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HomeMy Public PortalAboutOkaloosa Cnty Schl Dist Emerg Shlt Agrmnt (113)Aug. 16.2018 7:18AM No.7398 OICALOOSA COUNTY. SCHOOL DISTRICT STUDENT INTERVENTION SERVICES SCUM EVACUATION EMERGENCY SHELTER AGREEMENT MIS 6316 REV 7.24.201$ 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 alloyed to utilize the facilities of crestrriew in the event of an emergency at the School during the 2018 / 20 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 Sc By: ool Boar Mary B Superint Date: of Okalo J Jackson dent of Sc a County, Florida 4�/(244' T ols gl131zotg By: I rovid Print N e: Zell 2-a-bet1 Rai Title: G��'�' Date: �� 7/f Shelter Name: old Spanish Trail Date; Schoolrincip t ►j,I '501 w s 'ZI Z(F11% ( Li close I 11/2 mile or more) Address:'Stillwell•Boulevard_ — s ; / v ,J,L6tity_ Crestview FL zip, 32539 Shelter Name: ( close El 1/2 mile or more) Address: City: , EC 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 Hill 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 , 20 18 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 2018 / 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: Shelte rovider: School rincipa: BY . By: �1 �� pis*-...- Print Na e: lil/ZA-halq //i� n e. C� GAP ��- i� P`�j$ca.v.cl e-eS Title.. Date: 'Z Z e..- 1 j 1 % Date: l % hif Shelter Name: old Spanish Trail Address: Stillwell Boulevard City: Crestview close ✓ 1/2 mile or more) , FL Zip:32539 Shelter Name: ( LI close LJ 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 Svs-Carver Hill so we can obtain the Superintendent's signature. The original will be sent back to you after SIS makes a copy. r, Page 1 of 1 -`�� D CERTIFICATE OF LIABILITY INSURANCE DATE(M0/2018 os/2o/zols 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 (A/C, No�Ezt): 1-877-945-7378 I (A/C, No): 1-888-467-2378 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 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 INSD SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DDIYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY FSBITI8CAS7-1 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 -1, CLAIMS -MADE , X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ Included A MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ Included I GEN'L AGGREGATE POLICY ` OTHER: LIMIT APPLIES PER: PRO- JECT I LOC GENERAL AGGREGATE $ Unlimited 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 LIAB EXCESS LAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ 1 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (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 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 )-1 ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 16632594 slam 833570 E • 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 By: Print N."me:61lZ4-hern Title: G%�L Date: $7l /i Shelter Name: Spanish Trail Park School Principal: By: Print na Date: 6//3//`$` 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 O CERTIFICATE OF LIABILITY INSURANCE 1�R 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 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. Ext): (A/C, 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 Frakes 120 Lowery Place SE Fort Walton Beach, FL 32548 USA INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W7196800 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 FSBITI8CAS7-1 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/OPAGG $ Included $ AUTOMOBILE LIABILITY ANY AUTO OWNED 1 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. 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. AUTHORIZED REPRESENTATIVE �g 4W'fli1`� (S�� ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r • 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 By: Print Nm' e: C�/ Title: C / OJe /L/C. Date: S/VG7 Shelter Name & Address: Old Spanish City: Crestview FL Zip: 32536 Shelter Name & Address: School P incipal: By: d eek/1"a-_ Print name: Donna Goode Date: May 29, 2018 Trail Park, Stillwell Blvd. 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 ). f • Page 1 of 1 A`CC)Rt�® `r...� 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(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 No. ExQ: (A/C, No): E-MAIL E-M ADDRESS: certificates@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 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. 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 FSBITI8CAS7-1 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE RETE PREM SESO(Ea occur ence) $ 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 LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (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 Richbourg School Emergency Evacuation Shelter 2018/2019 School Year CERTIFICATE HOLDER CANCELLATION Old Spanish Trail , Stillwell 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. AUTHORIZED REPRESENTATIVE 1N11d 65 LYSI7' A� ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR xo: 16580028 BATCH: 828038 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) 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 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 � vide By: fail Print Nnna,le: I I2Lt,1)-CA-1'1 �114 Title: tit ef2-1(--- Date: 'l 1 T School Principal: By: Print nam : N i c,0 L e, IRi ck.r,rwy--., Date: lij as IaoJ S Shelter Name: Old Spanish Trail Park 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 cam,.., �® A `\...