Okaloosa County BOCC — 2013 meeting #1140 (date undetermined) — Reynolds Smith and Hill internal coordination sheet_contract renewal_certificate of insurance_ — reading text

CONTRACT & LEASE INTERNAL COORDINATION SHEET Contract/Leose Number, ©97:/737-/9P Tracking Number: 6523 Contractor/Lessee Name: Kernel " bY, inetd aad Lells, JAgtont Funded: YES NO Purpose: 3 (au am Date/Term: Welz ewth C annuef tents! _\. RI GREATER THAN $50,000 Amount: fee Late. sthetlik 2. 1] GREATER THAN $25,000 Department: Bssety 3. [7] $25,000 OR LESS Dep}. Monitor Name: _Z? Vitter: [7 Shue Document has been reviewed and includes ony attachments or exhibits. Purchasing Review bate: AS, Es Risk Management Review . Date: deaf, sf County Altforney Review Date: C (3 Fallowing Okaloosa County approval: Contracts & Grants Document has been received: Date: Contracts & Grants Manager CONTRACT/LEASE RENEWAL FORM June 18, 2013 Reynolds, Smith and Hills, Inc. Attn: Mr. Brad Wente 10748 Deerwood Park Blv.d South Jacksonville, FL 32256 RE: Contract Renewal Dear Mr. Wente: The Okaloosa County Airports agrees to renew the subject contract, #CO9-1737-AP for an additional term. The 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 Contractor:_. Reynolds, Smith and Hills, Inc. - “ob Approved By: Approved By? (as prescribed below on item 1) John F. Walz, PE Approved By: Title:_ Vice President (as prescribed below on item 1) Date: Date: a | [4 County Department Instructions: 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, OP ID: 29 DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 06/25/13 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 904-354-3785 NAMED BOT qnctcide wate ite i 000 904-634-1302 (alc. No, Ext): (Ale, No): Jacksonville, FL 32202 ML ss: Michael Ammiano PRODUCER pa REYNO-1 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Reynolds, Smith and Hills, Inc INSURER A: Charter Oak Fire Insurance Co 25615 10748 Deerwood Park Blvd South INSURER 8: Lexington Insurance Company 19437 Jacksonville, FL 32256 INSURER c: Phoenix Insurance Company 25623 INSURER D: Travelers Property/Casualty Co 25674 INSURER E : 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. . thin TYPE OF INSURANCE INSR WD. POLICY NUMBER (MMIDBIYYY) (aMDDIYYYY) LIMITS | GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A | X | COMMERCIAL GENERAL LIABILITY 630-4711N755 06/28/13 | 06/28/14 OA 4 Ce cwaurrance) $ 1,000,000 | cLaims-mape OCCUR MED EXP (Any one person) | $ 10,000 | X | No Deductible TRAVELERS PERSONAL & ADVINJURY | $ 1,000,000 —_ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $ 2,000,000 pour X 158 [| Loc § AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A |x| TRAVELERS oe2a3 | oeze4 [fester : enn | A | ANY AUTO 4 21M601& BA R BODILY INJURY (Per person) | $ |__| ALL OWNED AUTOS 810-4621M601& BA3979R8 BODILY INJURY (Per aocident)| 8 |__| SCHEDULED AUTOS PROPERTY DAMAGE ; | X | HIRED AUTOS (Per accident) | X_| NON-OWNED AUTOS Comp. Ded. $ 500 Coll. Ded. $ 1,000 | X_| UMBRELLALIAS =| X | occuR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB | 40,000,000 D CLAIMS-MADE UMB-4744N755 osiza13 | o6/2e14 | AGGREGATE $ : |__| DEDUCTIBLE 8 X [RETENTION $ 10,000 $ WORKERS COMPENSATION X WC STATU- OTH AND EMPLOYERS’ LIABILITY YIN TORY LIMITS ER C | ANY PROPRIETOR/PARTNER/EXECUTIVE PVYDN-UB-5388B307-12 12/0142 | 12/01/43 | &... EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA D | (Mandatory in NH) UB-915K3374-12 12/0192 | 12/01/13 | &... DISEASE -EA EMPLOYEE, $ 1,000,000 if yes, describe under DESCRIPTION OF OPERATIONS below E.L, DISEASE - POLICY LIMIT | $ 1,000,000 B_ |Profes'l Liab. wi 028395945 06/28/13 06/28/14 |$5MM/CLM $10MM AGG Contr.Pollut.Liab. CLAIMS MADE FORM $25K SIR Retrot/1/42 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Certificate holder is included as Additional Insured on General Liability as respects to work completed by Named Insured where required by written contract. Cancellation clause is as shown except for non-payment which is 10 days CERTIFICATE HOLDER CANCELLATION OKALOCO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Okaloosa County Attn: Tracy Stage ACCORDANCE WITH THE POLICY PROVISIONS. 1701 State Road 85 N Eglin AFB, FL 32542-1498 AUTHORIZED REPRESENTATIVE Plug R Aehtedas © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD NOTEPAD INSURED's Name Reynolds, Smith and Hills, Inc REYNO-1 OP ID: 29 PAGE 2 pate 06/25/13 Reynolds Smith & Hills, Inc Lemeul Ramos and Associates, Inc. a FL Corp RS&H Architects- En ineers- Planners Inc. a NC Corp Reynolds Smith and Hills CS incorporated a FL corp. Sylva Engineering Corporation, a 1X Corp, Reys olds Smith And Hills Architects - Fngineers- Planners, PA Architect and Engineer, PC, a NY Corp. Arkansas Inc California, Inc. Illinois, Inc iowa, P.C. Michigan, Inc. Mississippi, P.C. Montana, P.C. Nevada, inc. Qhio, Inc, . Oregon, Architects-Engineers-Planners, P.C. Alabama Inc & H Idaho, P.C. A o oa meego neem RS&H Commercial Realty, Inc. RS&H Land Surveyors, lnc., A NC Corp. RS&H Massachusétts, Inc. A Waiver of Transfer of Right of Recovery Against Other in favor of the certificate holder for General Liability. * Cancellation clause is 30 days except nonpayment of premium which is 10 days.