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CONTRACT & LEASE INTERNAL COORDINATION SHEET
Contract/Lease Number: Tracking Number: iC y { > {Y. -
/
A rook laa Grant Funded: YES_ = NO
Contractor/Lessee Name: fiviatern — (ont ach.
Purpose A’ fp Beat Carte ben Was
Date/Term: Syeda Bipoashe 1. ip GREATER THAN $50,000
sora ee Te Rn
Amount:__ 00,7 (an
2. L] GREATER THAN $25,000
Department: Ae 3. im $25,000 OR LESS
Dept. Monitor Name
Document has been reviewed and includes any attachments or exhibits.
Purchasing Review
Procurement requirements are met:
Date: 8 -9-lt
Joanne Kublik
jrector or Designee
Risk Management Review
wi thy Cc howe Qo eg, a-map
Appraved as-weritten:
Kealhe _ pate, B~ DO— (Ut
Manager or designee
7
County Attorney review See chenqe oy
Approved as written:
“
I AT Date: Svat T-4
Cotinfyttbrney ~ Gregory T. Stewart
~y Tok Aqveeds _
yee
mall
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Following Okaloosa County approval:
Contracts & Grants
Document has been received:
Date:
Contracts & Grants Manager
Joanne Kublik
From: Krystal King
Sent: Wednesday, October 01, 2014 11:19 AM
To: Joanne Kublik
Subject: RE: VPS--TRILLION CONTRACT
“ [am good withthe changes made to this contract.”
petal ling
Okaloosa County
Risk Management
(850)689-5977
Fax (850)689-5973
Please note: Due to Florida's very broad public records laws, most written communications to or from County employees regarding County
business are public records available to the public and media upon request. Therefore, this written email communication including your email
address, may be subject to public disclosure.
From: Joanne Kublik
Sent: Wednesday, October 01, 2014 9:43 AM
To: Greg Stewart; Lynn Hoshihara; Krystal King
Subject: FW: VPS--TRILLION CONTRACT
This is the agreement that has been going back and forth. Jon Morris has provided a new and improved version. Trillion
is in agreement with the changes. Please review and let me know if you are ok with this document. | will send, under
separate cover, the old document. Thanks, Jo
Joanne Kublik, Contracts and Lease Coordinator
Okaloosa County Purchasing Department
602-C North Pearl Street
Crestview, Florida 32536
(850) 689-5960
jkublik@co.okaloosa.fl.us
Please note: Due to Florida's very broad public records laws, most written communications to or from County employees regarding County
business are public records, available to the public and media upon request. Therefore, this written e-mail communication, including your e-mail
address, may be subject to public disclosure.
From: Jon Morris
Sent: Wednesday, October 01, 2014 8:40 AM
To: Joanne Kublik; Jack Allen
Cc: Dave Miner; Sunil Harman
Subject: FW: VPS--TRILLION CONTRACT
Jo,
The clean copy is attached. You can see below that | addressed each of Trillion’s concerns and denied some as well. On
page 8, | deleted the “job site” wording only with respect to COls.
Joanne Kublik
From: Greg Stewart
Sent: Thursday, October 02, 2014 7:38 AM
To: Joanne Kublik; Lynn Hoshihara; Krystal King
Subject: RE: VPS--TRILLION CONTRACT
rida
Please note: Due to Florida's very broad public records laws, most written communications to
or from County employees regarding County business are public records, available to the
public and media upon request. Therefore, this written e-mail communication, including your
e-mail address, may be subject to public disclosure.
From: Joanne Kublik
Sent: Wednesday, October @1, 2014 9:43 AM
To: Greg Stewart; Lynn Hoshihara; Krystal King
Subject: FW: VPS--TRILLION CONTRACT
This is the agreement that has been going back and forth. Jon Morris has provided a new and
improved version. Trillion is in agreement with the changes. Please review and let me know
if you are ok with this document. I will send, under separate cover, the old document.
Thanks, Jo
Joanne Kublik, Contracts and Lease Coordinator Okaloosa County Purchasing Department 602-C
North Pearl Street Crestview, Florida 32536
(858) 689-5960
jkublik@co.okaloosa.fl.us<mailto: jkublik@co.okaloosa.fl.us>
Please note: Due to Florida's very broad public records laws, most written communications to
or from County employees regarding County business are public records, available to the
public and media upon request. Therefore, this written e-mail communication, including your
e-mail address, may be subject to public disclosure.
