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Home My Public Portal AboutWalker Elementary- Shelter AgreementOKALOOSA COUNTY SCHOOL DISTRICT STUDENT INTERVENTION SERVICES SCHOOL EVACUATION EMERGENCY SHELTER AGREEMENT MIS 6316 REV. 7/29/15 THIS AGREEMENT, entered into this 15th day of June 20 17 by and between The School Board of Okaloosa County, Florida as the governmental agency having jurisdiction over Walker School (hereinafter called the "School") and City of Crestview , Florida is for the purpose of setting forth the terms and conditions under which the School will be allowed to utilize the facilities of Twin Hills Park Facilitites in the event of an emergency at the School during the 20 / 20 -10school 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 Twin Hills Park Facilities 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: Shelt rovider: By: a--/-im/ Print Name:4=7,w-64-1-41 Title: --/-1 Date: 7-'2- /7 Shelter Name & Address: ',N) City: OD kr FL Zip: 3.Q.S Shelter Name & Addeis: City: , FL Zip: School incipal: /iv By:, (92 ). Print name: k ,) r n 7-)k Date: - 1 5 - j 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 ). of 2 ACCP ID CERTIFICATE OF LIABILITY INSURANCE DATE i1M2/2o�) 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 WANED, 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. Bo: 305191 Nashville, TN 372305191 USA CONTACT NAME: PHONE 1-877-915-7378 FAX 1-888-467-2378 Ertk 1 (A/C. NoI. E-MAILNo. EM AgggEgg, cortif icates@willis. com INSURER(S)AFFORDING COVERAGE HNC INSURERA. Florida School Boards Insurance Trust D2772 INSURED Olcaloosa County School District Attn: Russ Praise 120 Lowery Place Si 900 Worth Calhoun St. Fort Walton Beach, FL 32546 INSURER B INSURER C : INSURER D: INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: W31a6399 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 UNSD SUER WVQ,„ POLICY NUMBER POLICY EFF POLICY EXP (MM/DDIYYYYI LIMITS A X COMMERCIAL GENERAL UABWTY FSBIT17CA87-1 ,.000DD/YYYY) 07/01/2017 07/01/2018 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED PREMISES (Es =Gn fire) S Included CLAIMS -MADE X OCCUR MED EXP (My one person) S Lscluded PERSONAL aADVINJURY S Included GENERAL AGGREGATE S Unlimited GEHL AGGREGATE UNIT APPUESPER JJEE T L LOC PRODUCTS - COMP/OP AGG S Included S AUTOMOBILE '—'- _. UABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY S SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMM NE6SINGLELIMIT IEs scoden1) S BODILY INJURY (Per person) S BODILY INJURY (Per 'cadent) S PROPERTY DAMAGE (Per acadenll S 3 UMBRELLAULa EXCESS LIAR OCCUR CLAIMS-A1ADE EACH OCCURRENCE S AGGREGATE S $ DED RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY ANYPROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) II yes, descnM uder DESCRIPTION OF OPERATIONS below y / N N / A I STATUTE ER E.L EACH ACCIDENT S E L DISEASE - EA EMPLOYEE S E L. DISEASE -POLICY UNIT S DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Addllwool Remeis Schedule, may be aldchW H more spars Is requital) This Voids and Replaces Previously Issued Certificate Dated 09/07/2017 WITH ID: W3465296. For the General Liability policy, General Aggregate is Unlimited. Shelter Address: 1446 Commerce Dr., Crestview, FL 32539 CERTIFICATE HO DER CANCELLATION City of Crestview and Crestview Community center 190 North Nilson Street Crestview, FL 32536 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE M 7Y�^� ACORD 25 (2016/03) 0 1988-2015 ACORD CORPO The ACORD name and logo are registered marks of ACORD ss 1n; 15044870 aATce' 442511 TION. All rights rase d. ACORE' AGENCY CUSTOMER ID: LOC 0: ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 AGENCY Willie Administrative Services Corporation ORA Willis Pooling NAREDONSURED Okal°osa County School District Attn: Ruse Risks■ 120 Lowry Place S! 1100 North Calhoun St. Fort Walton Beach, tL 3254S POLICY NURSER See Page 1 CARRIER See Page 1 NAIL CODE See Page 1 EFFECTNE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Liability subject to FS 768.28, Certificate is issued with respects to the School evacuation emergency shelter agreement between Walker School and City of Creeview, Florida during the 2017-2018 school year. ACORD 101 (2008101) CO 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo ere ropletered marks of ACORD SR ID: 15044870 suecx: 442511 cum: W3486399