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HomeMy Public PortalAboutRichbourg/Fast Track North Evacuation Shelter AgreementOICALOOSA COUNTY SCHOOL DISTRICT STUDENT INTERVENTION SERVICES SCHOOL EVACUATION EMERGENCY SHELTER AGREEMENT MIS 6316 REv. 7/29/15 THIS AGREEMENT, entered into this 5th day of June , 20 17 by and between The School Board of Okaloosa County, Florida as the governmental agency having jurisdiction over Richbourg School (0801) School (hereinafter called the "School") and City of Crestview is for the purpose of setting forth the terms and conditions under which the School will be allowed to utilize the facilities of Old Spanish Trail Park in the event of an emergency at the School during the 20 17 / 20 18 school year. The parties do agree as follows: 1. In the event of an emergency and/or crisis situation at the School then the students, faculty and staff of the School may be relocated to the facilities of Old Spanish Trail Park and Twin Hills Park which shall serve as a temporary shelter. 2. The administrators of the School shall be responsible for the supervision of students while they are at the temporary shelter facility. 3. The School District shall issue a certificate of insurance to the owner of the shelter facility for the use as outlined in the Agreement. The School Board of Okaloosa County, Florida By: Mary Beth Jackson Superintendent of Schools Date: ovid = r: e: )4-6-7M /9-2 Title: Date: /0 -/-7 School Principal: By: 1/4„a<s•cy-,4:)-1 Print name: Nicole Rickmon Date: 06/05/2017 Shelter Name & Address: Old Spanish Trail Park Stillwell Blvd City: Crestview , FL Zip: 32539 Shelter Name & Address: Twin Hills Park 100 Hathaway St S City: Crestview , FL Zip: 32539 Shelter Name & Address: City: FL Zip: The extra address lines are for those who use the multiple shelters approved by one source (like the city ). OKALOOSA COUNTY SCHOOL DISTRICT STUDENT INTERVENTION SERVICES SCHOOL EVACUATION EMERGENCY SHELTER AGREEMENT MIS 6316 REV.7/29/15 THIS AGREEMENT, entered into this 5th day of June , 2017 by and between The School Board of Okaloosa County, Florida as the governmental agency having jurisdiction over Fast Track North (0791) School (hereinafter called the "School") and City of Crestview is for the purpose of setting forth the terms and conditions under which the School will be allowed to utilize the facilities of Old Spanish Trail Park in the event of an emergency at the School during the 2017 / 2018 school year. The parties do agree as follows: 1. In the event of an emergency and/or crisis situation at the School then the students, faculty and staff of the School may be relocated to the facilities of Old Spanish Trail Park and Twin Hills Park which shall serve as a temporary shelter. 2. The administrators of the School shall be responsible for the supervision of students while they are at the temporary shelter facility. 3. The School District shall issue a certificate of insurance to the owner of the shelter facility for the use as outlined in the Agreement. The School Board of Okaloosa County, Florida By: Mary Beth Jackson Superintendent of Schools Date: Bhelt Provider: 7%2 Print Na�e: � reap Title: Cam` 04,6k- Date: 7 / D J/ 7 School Principal: By: Print name: Nicole Rickmon Date: 06/05/2017 Shelter Name & Address: Old Spanish Trail Park Stillwell Blvd City: Crestview , FL Zip: 32539 Shelter Name & Address: Twin Hills Park 100 Hathaway St S City: Crestview , FL Zip: 32539 Shelter Name & Address: City: FL Zip: The extra address lines are for those who use the multiple shelters approved by one source (like the city ). Page 1 of 1 ACC?Rfl0 CERTIFICATE OF LIABILITY INSURANCE ‘...........--- a i26i2o17 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 have ADDITIONAL INSURED provisions or 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 Willis Administrative Services Corporation DBA Willis Pooling c in 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA CONTACT NAME: pHONE 1_877-945-737$ FAX 1-$$$-467-2378 Eat) (A/C, No} E-MAILNo, E-Mcertif•cates6x' scam ADDRESS- INSURER(S) AFFORDING COVERAGE NAIC S INSURER A: Florida School Boards Insurance Trust D2772 INSURED Okaloosa County School District Attn: Russ Frakes 120 Lowery Place SE Fort Walton Beach, FL 32548 INSURER B : INSURER C • INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W3087084 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY N N FSBITI7CAS7-1 07/01/2017 07/01/2018 EACH OCCURRENCE $ 1,000,000 DAmAGMNTED PREM SES(Ea occurrence) $ Included CLAIMS -MADE X OCCUR MED EXP (Any one person) $ Excluded PERSONAL& ADV INJURY $ Included GENERAL AGGREGATE $ Unlimited GEN'L AGGREGATE LIMIT APPLIES PRO- JECT PER' LOC PRODUCTS - COMP/OP AGG $ Included $ AUTOMOBILE .___._.. LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 (Mandatory in NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mono space is required) For the General Liability policy, General Aggregate is Unlimited. Liability subject to FS 768.28. Certificate is issued with respects to the School evacuation emergency shelter agreement between Richbourg School (0801) and City of Crestview during the 2017-2018 school year. CERTIFICATE HOLDER CANCELLATION Old Spanish Trail Park Stillwell Blvd. Crestview, FL 32539 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 2 f"Ar} S wtl ACORD 25 (2016/03) UC 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 14879090 BATCH: 394900 Page 1 of 1 ACORN® `�. