Okaloosa County BOCC — August 5, 2014 — Verizon Wireless DTS Agreement — reading text

Khurjékar Title: Area Vice President Network Date: La. Wo .l<t 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) Penal CONTRACT & LEASE INTERNAL COORDINATION SHEET Contract/Lease Number: \ OFF pp Tracking Number: Grant Funded: YES No ee) lay Op Contractor/Lessee Name: Yi Le4@y, (0 CMs 7 7 “] at —— Purpose [e2iaeo ey Co Nee i [ Gy | 3 ol iG Date/Term: | Amount: i \ Dp Department: Af . 4 Dept. Monitor Name T\acsce = | i) dey LEAL Document has been reviewed and includes any attachments or exhibits: 1. L] GREATER THAN $50,000 2. L] GREATER THAN $25,000 3. LI $25,000 OR LESS SID Purchasing Review Procurement requireme fo sy i a — a Stare met: ° wo te Nee ihe? ; HA Jirector of Designee “Dec rye. K b Ate Date: e ~ 1G ” IF a Pirchasing’ Risk Management Review Approved as wrj 1p _ / - “snakager oc designe “9 V7, | Risk Manager or designee (wee so AC Kes / Date: Cfeo{i4 / County Attorney Review Approved as writteno™ Gage Ud) Date: b Ce S~ | Yf nevi me gpnty attorneyi( (eo o/TX lo lord Following Okaloosa County approval: Contracts & Grants Document has been received: Contracts & Grants Manager Date: L Joa\i4 AC oO Fe ~~ DATE(MM/DD/YYYY) cm CERTIFICATE OF LIABILITY INSURANCE osve7r2014 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 L 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 SONTACT 3 Aon Risk Services Northeast, Inc. PHONE FAX - Morristown NJ office ine No. Ext), (866) 283-7122 FAX oj; (800) 363-0105 g 44 whippany Road, Suite 220 E-MAIL oO 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 280 washington valley Road INSURER C: Illinois National Insurance Co 23817 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570054351591 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 SUGH POLIGIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR TYPE OF INSURANCE apy Suan POLICY NUMBER CTO) | camino) LIMITS A | x | COMMERCIAL GENERAL LIABILITY GL7266932 867507 2014106730 2015] EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED | CLAIMS-MADE OCCUR PREMISES (Ea oveurronce) $1,000,000 MED EXP (Any one person) || PERSONAL & ADV INJURY $1,000,000] 5 To) GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 D X | POLICY [ies Loc PRODUCTS - COMP/OP AGG $2,000,000 i OTHER: 8 A | AUTOMOBILE LIABILITY CA 350-06-58 06/30/2014]06/30/2015| COMBINED SINGLE LIMIT $1,000,000 o AOS Ea accident) , , . A [x | any auto CA 350-06-59 06/30/2014] 06/30/2015 | SODILY INJURY ( Per person) s /—7 ALL OWNED SCHEDULED MA BODILY INJURY (Per accident) o A |_| AUTOS AUTOS CA 350-06-60 06/30/2014] 06/30/2015 | pRopERTY DAMAGE 8 |__| HIRED AUTOS NONCOWNED VA {Per accident) i E o UMBRELLA LIAB OCCUR EACH OCCURRENCE Oo | | EXCESS LIAB [| CLAIMS-MADE AGGREGATE bED| [RETENTION B | WORKERS COMPENSATION AND wc026035004 06/30/2014/06/30/2015] y | PER | [OTH EMPLOYERS' LIABILITY YIN work Comp - AOS STATUTE ER B ANY PROPRIETOR / PARTNER / EXECUTIVE NIA wc026035006 06/30/2014|06/30/2015 E.L. EACH ACCIDENT $1,000,000 (Mandatory in NH) IL KY NC NH VT EL. DISEASE-EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1,000,000 RE: VZW Site: Destin Airport Das, Location Code: DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) sti 274869, Site Address: ts included as Additional Insured with respect to the General Liability policy under required by written contract. 1001 Airport Rd., Destin, FL 32541. Okaloosa County 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-cC North Pearl Street Crestview FL 32536 USA AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CEE Pas ERE a lal AGENCY CUSTOMER ID: 570000035381 —— © LOC #: ACCORD co ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Aon Risk Services Northeast, Inc. Cellco Partnership dba verizon wireless POLICY NUMBER See Certificate Number: 570054351591 CARRIER NAIC CODE See Certificate Number: 570054351591 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. INSR ADDLI sus POLICY POLICY LTR TYPE OF INSURANCE yep WD POLICY NUMBER cana ON LIMITS (MM/DD/YYYY) | (MM/DD/YYYY) WORKERS COMPENSATION B N/A wC026035007 06/30/2014 | 06/30/2015 AK AZ GA VA B N/A wc026035008 06/30/2014 | 06/30/2015 NJ PA C N/A wc02 6035009 06/30/2014 | 06/30/2015 FL B N/A wc026035011 06/30/2014 | 06/30/2015 MN - B N/A wc026035012 06/30/2014 | 06/30/2015 MA,ND,OH,WA,WI,WY A N/A WwC026035005 06/30/2014 | 06/30/2015 CA B N/A wc026035010 06/30/2014 | 06/30/2015 ME ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD