Backup Documents 01/24/2017 Item #16G1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNAT f ' re
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the . n At e} ffice
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2. -
3. County Attorney Office County Attorney Office
/S/ \\. \\V
4. BCC Office Board of County
Commissioners \\\-
5. Minutes and Reco Clerk of Court's Office
02(01I07 3.50ptr,
PRIMARY CONTACT INFORMATION
Normally the primary contact IN 'son who created/prepared the Executive Sunt v. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information. V
Name of Primary Staff Debbie Brueggeman,Ad in,Airport `1 Phone Number 642-7878 E .34
Contact/ Department thority
Agenda Date Item was i,..ainuary 24,20x1 • Agenda Item Number 164E
Approved by the BCC
Type of Document 1st Amendment to Site License Agreement Number of Original 1
Attached with Center Ring Circt> Doc9ueii s Attached
PO or account number N/A
if document is to be
recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) ,Applicable)
1. Does the document require the chairman's original signature? N/A
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into Accela.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of deadlines!
8. The document was approved by the BCC on 1/24/17 and all changes made during
the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable. •
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made,and the document is ready for the I\ t F`\
Chairman's signature. V
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
Ann P. Jennejohn
16G1
To: Brueggeman, Debra
Subject: FW: Site License Agreement Amendment#1 (Center Ring Circus)
Attachments: Backup Documents 01_10_2017 Item #16G1.pdf
From:Ann P.Jennejohn
Sent: Friday, February 03, 2017 12:15 PM
To: Brueggeman, Debra <DebraBrueggeman@colliergov.net>
Subject: Site License Agreement Amendment#1 (Center Ring Circus)
Hi Debbie,
The 1st Amendment to the Site License Agreement with Center Ring Circus,
that was approved by the Board ovt January 2.4, 2017 (Itewt #1641)
for the event that was held at the Iwtwtokalee Regional Airport,
is attached for you. If you would like paper copy, please let me know.
Have a nice weekend!
Ann Jennejohn, Deputy Clerk
Clerk of the Circuit Court
Clerk to the Value Adjustment Board
Collier County Board Minutes & Records Dept.
239-252-84O(, Fax 239-252-8408
1
1661
FIRST AMENDMENT TO SITE LICENSING AGREEMENT WITH
CENTER RING CIRCUS,INC.
THIS FIRST AMENDMENT is entered into this ,, day of X(war%) 2017, by and
between Collier County, a political subdivision of the State of Florida, through its Board of County
Commissioners, in its capacity as the Collier County Airport Authority, hereinafter referred to as
"Authority," and Center Ring Circus, Inc., hereinafter referred to as the "Licensee,"collectively stated
as the"Parties."
RECITALS:
WHEREAS, on November 15, 2016, the Authority entered into Site Licensing Agreement with
Licensee (hereinafter referred to as the "Agreement"and attached as Exhibit"A" hereto) for the use of
County-owned land for a circus on the 25th and 26th of January, 2017;and
WHEREAS, the Licensee desires to amend the dates of the event in accordance with the
Authority; and •
NOW, THEREFORE, in consideration of the foregoing Recitals, and other good and valuable
consideration, the receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree
as follows:
1. The foregoing Recitals are true and correct and are incorporated by reference herein.
2. Section 1 is hereby amended as follows:
The Site License Agreement shall take effect upon execution by the Parties ("Effective
Date.) The approval of the use of the Property by the LICENSEE shall extend from
January 25 29 to 26 February 2, 2017, with the event taking place on January 30 and
February 2, 2017, with The LICENSEE is granted use of the Property from 6:00 a.m.
until 11:00 p.m. [Set-up will begin approximately at -700 8:00 a.m. on Sunday.
January 25 29, 2017 and last approximately two (2) hours. Breakdown will occur at
approximately 8:30 m. 8:00 a.m. on January 26 February 2, 2017 and last roughly
three (3) hours. All equipment will be removed, including vehicles, by 5:s
January 2:00 p.m. on February 2, 2017.1 In the event the LICENSEE
should fail to return the Property to its pre-event condition by 7:00 a.m. on January 27,
281-7 2:00 p.m. on February 2, 2017, the County shall impose ,
hour or portion thereof. liquidated damages in the amount of $240 for each day or
portion thereof.
3. The terms, covenants and conditions set forth in the Agreement that have not been
specifically amended herein, will continue in existence, are hereby ratified, approved and confirmed,
and will remain binding upon the parties. This First Amendment merges any prior written and oral
understanding and agreements, if any, between the parties with respect to the matters set forth herein.