From: Jon Morris
Sent: Wednesday, October 01, 2014 8:40 AM
To: Joanne Kublik; Jack Allen
Cc: Dave Miner; Sunil Harman
Subject: FW: VPS--TRILLION CONTRACT
Jo,
The clean copy is attached. You can see below that I addressed each of Trillion’s concerns
and denied some as well. On page 8, I deleted the “job site” wording only with respect to
COIs.
By Dan Benzon’s reply below, they are in agreement. Hope you can get in on the agenda with
Zan for Oct 21, and I will be happy to attend for questions.
Thanks,
@
ACORD
Qo
CERTIFICATE OF LIABILITY INSURANCE
DATE = (MM/DDIYYYY)
06/25/2014
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).
RROOUCER, DAVID HEAD
Head Insurance Group LP
| PHONE
CONTACT
NAME: DAVID HEAD
(alc, No, Ex; (512) 336-2929 (iG, No; (512) 336-2930
E-MAIL
201 S. Lakeline Blvd., #304 avpress; Gavidhead@headinsurancegroup.com
CUSTOMER 1D +
Cedar Park TX 78613- INSURER(S) AFFORDING COVERAGE NAIC #
INSURED iwsureR A ‘Travelers Casualty Insurance Co
Trillion Av LLC wsurer 8 :The Charter Oak Fire Insn Co
4301 WILLIAM CANNON DR INSURER ¢ :
STE B-150, #293 INSURER D
INSURER E
Austin TX 78749- 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
INSR ADDL 'SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WvD POLICY NUMBER (MM/DDIYYYY) _ (MM/DDIYYYY) UMITS
GENERAL LIABILITY Y 680-4740M104-13 07/01/2014 07/01/2015 eacy OCCURRENCE s 2,000,000
L DAMAGE TO RENTED 0 0001
XX COMMERCIAL GENERAL LIABILITY ae cf PREMISES (Ea occurrence) $ 300,000
A CLAIMS-MADE X OCCUR a7 te MED EXP (Any one person) $ 5,000]
— ot ‘ft PERSONAL & ADVINJURY | $ 2,000,000
at ce GENERAL AGGREGATE is 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER te vos PRODUCTS - COMP/OP AGG $ 4,000,000
X_poucy SBS; Loc a a EXTCV 5
AUTOMOBILE LIABILITY 7 / / 7s COMBINED SINGLE LIMIT $
AiR 680-4740M104~-13 07/01/2014 07/01/2015 . E8.acciten)
-_ —_ BODILY INJURY (Per person)
A __| ALLOWNED AUTOS -_ op BODILY INJURY (Per accident) $
SCHEDULED AUTOS PROPERTY DAMAGE $
X prep autos ff a (Per accident)
X Non-ownen autos cet cf EACH OCCURRANCE $ 2,000,000)
af a GENERAL AGGREGATE $ 4,000,000
UMBRELLA LIAB OccuUR cr and EACH OCCURRENCE s
EXCESS LIAB CLAIMS-MADE 44 St AGGREGATE $
: et yt $
DEDUCTIBLE
/f¢ bod
RETENTION WC STATU OTH: ‘
WORKERS COMPENSATION Lf fog x ORY LiNITS Ais
AND TEMECOYERS: SARE YIN 07/01/2014 07/01/2015
ANY PROPRIETOR/PARTNER/EXECUTIVE IN UB 4947M99 9 11 E.L. EACH ACCIDENT $s 100,000
OFFICERMEMBER EXCLUDED? [] NIA / / / /
B (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 100,000
DeSERIPTION OF OPERATIONS below nd ti EL DISEASE - POLICY LIMIT $ 500,000
A PROFESSIONAL LIABILITY IL PACP 4740M10 4 ACJ 11 11/01/2013 11/01/2014 — $1 000,000 PER CLAIM NOT
a phi TO EXCEED $1,000,000 YR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES {Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER
CANCELLATION
() m ( ) -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
a P
AUTHORIZED REPRESENTPTIVE
ACORD 25 (2009/09)
INS025 (200909)
© 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
