Loading...
HomeMy Public PortalAboutShoal River MS-Evacuation Emergency Shelter AgreementOICALOOSA COUNTY SCHOOL DISTRICT STUDENT INTERVENTION SERVICES SCHOOL EVACUATION EMERGENCY SHELTER AGREEMENT MIS 6316 REV. 7/29/15 THIS AGREEMENT, entered into this 20 day of June , 20 17 by and between The School Board of Okaloosa County, Florida as the governmental agency having jurisdiction over Shoal River Middle School 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 Spanish Trail Park and Twin Hills 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 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 Sch Board f Okaloo Count ,Florida v By: Mary Beth ckson Superintendent of S hools 8 lc fP-01,7 Date: She t By: ovi er: Print Name: Title: Date: eleck, Shelter Name & Address: City: Crestview Shelter Name & Address: City: Crestview Shelter Name & Address: City: School P incipa : By: Print name. ary G. Masse Date: 64 (V/ 7 Spanish Trail Park 205 Stillwell Boulevard , FL Zip: 32539 Twin Hills Park /, /16-dAal,,ciay (371 Cke_d'iv‘ e 6,3 , FL Zip: 32539 , 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 20 day of June , 20 17 by and between The School Board of Okaloosa County, Florida as the governmental agency having jurisdiction over Shoal River Middle School 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 Spanish Trail Park and Twin Hills Park in the event of an emergency at the School during the 20 17 / 20 18 school year. The parties do agree as follows: 1.1n 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 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 Scrn Board of Okaloo Co:in ,Florida v By: Mary Beth ckson Superintendent of S lhools c [ go I 7 Date: Shelt er: By: Print Name: Title: Date: School Principal: By: Print name. ary G. Masse Date: 412_ 4,// 7 Shelter Name & Address: Spanish Trail Park 205 Stillwell Boulevard City: Crestview , FL Zip: 32539 Shelter Name & Address: Twin Hills Park /G0 I-16-i /-1-?aa.ia,y S Ckedeivs et-j 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 20 day of June , 20 17 by and between The School Board of Okaloosa County, Florida as the governmental agency having jurisdiction over Shoal River Middle School 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 Spanish Trail Park and Twin Hills 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 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: Shel er: By: y:-.6/ / ? Print Name: tit 4ibe-16.- Title: (7..4 C i e: . c (L., Date: //I School Principal: By: Print name. ary G. Masse Date: 412_ ey/ Shelter Name & Address: Spanish Trail Park 205 Stillwell Boulevard City: Crestview FL Zip: 32539 Shelter Name & Address: Twin Hills Park 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 1 ® ALA 0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/15/2017 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 1-677-945-7378 FAX 1-888-467-2378 Eat): (A/C No): E-MAILNo. E-M ADDRESS. certificates@willis.com INSURER(S) AFFORDING COVERAGE NAICS 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 USA INSURER B : INSURER C: INSURER D : INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: W3283635 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 FSBITI7CAS7-1 07/01/2017 07/01/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ Included CLAIMS -MADE X OCCUR MED EXP (Any one person) $ Excluded PERSONAL 3ADVINJURY $ Included GENERAL AGGREGATE $ Unlimited GEN'L AGGREGATE LIMIT APPLIES 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 O 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 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 Shoal River Middle School and City of Crestview during the 2017-2018 school year. 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. AUTHORIZED REPRESENTATIVE Twin Hill Park 100 Hathaway St. S. � Crestview, FL 32539 �t w1"AU�fl ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 14950653 BATCH: 415794 Page 1 of 1 CCiR 1 0 ACCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/15/2017 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 Ext)' (A/C, No): E-MAIL(AlcNa. E-Mcertificates@willis.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAICN INSURER A: Florida School Boards Insurance Trust D2772 INSURED Okaloose County School District Attn: Russ Frakes 120 Lowery Place SE Fort Walton Beach, FL 32545 USA INSURER B : INSURER C INSURER D . INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W3283633 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/DO/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 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 3ADVINJURY $ Included GENERAL AGGREGATE $ Unlimited GEN'L AGGREGATE LIMIT APPLIES PER 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 UAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED (Mandatory In NH) It yes, descnbe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER El, 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 spats 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 Shoal River Middle School and City of Crestview during the 2017-2018 school year. CERTIFICATE HOLDER CANCELLATION Spanish Trail Park 205 Stillwell Blvdt1"M 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 wt�� ACORD 25 (2016/03) c01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 14950653 BATCH: 415794