Okaloosa County BOCC — April 1, 2014 — Verizon Site Access Agrmt 3-21-14 — reading text

forth in the first paragraph of this Agreement, or to such other address as the intended recipient may designate by notice given to the sender in accordance with this section. A validly given notice, consent, demand, request, or approval will be effective on the earlier of its receipt, if delivered personally or by e-mail, telecopy, or commercial courier, or the third day after it is postmarked by the United States Postal Service, if delivered by first class, postage prepaid, United States mail. Each party promptly shall notify the other of any change in its mailing address or telephone contact number stated in this Agreement. 12. Complete Agreement; Survival. This Agreement records the entire understanding between the parties regarding the subjects addressed in it and supersedes any previous or contemporaneous agreement, understanding, or representation, oral or written, by either of them. 13. Execution and Effectiveness. The parties may execute this Agreement in counterparts. Each executed counterpart will constitute an original document, and all executed counterparts, together, will constitute the same agreement. This Agreement will become effective upon the last signatory’s delivery of the fully executed document to the other party, and the last signatory shall fill in the EXECUTED date below prior to such delivery. <Signature Page to Follow> 21771013v1 4 EXECUTED: 20 ATTEST: GARY J. STANFORD DEPUTY CLERK OF CIRCUIT COURT OKALOOSA COUNTY, FLORIDA 21771013v1 BOARD OF COUNTY COMMISSIONERS OKALOOSA COUNTY, FLORIDA CHARLES K. WINDES, JR CHAIRMAN 21771013v1 LICENSEE: Verizon Wireless Personal Communications LP d/b/a V' i ae A LU ly Peat Name: “Caf [p21 CC* % Title: Eee Dire] The undersigned “Licensee Representative” has reviewed this Agreement and hereby agrees to comply with all obligations pertaining to, and imposed on, Licensee Representatives contained herein. 21771013v1 Agreed to and accepted by: Environmental consulting firm to VZW By: waa. WL Name: Séun f&. MEnNDav Title: Fruve f¢AL Date:_“3 |i 2[ty A co R ~~ DATE(MM/DD/YYYY) oO CERTIFICATE OF LIABILITY INSURANCE tapsti2013 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 Po certificate holder in lieu of such endorsement(s). = PRODUCER Reneect 3 Aon Risk Services Northeast, Inc. PHONE FAX 7 je Morristown NJ office (AIC. No. Ext): (866) 283-7122 {AlG, No); (800) 363-0105 g 44 whippany Road, Suite 220 E-MAIL ra} 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 Basking Ridge NJ 07920 USA INSURER C: Illinois National Insurance Co 23817 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570052493690 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. Limits shown are as requested ISR TYPE OF INSURANCE ADDY SUBR POLICY NUMBER (MRR Tey) | money) LIMITS A | GENERAL LIABILITY 9094699 0673072015] 0/2014] EACH OCCURRENCE $1,000,000 : DAMAGE TO RENTED X | COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $1,000,000 CLAIMS-MADE OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000} §& GENERAL AGGREGATE $2,000,000 8 2 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000] & | x | POLICY [| ver [| Loc S A | AUTOMOBILE LIABILITY 5196456 06/30/2013106/30/2014| COMBINED SINGLE LIMIT $1,000,000 9 AOS {Ea accident) ' , - A [x ] ANYAUTO 5196458 06/30/2013)06/30/2014] BODILY INJURY ( Per person) 3 |__| ALL. OWNED SCHEDULED MA BODILY INJURY (Per accident) 2 A |__| autos 5196457 06/30/2013/06/30/2014 TERopERTY DAMAGE 8 |__|HIRED Autos ayroe NEP VA (Per accident) P= 5 UMBRELLA LIAB OCCUR EACH OCCURRENCE oO | | EXCESS LIAB CLAIMS-MADE AGGREGATE bED| [RETENTION B | WORKERS COMPENSATION AND 049901115 06/30/2013106/730/72014 x | Wo STATU- | [ete EMPLOYERS' LIABILITY YIN AOS TORY LIMITS ER 8 | Orricenwemberexciupen? [N |inral [049901117 06/30/2013]06/30/2014| £1: EACH ACCIDENT $1,000,000 (Mandatory in NH) IL KY NC NH VT E.L. DISEASE-EA EMPLOYEE $1,000,000 OESGhE TION OF OPERATIONS below E.L, DISEASE-POLICY LIMIT $1,000,000 — ima = DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) em RE: VZw Site: NW FLORIDA REG AIRPORT DAS Location Code: 274867 Site: Site ID: Site address: 1701 Florida 85, Eglin a AFB, FL 32542. os as Sn! ie co _s CERTIFICATE HOLDER CANCELLATION =: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE tes EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE =r POLICY PROVISIONS. or Okaloosa County AUTHORIZED REPRESENTATIVE Lijeatl 602-C North Pearl Street Loe Crestview FL 32536 USA a Gy Bh Lives Noviheast Inve = —_ ACORD 265 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000035381 —— « LOC #: ae ADDITIONAL REMARKS SCHEDULE Page _ of _ Aon Risk Services Northeast, Inc. POLICY NUMBER See Certificate Number: 570052493690 CARRIER NAIC CODE See Certificate Number: 570052493690 Cellco Partnership dba Verizon Wireless 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. SR appt su POLICY POLICY tee TYPE OF INSURANCE INSR wD POLICY NUMBER veal EXPIRATION LIMITS (MM/DD/YYYY) | (MM/DD/YYYY) WORKERS COMPENSATION B N/A 049901118 06/30/2013 | 06/30/2014 AK AZ GA VA B N/A 049901119 06/30/2013 | 06/30/2014 NJ PA fa N/A 049901120 06/30/2013 | 06/30/2014 FL B N/A 049901121 06/30/2013 | 06/30/2014 MN B N/A 049901122 06/30/2013 | 06/30/2014 MA ,ND,OH,WA,WI,WY A N/A 049901116 06/30/2013 | 06/30/2014 CA ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RECEIVED FEB 07 205 CONTRACT & LEASE INTERNAL COORDINATION SHEET Contract/Lease Number: Tracking Number: 29) -/ f" Contractor/Lassee nome: Vara Grant Funded: YES No_% Purpose g Wee Reeesa De tern dt Date/Term: als 1. [7] GREATER THAN $50,000 / fr 2, [7] GREATER THAN $25,000 Department: AP 3. Ad $25,000 oR LESS Dept, Monitor Name: ae enn ON TO um Document has been reviewed and Includes any attachments or exhibits, Amount: Purchasing Review Date: > ~L ~/ a ~soanne-_ kwblite Le Approved as Wy he tran itd obs ; nS Oe feted. L. iy a Mera wdecrke ate_2- 7- LL Risk Mage [pre or “by ; sf ‘ Lod ble oan Mciew < ‘County Attorney Review . PAL a Date; Hl f /} ta County Attorney Following Okaloosa County approval: Contracts & Grants Document has been received: Date: Contracts & Grants Manager