Loading...
HomeMy Public PortalAboutSchool Evacuation Shelter Okaloosa County Schools-NorthAug. 16.2018 7:18AM No.7398 P. 2 By: OICALOOSA COUNTY SCHOOL DISTRICT STUDENT INTERVENTION SERVICES SCI-LOOL EVACUATION EMERGENCY SHELTER AGREEMENT MIS 6316 REV 714.2018 THIS AGREEMENT, entered into this 26th day of lWY _ , 2018 by and between The School Board of Okaloosa County, Florida as the governmental agency having jurisdiction over Davidson Middle School School (hereinafter called the "School') and Old Spanish Trail is for the purpose of setting forth the terms and conditions under which the School will be allowed to utilize the facilities of crest -view in the event of an emergency at the School during the 2018 / 20 I9 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 Crestview - old Spanish grail 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 Okalo J Mary B Jackson Superint dent of Scll6ols Date: a County, Florida 4,a SLl3(Z018 Shelte rovider: By: _4/4.1.o Print N eej: /r/ 2�h% Rd/ Title: L l Gr'P f��- Date: 7M Shelter Name: old Spanish Trail Address:'Stillwell-BvulevauL— 2.,e5- OPkeity: Crestview School Princip 4.1Avat-g•-- PganRnei_ 1-0-) S o .1 ceS Date: 11 Z 6.1 1 % Shelter Name: ( Li close 2.1./2 mile or more) , FL Zip:32539 (I I close L1.1/2 mile or more) Address: City: FL Zip: The extra address lines are for those who use the multiple shelters approved by one source (like a City Counsel ). Send original to Student Sys -Carver Inn so we can obtain the Superintendent's signature. The original will be sent back to you after SIS makes a copy. OKALOOSA COUNTY SCHOOL DISTRICT MIS 6316 REV 7.24.2018 STUDENT INTERVENTION SERVICES SCHOOL EVACUATION EMERGENCY SHELTER AGREEMENT THIS AGREEMENT, entered into this 26th day of July , 2018 by and between The School Board of Okaloosa County, Florida as the governmental agency having jurisdiction over Davidson Middle School School (hereinafter called the "School") and Old Spanish Trail is for the purpose of setting forth the terms and conditions under which the School will be allowed to utilize the facilities of Crestview in the event of an emergency at the School during the 2015 / 20 /9 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 Crestview- old Spanish Trail 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: Shelterovider: By: Print Nay e:!?it'12A-he,71-7 Title: Date: �� % / %i Shelter Name: Old Spanish Trail School i'rincipa By: P Date: '50-1 Ste. 1 Z4��g Address: Stillwell Boulevard ( City: Crestview close I V 11/2 mile or more) FL Zip:32539 Shelter Name: (❑ close 01/2 mile or more) Address: City: , FL Zip: The extra address lines are for those who use the multiple shelters approved by one source (like a City Counsel ). Send original to Student Svs-Carver Hill so we can obtain the Superintendent's signature. The original will be sent back to you after SIS makes a copy. Page 1 of 1 A`CPRO® CERTIFICATE OF LIABILITY INSURANCE DATE /zoi2oie 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(les) 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 (NC, No. ): (NC, No): E-MAIL certificates@willis.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC* INSURER A: Florida School Boards Insurance Trust D2772 INSURED Okaloosa County School District Attn: Russ *rakes 120 Lowery Place SE Fort Walton Beach, FL 32548 USA INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W7227178 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 POUCY NUMBER POLICY EFF (MWDD/YYTY) POLICY EXP (MM/DDNYYY) LIMITS A X COMMERCIAL GENERAL UABIUTY FSBITI8CAS7-1 07/01/2018 07/01/2019 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 JET PER: 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 UAB O OCCUR CLAIMS -MADE _ - EACH OCCURRENCE $ AGGREGATE $ $ - -- - --- DED I RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/IXECUTNE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) 11 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. Evidence of coverage as it relates to Northwood ES Emergency Evacuation Shelter 2018/2019 SY CERTIFICATE HOLDER CANCELLATION Old Spanish Trail Park 205 Stillwell Blvd 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. AUTHORIZED REPRESENTATIVE (/•).S ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 16632594 BATCH: 833570 OKALOOSA COUNTY SCHOOL DISTRICT STUDENT INTERVENTION SERVICES SCHOOL EVACUATION EMERGENCY SHELTER AGREEMENT MIS 6316 REV. 6/6/17 THIS AGREEMENT, entered into this 20th day of ,June , 2018 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 18 / 2019 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: Shelt' Provid - r: School rincipal: Print N.me:6I/?A-h2f17 �1 31/ Print na Title: aette' ` Date: 6 �!I Date: f Vg Shelter Name: Spanish Trail Park a Address: 205 Stillwell Boulevard City: Crestview , FL Zip: 32539 Shelter Name: Twin Hills Park Address: 100 Hathaway Street 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 A`CGR�® v CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 08/15/2018 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 pollcy(les) 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 No. ExO. (NC, No): E-M EMAIL certificates@willis.