Okaloosa County BOCC — February 17, 2015 — NetworkCablingAndRepairContractRenewals — reading text

INSURER 0 : , INSURERE: IllSURERF ' COVERAGES CERTIFICATE NUMBER' REVISION NUMBER' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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. lrM GeNERAL UABIUTY TYPE OF INSURANCE '1IN9R I \WI} POUCY NUMBER 11=-~g~1 'l'~~~ EACH OCCURRENCE UMITS $ 1,OOO,OOIl ~ X CPP0018945 07/2212014 07/2212016 ~~J?e:~~ED 300,OOll A -.!. COMMERCIAl GENERAL UABIUTY S - P ClAIMs.MADE [!J OCCUR YEO EXP '(Any ane po...",,) PERSONAl. & ADV INJURY $ 10,OOll 1,OOO,OOll $ - GENERAL AGGREGATE 2,000,000 $ r- GEN'l AGG~Em LIMIT APFlS PER: PROOUCTS • COMPIOP AGG I $ 2,000,OOIl n. POLICY X AUTOMOBILE UABIUTY ~8i LOC ~~~NGlE UMIT s 1,OOO,OOIl ~ r-­ CAOO27673 07/2212014 0712212015 BOOILYINJURY (per _ n ) S A X ANYAlJTO r - AlLOWNED r-- SCHEOULED BODILY INJURY (per accidonl) S r ­ AUTOS - AUTOS NQN..OWNEO [;lk~bb~ S ~ HIRED AUTOS - AUTOS $ X UM_BRELLA LIAB r­ ~ OCCUR EACH OCCURRENCE Is 5,OOO,OOC A EXCESSUAB ClAIIoIS-MADE UMB0019317 07/2212014 07/22/2015 AGGREGATE $ 5,OOO,OOC OED I X I RETEIIITION $ 10000 $ WORKERS COMPENSATION AND EMPLOYERS" UABIUTY , T~~TtJr'ts I ,OJ': ANY PROPRIETORIPARlNERlEXECUTIIIE OfflCERlMEMBER EXCLUDED? YIN D N/A E.L. EACH ACCIDEI'IT $ (Nandatary In NHI E.L DISEASE· EA 'EMPlOYEE $ grsCR~=01~PERATI~NS below E.L DISEASE· POLICY UMn '$ A Installation Fltr CPPOO18945 07/2212014 07/22/2016 Llmlt-$ 300,OOCl A Leased Equipment CPP0018945 07/2212014 07/22'2015 Llmit-$ 100,000 DESCRJP'!1ON OF OPERA nONS I LOCA noNS IVEHlCLES (AIIactr ACORD 1111, Additional Rem.rkIi Sc:hedull, If more apace Is requlrm) Okaloosa County is includad as Additional Insured with respect to the General Liability policy when required by written contract. CERTIFICATE HOLDER CANCELLATION OKALC01 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE lliE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Okaloosa County 602·C North Pearl Street AuntORIZED REPRESEI'ITATIVE CrestvIew, FL 32636 I ~~/}- @1988·2010 ACORD CORPORATION. All nghts reserved. ACORD 25 (201,0105) The ACORD name and logo are registered maries of ACORD ~) " CONTRACT & LEASE INTERNAL COORDINATION SHEET Contract/lease Number: -c2, J -IS Tracking Number:.--=-.=:....L.>.L....-~~ . /) /? Grant Funded: YES_ _ NO~ ~:::~~. Date!Term: ~ e:z~"ijJS - c:tPV1£, 1. 0 GREATER THAN $50,000 Amount: cj>SO, m 2. D GREATER THAN $25,000 Department: ::r;s 3. D $25,000 OR LESS Dept. Monitor : ame: ~(jIftJ.£ 4­ Document has been reviewed and includes any attachments or exhibits. Purchasing Review Date: / -;;J--/5 Joanne Kublik Risk Management Review Approved as written: Date: J- ~ - \5 Kay Godwin or Krystal King County Attorney Review Approved as written: c:::::: ~~ Date:.~' --=-{'S /2.b+-=-­_ Coun T. Stewart or Lynn Hoshihara Following Okaloosa County approval: Contracts & Grants Document has been received: Date:._ _ __ __ _ __ Contrclw & Grants Mana~er  CONTRACT/LEASE RENEWAL FORM Date: January 8,2015 Universal Cabling systems, Inc. Attn: Ronald P. Dubeau 914 Fern st West Palm Beach, FL 33401 RE: Contract #C 14-2148-IS Dear Ron : The Okaloosa County Board of County Commissioners agrees to renew the subject contract/lease, #C 14-2148-IS for an additional term. The contract renewal period will be 02/18/15 to 02/17/16. The annual budgeted amount for this contract could possibly exceed $50,000.00. If you are in agreement, please sign below and return this form along with a current Certificate of Insurance listing Ok oosa County as co-insured (if applicable). AUTHORIZED COMPANY REPRESENTATIVE Dept. Director Contractor: Sig n atu re :--f----,~-____".,....:::..~"F-- Approved By: ~~=;Z:::::.I..:~~-==;"- A P proved By: --.f-..,qL.!J£f.~~.:3£:.!!!!...<:J..aLL£l~ (as presc JOHN HOFSl'AD t UUNTY ~ IN ISTRATOR Approved By: _ _ _ _ _ _ __ Title: Vice President NATHAN D. BOYLES (as prescribL _ CH.AI~M-!:~ """ ,. I I Date:_ _ _ _ _ _ _ _ _ _~ Date: 1/8/15 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. (If applicable). 2) Keep a copy of this form for your records. 3) Send