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 07/26/2017 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 have ADDITIONAL INSURED provisions or 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 Willis Administrative Services Corporation DBA Willis Pooling c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA CONTACT NAME: PHONE 1-877-945-7378 FAX 1-888-467-2378 (A/C. No. Eat): LAIC, No)� E-MAIL ADDRESS certif icates@willis. com INSURER(S) AFFORDING COVERAGE NAIC INSURER A. Florida School Boards Insurance Trust D2772 INSURED Okaloosa County School District Attn: Russ Frakes 120 Lowery Place SE Fart Walton Beach, FL 32548 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: w3087089 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. INSRR TYPE OF INSURANCE INSD SUBR WVD POLICY NUMBER POLICY EFF (MWDD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY N N FSHITI7CAS7-1 07/01/2017 07/01/2018 EACH OCCURRENCE $ 1, 000 , 000 DAMAGE TO RENTED PREMISES (Ea occurrence $ Included CLAIMS -MADE X I OCCUR MED EXP (Any one person) $ Excluded PERSONAL SADVINJURY $ Included GENERAL AGGREGATE $ Unlimited GEN'L - AGGREGATE POLICY OTHER LIMIT APPLIES PRO- JECT PER' ^. LOC PRODUCTS-COMPtOPAGG $ Included $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY Per accatlent} $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED, (Mandatory In NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below Y / N N/A PER STATUTE ERH E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS t LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) For the General Liability policy, General Aggregate is Unlimited. Liability subject to FS 768.28. Certificate is issued with respects to the School evacuation emergency shelter agreement between Fast Track North School (0791) and City of Crestview during the 2017-2018 school year. CERTIFICATE HOLDER CANCELLATION Twin Hills Park 100 Hathaway St. S. Crestview, FL 32539 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Q WtS� ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 14879090 BATCH: 394900 Page 1 of 1 Ai C4/R� ���..r' CERTIFICATE 4F LIABILITY INSURANCE DATE {MM/DDIYYYY} 07/26/2017 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 have ADDITIONAL INSURED provisions or 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 Willis Administrative Services Corporation DEA Willis Pooling c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA CONTACT NAME: PHONE 1-g77-945-7378 FAX 2-$$8-46?-2378 Ext): (AtC, No}: E-MAILNo, E-M ADDRESS: certificates8willis.com INSURER(S) AFFORDING COVERAGE NAIL S INSURER A: Florida School Boards Insurance Trust D2772 INSURED Okaloosa County School District Attn: Russ Frakes 120 Lowery Place SE Fort Walton Beach, FL 32548 INSURER B : INSURER • INSURER D : INSURER E : INSURER F : ERTIFICATE NUMBER: W3087083 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL CLAIMS -MADE LIABILITY X OCCUR N N FSBITI7CAS7-1 07/01/2017 07/01/2018 EACH OCCURRENCE $ 1,000,000 ORENTED PREMISES (Ea occurrence) $DAMAGE included MED EXP (Any one person) $ Excluded PERSONAL SADVINJURY $ Included GENERAL AGGREGATE $ Unlimited GEN'L AGGREGATE LIMIT APPLIES PET PER LOC PRODUCTS - COMP/OP AGG $ Included $ AUTOMOBILE _ LIABILITY ANY AUTO OWNED SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ _... $ �_. BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER OTH- STATUTE ER E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 11 more space is required) For the General Liability policy, General Aggregate is Unlimited. Liability subject to FS 768.28. Certificate is issued with respects to the School evacuation emergency shelter agreement between Fast Track North School (0791) and City of Crestview during the 2017-2018 school year. HOLDER CANCELLATION Old Spanish Trail Park Stillwell Blvd. Crestview, FL 32539 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ��'()()'_ t� ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 3.4979090 BATCH: 304900 Page 1 of 1 ACORO® `�. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 07/26/2017 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 have ADDITIONAL INSURED provisions or 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 Willis Administrative Services Corporation DBA Willis Pooling c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA CONTACT NAME: PHONE FAX LAIC. No. Ext). 1-877-945-7378 (A/C No): 1-688-467-2378 E-MAIL ADDRESS: certificates@willis.com INSURER(S) AFFORDING COVERAGE NAICM INSURER A: Florida School Boards Insurance Trust D2772 INSURED Okaloosa County School District Attn: Russ Frakes 120 Lowery Place SE Fort Walton Beach, FL 32548 INSURER B : INSURER C . INSURER D : INSURER E : INSURER F ' COVERAGES CERTIFICATE NUMBER: W3°87°9° 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY N N FSBITI7CAS7-1 07/01/2017 07/01/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED PREM SESO(Ea occurrence) $ Included CLAIMS -MADE X OCCUR MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ Included GENERAL AGGREGATE $ Unlimited GEN'L AGGREGATE LIMIT APPLIES PET PER LOC PRODUCTS - COMP/OP AGG $ Included $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N NIA PER STATUTE OTH- ER E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) For the General Liability policy, General Aggregate is Unlimited. Liability subject to FS 768.28. Certificate is issued with respects to the School evacuation emergency shelter agreement between Richbourg School (0801)and City of Crestview during the 2017-2018 school year. CERTIFICATE HOLDER CANCELLATION Twin Hills Park 100 Hathaway St. S. Crestview, FL 32539 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 616)2.. ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 14879090 HATCH 394900