(�"J,,R 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(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. Ext): (A/C, No): E-MAIL ADDRESS: certificates@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 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 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 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 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 LIAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED9 (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. AUTHORIZED REPRESENTATIVE Old Spanish Trail, City of Crestview Stilwell Blvd Crestview, FL 32539 ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 16579981 BATCH: R27969 Page 1 of 1 ACORO® A.. ACC)REP 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(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-MAILE-ML ADDRESS: certificates@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 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 SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS 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 8, ADV INJURY $ Included GEN'L AGGREGATE LIMIT APPLIES RO- PJECT PER: LOC GENERAL AGGREGATE $ Unlimited 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 LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (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 Fast Track North (0791) Emergency Evacuation Shelter 2018/2019 SY. CERTIFICATE HOLDER CANCELLATION Twin Hills Park, City of Crestview 100 Hathaway Street S*(),(L 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 1NN((�� ACORD 25 (2016/03) 01988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 1 F57QQF1 BATCH: R9R'iR7 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 / 20 19 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 vidw School Principal: By: By: Print Name: ` / 24-hetil � Print name: Title: 0--t/ly e-de-A Date: Date: 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 ACCPRc. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ ON $ ) 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 terns 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 1-877-945-7378 FAX 1-888-467-2378 (A/C, N yE�: (A/C, No): E-MAIL certificates@willis.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL# INSURER A: Florida School Boards Insurance Trust D2772 INSURED Okaloose 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: W7196182 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. ILTR TYPE OF INSURANCE IINSD SUBR WVD POLICY EFF POLICY EXP POLICY NUMBER (MM/DD/YYYYj (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY FSBITI8CAS7-1 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X I OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ Included MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ Included GEN'L AGGREGATE LIMIT APPLIES E� PER: I LOC GENERAL AGGREGATE $ Unlimited 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 LIAB EXCESS LIAB I 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 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 Remarlcs 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 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. AUTHORIZED REPRESENTATIVE `1,1 Y ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 16579981 BATCH: 827965 i 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 July , 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 of setting forth the terms utilize the facilities of is for the purpose d conditions under/which the School will bA1 allowed to 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, �aculty and staff of thchool may be relocated to the facilities iC, +ie .4 i'e;i,`7 IY\ (.. 1 � -A(1 �� 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 By: t1,,. tigv Print Nalme: 021. 4 Title: Celli cle/a' Date: g7 7/ / Y Shelter Name: T$-1(- P ovi r: Address: 100--N--- thaway-Steeet- School Principal: By: (9zn Print name: 1. n rr\ Date: LQ— CP-- 8 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 i 1 ® /��RD CERTIFICATE 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(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. Ext): {A/C, 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 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 INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY OCCUR FSBITI8CAS7-1 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X DAMAGE RENTE PREM SESO(Ea occur ence) $ Included MED EXP (Any one person) $ Excluded PERSONAL &ADV INJURY $ Included GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Unlimited POLICY IPE� OTHER: LOC PRODUCTS - COMP/OPAGG $ 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 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 Y / N N/A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ below 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. Old Spanish Trail Park AUTHORIZED REPRESENTATIVE 205 Stillwell Blvd Crestview, FL 32536 e `; iNtS�� L.,. g S ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 1 FAii FQd BATCH: Gii7Fin 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 Su.._-rintendent of Schools D Shelter Provide cy� 4-- By: ✓ �� /�L Print Name: aYthe5tY1 )41'1 fa/ Title: C I lei Date: 7 l� Shelter Name: Old Spanish Trail Park School Principal: By: G Print name: Date: ILD 1 as a.D)f), Address: Stillwell Blvd City: Crestview Shelter Name: Twin Hills Park FL Zip: 32539 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� �® 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(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 1-886-467-2378 (A/C No. ExU: (A/C, 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 Frakes 120 Lowery Place SE Fort Walton Beach, FL 32548 USA INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W7196298 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 FSBITI8CAS7-1 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1 ,000,000 DAMAGE RENTE PREM SESO(Ea occur ence) $ Included CLAIMS -MADE X OCCUR MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ Included GENERAL AGGREGATE $ Unlimited GEN'L AGGREGATE LIMIT APPLIES PRO- 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 LIAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (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 I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space 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. ATE HOLDER 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 /, 0)2 -4N±3� (% ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 16579985 BATCH: 827949 Page 1 of 1 ;.� A�C01213 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(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 Ext): (A/C, 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 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 MAYBE 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 FSBITI8CAS7-1 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 GEN'L AGGREGATE LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ Unlimited 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 LIAB EXCESS LIAB O 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 space 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 IY�P� (,_ {tW: ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 1651;0049 BATCH: 1;914057