Okaloosa County BOCC — March 1, 2016 — Glazesignedcontrenewal — reading text

CO NTRACT/LEASE RENEWAL FORM 02/17/2016 Glaze Communications Services, Inc. Attn: Brett W. Glaze 1864 Cowen Road Gulf Breeze, FL 32563 RE: Contract #C14-2147-IS Dear Brett: The Okaloosa County Board of County Commissioners agrees to renew the subject contract/lease, # C14-2147-IS for an additional term. The contract renewal period will be 02/17/2016 to 02/16/2017 . The annual budgeted amount for this contract is shall be based off of unit pricing which shall vary by Department budget. All other terms and conditions of the original agreement shall remain in full force and effect through the duration of this renewal. 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. Director Signature: _ _ _ _ _ _ _ _ __ Date: _ _ _ _ _ _ _ _ _ _ __ Approved By: _ _ _ _ _ _ __ (as prescribed below on item 1) Approved By: 7 ~?--- Date: _ _ _ _ _ _ _ _ _ _ __ Approved By: _ _ _ _~--- Title :_--"-e <-..Lf'--:e>=:..$ ~~f"-,(l~-t: :::..-<... ; _ _ _ _ _ __ (as prescribed below on item 1) Date:_ _ _ _ _ _ _ _ _ _ __ Date:_----"~__J/~ ~/ "7_ _ _7J<--/<.. . LLhL...----- 7 7 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 sUire the company provides a current Certificate of Insurance. (If 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.  ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE IMMIDDIYVVY) ~ 2/10/2016 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 CERTI FICATE 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 Il ieu of such endorsement(s). PRODUCER ~~~~~CT Waldorfi' 'il nsurance & Bonding ;A~~NJ; ~.t\. 850-581-4925 I Fti, Nol' 850-581-4930 45 Eglin Parkway NE Ste 202' Fort Walton Beach FL 32548 ~A~~SS' receptionist@waldorffinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Westfield Insurance Company 24112 INSURED GLAZ-01 INSURER B :The FCCI Insurance Company 10178 Glaze Communications Services, Inc. INSURER c; 1864 Cowen Road INSURER D: Gulf Breeze FL 32563 INSURER E ; INSURER F: COVERAGES CERTIFICATE NUMBER' 1807767935 REVISION NUMBER' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEHIOD 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 1 1 ~3)6g~) 1~~7~%~) Ut, . LTR TYPE OF INSURANCE I ~~~~ V'ND POLICY NUMBER LIMITS A .L - - o COMMERCIAL GENERAL LIABILITY CLAIMS·MADE OCCUR GJ Y CWP0937612 2/12/2016 2/12/2017 EACH OCCU RR ENCE DAMAGE !U_ RENTED ~'~~Ea occurrence} $1 ,000 ,00 0 $ 150 .000 MED EXP (Any one person) $1 000 PERSONAL & ADV INJURY $1, 000 000 - GENERAL AGG REGATE = j'L AGGREGATE LIMIT APPUES PER $2000 .000 POLICY [ i J JECT PRO­ LOCD PRODUCTS· COMP/OP AGG $2.000 .000 OTHER $ A AUTOMOBILE LIABILITY CWlP0937612 2/1212016 2/12/2017 (E:;"::~dd~~'~ ING LE LI MIT $1,000 ,000 - X P,NY AUTO BOD ILY INJ URY (Per person) $ - ALL OWNED r-­ SCHEDULED BOD ILY INJ URY (Per accidenl) $ AUTOS AUTOS i-­ r-­ NON-OIAN ED X HI RED AUTOS X AUTOS fp~?~~d~ill?AMAG E $ I-­ r-­ M $ A X UMBRELLA LlAB CWP0937612 2112/2016 2/12/2017 EACH OCCU RRENCE $3.000,000 I-­ OCCUR EXCESS LlAB CLAIMS·MADE AGGREGATE $3,000.000 OED X I IRETENTION $ 0 S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN 001WC16A67995 2/12/2016 2/12/2017 X 1 ~¥fTUTE I I ~H. ANY PROPRIETOR/PARTN ER/EXECUTIVE E.L EACH ACCIDENT $1 ,000,000 OFFICER/M EMBER EXCLUDED? IMandatory in NH) 0 NIA E.L DISEASE · EA EMPLOYEE $1 ,000,000 If yes, descnbe under DESCR IPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A LeasedlRented Equip CWlP0937612 2/12/2016 2/12/2017 Limit: $25,000 Ded: $1,000 Installation Floater Limit $280,000 Ded: $1,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) It is hereby understood arid agreed that the below named Certificate Holder is listed as additional Insured as pertains to General Liability only when required by w,itten contract. RE: Jobs per network Cabling & repair contract. .