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Florida School Boards Insurance Trust D2772 INSURED Okaloosa County School District Attn: Ruse Frakee 120 Lowery Place SE Fort Walton Beach, FL 32548 USA INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W7196e00 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 POUCY NUMBER POUCY EFF (MM/DD/YYYY) POUCY EXP (MM/DD/YYYY) LIMBS A X COMMERCIAL GENERALLLABIUTY FSBITI8CAS7-1 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES (EaENTED occurrence) $ Included CLAIMS -MADE X OCCUR MED EXP (Any one person) $ Excluded PERSONAL 3ADVINJURY $ Included GENERAL AGGREGATE $ Unlimited GEN'L AGGREGATE LIMIT APPLIES PRO - PRO JECT PER: LOC PRODUCTS - COMP/OPAGG $ Iaaluded $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY 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 UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A 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 If more space Is required) For the General Liability policy, General Aggregate is Unlimited. Evidence of coverage as it relates to Fast Track North (0791) Emergency Evacuation Shelter 2018/2019 School Year CERTIFICATE HOLDER CANCELLATION Old Spanish Trail Park, 100 Hathaway Street S Crestview, FL 32539 City of Crestview SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AIRHORIZEDREPRESENTATNE �'wl,~M'.6 ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD t' a OKALOOSA COUNTY SCHOOL DISTRICT STUDENT INTERVENTION SERVICES SCHOOL EVACUATION EMERGENCY SHELTER AGREEMENT MIS 6316 REV. 7/29/15 THIS AGREEMENT, entered into this 29th day of May, 2018 by and between The School Board of Okaloosa County, Florida as the governmental agency having jurisdiction over Northwood Elementary School (hereinafter called the "School') and Old Spanish Trail Park 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 2018/ 2019 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 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 Pr eider: / School P incipal: By: , <<� By: OVVVyk— Print N. me: Vi % /N Print name: Donna Goode Title: /�Ly /LIC. Date: May 29, 2018 Date: Shelter Name & Address: Old Spanish Trail Park, Stillwell Blvd. City: Crestview FL Zip: 32536 Shelter Name & Address: City: , FL Zip: 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 ® CERTIFICATE OF LIABILITY INSURANCE A`�� DATE (MM/DDIYYYY) 08/15/2018 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 pollcy(les) 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, Ext): (A/C, No): 2 -- E-MAIL ADDRESS: certificates@willis.com INSURER(S) AFFORDING COVERAGE NAILS 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: W7196858 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. I�7R TYPE 0� INSURANCE ADDL INSD SUER WVO POUCY NUMBER POUCY EFF (MM/DD/YYYY) POUCY EXP (MM/DWYYYY) UMITS A X COMMERCIAL GENERAL LIABILITY FSBITI8CAS7-1 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ Included MED EXP (Any one person) $ Excluded PERSONAL hADVINJURY $ Included GEN'L AGGREGATE LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ Unlimited PRODUCTS - COMP/OPAGG $ Included $ AUTOMOBILE _ UABIUTY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY 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 UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 (Mandatory In NH) II 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 apace Is required) For the General Liability policy, General Aggregate is Unlimited. Evidence of coverage as it relates to Richbourg School Emergency Evacuation Shelter 2018/2019 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. Old Spanish Trail , Stillwell Blvd Crestview, FL 32539 City of Crestview AUTHORIZED REPRESENTATIVE �p lOt. W1� ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BR To: 1F5R007R BATCH: FORnaR c OKALOOSA COUNTY SCHOOL DISTRICT STUDENT INTERVENTION SERVICES SCHOOL EVACUATION EMERGENCY SHELTER AGREEMENT MIS 6316 Rev. 6/6/17 THIS AGREEMENT, entered into this 29th day of June , 2018 by and between The School Board of Okaloosa County, Florida as the governmental agency having jurisdiction over Richbourg School (0801) the "School") and City of Crestview School (hereinafter called 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 2018 / 2019 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: Shelter 2vide By. Print Narie: i 12A.11CAH'1 rvt R _ f Title: ek eA9--k- Date: ? ri / i Shelter Name: Old Spanish Trail Park School Principal: By: Print nam : NI i c,0 I e, IRi eke...Noy-, Date: l.0 act aao) s Address: Stillwell Blvd City: Crestview FL Zip: 32539 Shelter Name: Twin Hills Park Address: 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 ® A tCORO V CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 08/15/2018 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 pollcy(les) 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 (AIC No Est): (A/C, No): E-MAIL ADDRESS: certificates@willis.com INSURER(S) AFFORDING COVERAGE NAIC N 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: W7196782 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 TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY FSBITI8CAS7-1 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES 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/OPAGG $ 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 UAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 (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. Evidence of coverage as it relates to Davidson MS Emergency Evacuation Shelter 2018/2019 SY ERTIFICATE HOLDER CANCELLATION Old Spanish Trail, Stilwell Blvd Crestview, FL 32539 City of Crestview SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDREPRES1ENTATNE i'6 1"f tn+l� ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 1 F5799R1 BATCH• R9'79QF Page 1 of 1 ® � � A CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08/15/2018 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 pollcy(les) 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 Willie 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. Ext): (A/C, Nol: E-MAIL certificates0willis.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAICB INSURER A: Florida School Boards Insurance Trust D2772 INSURED Okaloosa County School District Attn: Ruse Frakes 120 Lowery Place SE Fort Walton Beach, FL 32548 USA INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W7197485 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 SUER WVD POUCY NUMBER POLICY EFF (MWDD/YYY1) POUCY EXP (MM/DD/YYYY) LIMBS A X COMMERCIAL GENERAL LIABILITY FSBITI8CAS7-1 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES (EaENTED occurrence) $ Included CLAIMS -MADE X OCCUR MED EXP (Any one person) $ Excluded PERSONAL 6ADVINJURY $ Included GENERAL AGGREGATE $ Unlimited GEN'L AGGREGATE LIMIT APPLIES PRO - PRO JECT PER LOC PRODUCTS - COMP/OPAGG $ Iacluded $ AUTOMOBILE UABIUTY 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 UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ WORKERS COMPENSATIONTH- AND EMPLOYERS' UABIUTY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 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 If more space Is required) For the General Liability policy, General Aggregate is Unlimited. Evidence of coverage as it relates to Fast Track North (0791) Emergency Evacuation Shelter 2018/2019 SY. CERTIFICATE HOLDER CANCELLATION Twin Hills Park, City of Crestview 100 Hathaway Street 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. AUTHORIZEDREPRESENTATNE �p YIX wIY�� ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 1 KK7oOK1 BATCH: 1:19A7517 L OKALOOSA COUNTY SCHOOL DISTRICT STUDENT INTERVENTION SERVICES SCHOOL EVACUATION EMERGENCY SHELTER AGREEMENT MIS 6316 REV. 6/6/17 THIS AGREEMENT, entered into this 1 day of June , 2018 by and between The School Board of Okaloosa County, Florida as the governmental agency having jurisdiction over Crestview High 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 Crestview Community Center 1446 Commerce Dr in the event of an emergency at the School during the 2018 / 2019 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 Crestview Community Center 1446 Commerce Dr 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: Shelte �" , .vid School Principal: By: X By: Print Name: tit 24-he17 Print name: Title: et/tlf e-ede-r— Date: Date: 11 Vi( Shelter Name: Crestview Community Center Address: 1446 Commerce Dr City: Crestview , FL Zip: 32539 Shelter Name: Address: City: , FL Zip: 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 ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE il ;2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. AND CONFERS NO RIGHTS UPON THE CERTIFICATE EXTEND OR ALTER THE COVERAGE AFFORDED HOLDER. THIS BY THE POLICIES AUTHORIZED A CONTRACT BETWEEN THE ISSUING INSURER(S), 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 WC, No. Ext): (MC, No): ADDRESS: certificates brillis.com INSURER(S)AFFORDING COVERAGE NAIC11 INSURER A: Florida School Boards Insurance Trust D2772 INSURED Okaloosa County School District Attn: Russ Frakee 120 Lowery Place SE Fort Walton Beach, FL 32548 USA INSURER B : INSURERC: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W7196782 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 (MWDDIYYYY) LIMITS A X COMMERCIAL GENERALLUABIUTY FSBITI8CAS7-1 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGES( RENTED PREMISES (Ea occurrence) $ Included MED EXP (My one person) $ Excluded PERSONAL6ADVINJURY $ Included GEN'L AGGREGATE LIMIT APPLIES JET PER: LOC GENERAL AGGREGATE $ Unlimited PRODUCTS - COMP/OP AGG $ Included $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY 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 LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION IA AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 (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. Evidence of coverage as it relates to Davidson MS Emergency Evacuation Shelter 2018/2019 SY 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. Old Spanish Trail, Stilwell Blvd Crestview, FL 32539 City of Crestview AUTHORDEDREPRESENTATIVE W� (� � A ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ea ID: 16579981 BATCH: 827965 OKALOOSA COUNTY SCHOOL DISTRICT STUDENT INTERVENTION SERVICES SCHOOL EVACUATION EMERGENCY SHELTER AGREEMENT MIS 6316 REV. 6/6/17 THIS AGREEMENT, entered into this 1 day of JuIY , 2018 by and between The School Board of Okaloosa County, Florida as the governmental agency having jurisdiction over Walker Elementary School School (hereinafter called the "School") and the City of Crestview is for the purpose of setting forth the terms d con itions under which the Scho 1 will bA allowed to utilize the facilities of '�; e,(.3 ,Ohnm1.1/4.h( Ley) -}"Er in the event of an emergency at the School during the 2018 / 2 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, e;ilty and staff of th ISchool`may be relocated to the facilities LC �e V,; ta(ti� t1r\Pn(i�Y\ e �r 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: Shelter P ovi •.; r: Schoo�l/l incipal: By: % , J By:OL S?m Print Name: 02Arbein Iv1. i‘etgj Print name: Le) r•n a( Title: aerlti - Date: 4)- 117-- 18 Date: g17// 2- Shelter Name: T-k- C.o✓n`i Address: 109 beet City: Crestview Shelter Name: Address: City: FL Zip: 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 ). , FL Zip:32539 a Page 1 of 1 Al COII�� DQ® VCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08/20/2018 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(les) 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 a/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. Ext): (A/C, No): EMAIL certificates@willis.