Page I
...............
6 G
4. This First Amendment shall be recorded by the County, at the expense of the ounty,in le
it
Official Records of Collier County, Florida,within sixty(60) days of approval by the Board of County
Commissioners.
IN WITNESS WHEREOF, the Parties have executed this First Amendment to Site Licensing
Agreement with Center Ring Circus, Inc. on the date and year first above written.
Attest: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK. Clerk OF COLLIER COUNTY, FLORIDA
By: 1Ld.....4 ..*!.......Y i:.:`)-t- • By: , ,,a...ts44.
vii eputy Clerk PENNY T R , CHAIRMAN
Attes as lo Chairtilan's
signature only.
CENTER RING CIRCUS, INC,
WITNESSES:
iltel.i, o' ' kvifee By:lb*.
Print Naie: )6e1L(..lit ‘A Signature
‘,./2 ,4 - --.
Cl\--S-\‘ • CNC\ _.1.\,022,
Print Name:-6.,l kyk 54-e3cs-- Printed/Typed Name
Printed/Typed Title
Approved as to form
and legality
Jennifer A. Belpedi
Assistant County At ey
Item#
Agenda
Date
...... k....t...,‘
Date
Recd _a_11,-1
1 4 •
Deputy cimia
A.I I I r ..
Page 2
Exhibit "A"
1 6 GI
SITE LICENSE AGREEMENT:
BIG TOP CIRCUS EVENT
AT IMMOKALEE REGIONAL AIRPORT
SITE LICENSE AGREEMENT BETWEEN THE COLLIER COUNTY AIRPORT AU-
THORITY AND CENTER RING CIRCUS, INC. APPROVING THE USE OF COUNTY-
OWNED PROPERTY FOR THE PURPOSE OF HOLDING A BIG TOP CIRCUS
EVENT.
By this SITE LICENSE AGREEMENT entered into this _154.^ day Of Kof' , 2016 by
and between The Board of County Commissioners, in its capacity as the Collier County Airport
Authority, hose mailing address is in care of Airport Authority Director, 2005 Mainsail Drive,
Suite I Naples, Florida 34114, herein called the AUTHORITY and Center Ring Circus, Inc,
whose mailing address is 8051 N. Tamiami Trail, Suite C-4, Box 52, Sarasota, Florida 34234,
herein referred to as the LICENSEE.
WHEREAS, the LICENSEE requests the use of County-owned land for the purpose of ac-
tivities related to the LICENSEE's event held on the 25th and 26th of January, 2017.
WHEREAS. the AUTHORITY is willing to approve the use of the subject County-owned
land such purposes.
NOW, THEREFORE. IN CONSIDERATION OF THE MUTUAL CONVENANTS CON-
TAINED HEREIN AND OTHER VALUABLE CONSIDERATION, THE PARTIES AGREE
AS FOLLOWS:
The AUTHORITY hereby licenses real property in Collier County, Florida, described as a por-
tion of the open field at the Immokalee Airport, further shown on the attached Exhibit "A", here-
inafter referred to as "Property," for the purpose of holding a Big Top Circus event. Public and
all vehicular parking shall also be delineated on the map/diagram attached to this Agreement in-
cluded in Exhibit "A.- Personnel shall be utilized by LICENSEE to ensure that all parking at the
event is conducted according to the attached Exhibit "A." LICENSEE shall be allowed to enter
upon the Property for three-day period.
1. The approval of the use of the Property by the LICENSEE shall extend from January 25 to
26, 2017. The LICENSEE is granted use of the Property from 6:00 a.m. until 11:00 p.m. fSet-up
will begin approximately at 7:00 a.m. on January 25, 2017 and last approximately two (2)
hours. Breakdown will occur at approximately 8:30 p.m. on January 26, 2017 and last roughly
three (3) hours. All equipment will be removed, including vehicles, by 5:30 a.m. on January
27, 2017]. In the event the LICENSEE should fail to return the Property to its pre-event condi-
tion by 700 a.111. on January 27, 2017, the County shall impose a penalty of$1,000 per hour or
portion thereof.
2. The LICENSEE shall monitor, control, and assume responsibility for all activities, ven-
dors, licensees, and invitees associated with such event, such responsibility not being limited to
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trash collection and clean-up of the Property. The LICENSEE accepts the property "as is." AU-
THORITY shall not be obligated or required to improve, repair, or maintain the Property or any
part thereof in any manner whatsoever. The LICENSEE agrees to provide adequate personnel for
the timely removal all event items and remnants.
