Okaloosa County BOCC — August 6, 2013 — Contract Renewal — reading text

CONTRACT/LEASE RENEWAL FORM October ?, 2013 Airport Management Resources, Inc. Mr. John Tomec 446 Ridgemont Drive Industry, PA 15052 RE: Contract Renewal Mr. Tomec: The Okaloosa County Airports agrees to renew the subject contract, #C04-1104-AP for an additional term. The contract renewal period will be October 1, 2013 to May 1, 2014. The annual budgeted amount for this contract is $50,000. 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:__AMRL Inc reronaal 2X fom (as prescrived gh iter John Tomec Dept. Director Signature: Approved By: Tifle:__ President (as prescribed below on item 1) Date: Date:_ October 9, 2013 County Department Instructions: 1) Obtain signatures from Department Director, authorized Company Representative and then 2) 3) Purchasing Director <$25K and less, County Administrator <S50K and less or Board >S50K, 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). Keep a copy of this form for your records. Send original to Purchasing Services Coordinator. If you have any questions please contact the Purchasing Director at 850-689-5960, Fax: 850- 689-5998. ) ® ACCORD Me CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 10/09/2013 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 PAT PROTZMAN 3495 DUTCH RIDGE RD BEAVER PA 75009 NAME” SHARON MENGEL (Ale No, Ext): 724-728-2702 E-MAIL ; ADDRESs: Sharon.d.mengel.iubp@statefarm.com (AIG, No}: 724-728-9515 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : State Farm Fire and Casualty Company 25143 INSURED AIRPORT MANAGEMENT RESOURCES INC INSURER B: 446 RIDGEMONT DR INSURER C: INDUSTRY PA 15052 INSURER Ds INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S 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 (MNIDDIYYYY) | (MMIDDIYYYY) Limits GENERAL LIABILITY [ | EACH OCCURRENCE $ 1,000,000 — DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY 05/26/2013 | 05/26/2014 | PREMISES (Ea occurrence) $ CLAIMS-MADE [| OCCUR 98-BE-Z767-8 F MED EXP (Any one person) $ X | BUSINESS LIABILITY PERSONAL & ADVINJURY | $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $ X | poucy| | fo | Loc $ AUTOMOBILE LIABILITY |_| [ | ED INGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) | ¢ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ $ UMBRELLA LIAB OCCUR nim EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED | | RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH AND EMPLOYERS’ LIABILITY YIN TORY LIMITS ER — ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT 1,000,000 OFFICE/MEMBER EXCLUDED? [_]isral | 98-B3-T693-9 01/01/2013 | 01/01/2014 8 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 4,000,000 If yes, describe under DESCRIPTI E.L. DISEASE - POLICY LIMIT | $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION OKALOOSA COUNTY JACK ALLEN 602 C NORTH PEARL STREET CRESTVIEW, FL 32536 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2010/05) The ACORD name and logo are registered . 4988-2010 AGORD CORPORATION. Al/righfe reserved. ks of ACORD 1001486 132849.6 11-15-2010