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC N 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: W7227178 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 INSO SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY FSBIT18CA37-1 07/01/2018 07/01/2019 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 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 UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ WORKERS COMPENSATION AND EMPLOYERS' UABILI Y ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 (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. Evidence of coverage as it relates to Northwood ES Emergency Evacuation Shelter 2018/2019 SY 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 Old Spanish Trail Park 205 Stillwell Blvd Crestview, FL 32536 ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AR ID. 1 Pigl9Red BATCH: 1:1'31C.7r1 OKALOOSA COUNTY SCHOOL DISTRICT STUDENT INTERVENTION SERVICES SCHOOL EVACUATION EMERGENCY SHELTER AGREEMENT MIS 6316 REV. 6/6/17 THIS AGREEMENT, entered into this 29th day of June , 2018 by and between The School Board of Okaloosa County, Florida as the governmental agency having jurisdiction over Fast Track North (0791) the "School") and City of Crestview School (hereinafter called 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 2018 / 2019 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 iu el- rintendent of Schools Da i Shelter P ovid •/ By: Print Name: ch t barb 1 01 Title: C Ifll i�ta- Date: 7 Shelter Name: Old Spanish Trail Park School rincipal: By: ,� 1l n Print name: ! col t, Ili de—n-wYM6 Date: LP 1 aq 44:03 Address: Stillwell Blvd City: Crestview FL Zip: 32539 Shelter Name: Twin Hills Park Address: 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 A` CGR�® v CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08/15/2018 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(les) 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. Ext): (A/C, No): E-MAIL ADDRESS: certificates@willis.com INSURER(S)AFFORDING COVERAGE NAICN INSURER A: Florida School Boards Insurance Trust D2772 INSURED Okaloosa County School District Attn: Rues Frakes 120 Lowery Place SE Fort Walton Beach, FL 32548 USA INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W1196298 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 SUER WVD POLICY NUMBER POLICY EFF (MWDD/YYYY) POLICY EXP (MM/DD/YYYY) LIMBS A X COMMERCIAL GENERAL LIABILITY FSBITI8CAS7-1 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES (EaENTED occurrence) $ Included CLAIMS -MADE X OCCUR MED EXP (Any one person) $ Excluded PERSONAL BADVINJURY $ Included GENERAL AGGREGATE $ Unlimited GEN'L AGGREGATE LIMIT APPLIES JECT PRO-LOC PER: PRODUCTS - COMP/OP AGG $ Included $ AUTOMOBILE _ LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY 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 UAB 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 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 apace is required) Evidence of coverage as it relates to Shoal River MS Emergency Evacuation Shelter 2018/2019 SY. For the General Liability policy, General Aggregate is Unlimited. CANCELLATION Spanish Trail, City of Crestview 205 Stilwell 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 ��+(If� I� ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR In: 16579985 BATCH: 827849 Page 1 of 1 AICCPR�® `/ CERTIFICATE OF LIABILITY INSURANCE DATE (MMID2018 ) o8/15/tole 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(les) 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. Ext): (A/C, No): E-MAIL certificates@minis.com ADDRESS: 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 Fort Walton Beach, FL 32548 USA INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W7196880 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) LIMBS A X COMMERCIAL GENERAL LIABILITY FSBITI8CAS7-1 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE RENTED PREM SESO(Ea occurrence) $ Included 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 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 UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATIONTH- AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N NIA 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 If more apace Is required) For the General Liability policy, General Aggregate is Unlimited. Evidence of coverage as it relates to Richbourg School Emergency Evacuation Shelter 2018/2019 School Year CERTIFICATE HOLDER CANCELLATION Twin Hills Park , City of Crestview 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 1 t)/) �' W1�� ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR /D: 165R0049 HATCH : R9R057