3The LICENSEE shall acquire any and all permits required by Collier County and any other
governmental entity including and not limited to waiver, to conduct such event and related ac-
tivities on the Property prior to the dates of the intended event. Said permits are issued by the
Planning and Permitting Department located within the Collier County Growth Management Di-
vision building on Horseshoe Drive.
4. LICENSEE shall pay the AUTHORITY. S1200 for the event, plus applicable sales tax,
for the use of the site.
5. NON PERMANENT IMPROVEMENTS: Prior to making any changes, alterations, addi-
tions or improvements to the Property, the LICENSEE will provide to AUTHORITY, in writing,
all proposals and plans for alterations, improvements, changes or additions to the Property. The
LICENSEE covenants and agrees in connection with any maintenance, repair work, erection,
construction, improvement, addition or alteration of any authorized modifications, additions or
improvements to the Property, to observe and comply with all present and future laws, ordinanc-
es, rules, regulations, and requirements of the United States of America, State of Florida, County'
of Collier, and any and all governmental agencies. All alterations, improvements. and additions
to the Property shall, at once, when made or installed, be deemed as attached to the freehold and
to have become the property of Collier County and shall remain for the benefit of the County at
the end of the term set forth in this Agreement in as good order and condition as they were when
installed, reasonable wear and tear excepted; provided, however, if AUTHORITY's staff so di-
rects, the LICENSEE shall promptly remove the additions, improvements, alterations, fixtures
and installations which were placed in, on, or upon the Property by the LICENSEE, and repair
any damage caused to the Property by such removal.
6. This Agreement hereby expressly adopts and incorporates by reference as it fully set out
herein the attached Exhibit "B": the Collier County' Airport Authority Contract Insurance Re-
quirements. All terms and conditions of such Agreement are deemed to apply to this Site Li-
cense Agreement and LICENSEE expressly agrees to abide by the conditions listed in Exhibit
"B.-
7. The LICENSEE, shall indemnify, defend and hold harmless Collier County, the AU-
THORITY, the Board of County Commissioners and all of each entity's respective agents and
employees from and against any and all liability (statutory or otherwise), damages, claims suits,
demands, judgments, costs, interest and expenses (including, but not limited to, attorneysfees
and disbursements both at trial and appellate levels) arising, directly or indirectly, from any inju-
ry to, or death of, any person or persons or damage to property (including loss of use thereof)
related to (A) LICENSEE'S use of the Property, (B) any work or thing whatsoever done, or any
condition created (other than by AUTHORITY, its employees, agents or contractors) by or on
behalf of LICENSEE in or about the Property, (C) any condition of the obligations under this
Agreement, or (D) any act, omission or negligence of LICENSEE or its agents, contractors, em-
ployees, subtenants, licensees, invitees or patrons. In case any action or proceeding it AU-
/
1 6 G 1
THORITY shall so request. at LICENSEE'S expense, by counsel reasonably satisfactory to AU-
THORITY.
The AUTHORITY shall not be liable for any injury or damage to person or property caused by
the elements or by other persons on the Property, or from the street or sub-surface, or from any
other place, or for any interference caused by operations by or for a governmental authority in
construction of any public or quasi-public works.
The AUTHORITY shall not be liable for any damages to or loss of, including loss due to petty
theft, any property, occurring on the Property or any part thereof and the LICENSEE agrees to
hold the AUTHORITY harmless from any claims or damage, except where such damage or inju-
ry is the result of the gross negligence or willful misconduct of the AUTHORITY or its employ-
ees. The County shall not be responsible for any loss, theft or damage to any vehicle using the
designated vehicle parking area.
8. The LICENSEE covenants and agrees not to assign this Agreement or to permit any other
persons to occupy same without the prior written consent of the AUTHORITY.
9. Either party may cancel and/or reschedule any or all of the above-described activities,
scheduled for any or all of the above-listed days for any reason, upon ten (10) days written notice
of its intent to reschedule and/or cancel to the other party. If the AUTHORITY cancels the
event, all monies will be returned to LICENSEE in a timely manner.
10. Any notice to be given by either party to the other pursuant to the provisions of this
Agreement shall be in writing, but may be delivered by mail, fax, email or any other means of
actual written notice. Notice shall be effective upon actual receipt by the addressee.
11. The AUTHORITY and LICENSEE specifically agree that this Agreement represents a
Rare License with no interest coupled thereto for the LICENSEE'S use of the Property and does
not convey any estate in the Property or create any interest whatsoever.
