WORKERS COMPENSATION B N/A 049901118 06/30/2013 | 06/30/2014 AK AZ GA VA B N/A 049901119 06/30/2013 | 06/30/2014 NJ PA C N/A 049901120 06/30/2013 | 06/30/2014 FL B N/A 049901121 06/30/2013 | 06/30/2014 MN B N/A 049901122 06/30/2013 | 06/30/2014 MA,ND,OH,WA,WI,WY A N/A 049901116 06/30/2013 | 06/30/2014 CA ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CONTRACT & LEASE INTERNAL COORDINATION SHEET Contract/Lease Number: Contractor/Lessee Name: Vopr LOnxbaes Grant Funded: YES__. NO : Purpose: on eg Boy Wy ie a fp Date/lerm: _ 4)30 [ see | | 1. [] GREATER THAN $50,000 Amount: y 7 . - 2. (.] GREATER THAN $25,000 | Department: ALLO pisabs 3, []. $25,000 OR LESS Dept. Monitor Name: “a eumee- JA vena. Document has been reviewed and ached any ailachmen|s or exhibits, YL < wf. Tracking Number: © {3~/ vi Purchasing Review qyremen! ay nts are met. f a aw, Date: if aap ae sig Director or designee Oe "Risk Management Review _= f hl UL rt Toke De we te-7P er IN an q Approved ap weiten: oo — Boel it? / - C ey, of oe é | de é f £ ; - Rerenense weds Can /@ / Y july Tan ra piv! * ¥$ Date: 4 4 iffy Risk Manager or “desi ignee County Attorney Review eee) | | af 7 Nu Date: County Attorney Following Okaloosa Counly approval: Contracts & Grants Document has been received: Date: | Contracts & Grants Manager