12. The LICENSEE represents and warrants to the AUTHORITY that no hazardous materials
will be discharged to the air, grounds, sewer, or to a septic system on the Property. At termina-
tion of this Agreement, at no cost to the AUTHORITY, the AUTHORITY may request that the
LICENSEE conduct and provide to the AUTHORITY an environmental audit, which shall con-
tain a written declaration from an environmental consultant acceptable to AUTHORITY, which
verifies that the Property which is the subject of this Agreement is in compliance with all appli-
cable State and Federal envirorunental lawsand that the property- surrounding the Property is
free from contamination. The LICENSEE acknowledges its obligation hereunder for the cost of
conducting the environmental auditbringing the subject facilities into compliance and any and
all costs for clean upremoval and remediation, if any, but only if such clean up, removal and
remediation is the result of acts of the LICENSEE during the period of the event. LICENSEE
shall not be responsible for clean up, removal and remediation of any existing environmental
condition prior to the date of the event.
TAO!
X6G1
13. The LICENSEE shall be responsible for paying all applicable sales taxes, and charges as-
sociated with or resulting from the holding of this event.
14, The LICENSEE shall be alio\Ned to utilize water on AUTHORITY's Property, it available,
without any cost to LICENSEE.
15. At its sole cost and consistent with County requirements for special events, LICENSEE
shall be required to provide portable lavatories and dumpsters, on the Property during the event
and remove said portables and lavatories following the event.
16. At its sole cost and consistent with County requirements for special events, the LICENSEE
shall be responsible for contracting bona-fide security or police protections for crowd and/or traf-
fic control in sufficient numbers to protect the health welfare and safety of the public attending
the event. LICENSEE shall be solely responsible for obtaining and compensating personnel to
handle all parking requirements. Parking requirements include personnel necessary for the
maintenance of the adequate and acceptable flow of traffic entering and leaving the event. If
LICENSEE fails to provide such personnel and County staff, agents, employees or workers must
be used to handle traffic congestion issues; LICENSEE shall reimburse Collier County for such
costs.
17. This Agreement is governed and construed in accordance with the laws of the State of
Florida, This License shall not be construed for or against a party because that party wrote it.
Any action or proceeding arising from this License shall be brought only in a state court of com-
petent jurisdiction in Collier County. The parties waive any right to a jury trial in an action or
proceeding arising out of this License.
IN WITNESS WHEREOF. the parties have hereto executed this Agreement the day and
year first above written.
AS TO LICENSEE:
iI / 1 1
/ 1 'E3)' 61 Ammo,
/ CATIA MELUZZI, Preside
'ITNE!S (signature)
,print nal e)
•
....4'TESS (signature)
ad\r\ C-)i...AAN\
(print name)
AS TO THE OWNER:
4
(&01
16G1
Attest: BOARD OF COUNTY COMMISSIONERS
DWIGHT a BROCK, Clerk OF COLLIER COUNTY, FLORIDA, serving as the
COLLIER COUNTY AIRPORT AUTHORITY
( 7
By: U /
A--- By:
Depub Clkrk/ DONNA FIALA, CHAIRMAN
Attest as to Chairman's
signature only
Approved as to form
and legal sufficiency:
c")
Jennifer A. Belpedio, P1/4istant County Attorney z2
/
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16G1
Exhibit B insurance and Bonding Requirements-Airport Facility Leases
0 Aviation Tenant ❑ Non-Aviation Tenant
insurance j Bond Type RRequired,LIngts , : :' .'
1. ❑Worker's Compensation Statutory Limits of Florida Statutes, Chapter 440 and all Federal Government
Statutory Limits and Requirements
2. Z Employer's Liability $500,000 single limit per occurrence
3. ®Commercial General Bodily Injury and Property Damage
Liability(Occurrence Form)
patterned after the current $1,000.000 single limit per occurrence, $2,000,000 aggregate for Bodily Injury
ISO form Liability and Property Damage Liability. This shall Include Premises and
Operations; Independent Contractors;Products and Completed Operations and
Contractual Liability
1. $2,000,000 General Aggregate
2. $2,000,000 Products/Completed Operations
3. $1,000,000 Personal and Advertising Injury
4. $1,000,000 Each Occurrence
5. $5,000 Medical Payments
6. Coverage will be included for all activities including but not limited to the
following:Grandstands or bleachers, Amusement Devices of any type,Animals
-any animal whether owned, non-owned, rented or hired, Fireworks, Parades,
Aircraft of any type, Concerts or Music events and Motorized vehicles being
used in any type of activity
4. ❑Indemnification To the maximum extent permitted by Florida law, the Lessee shall indemnify
and hold harmless Collier County, its officers and employees from any and all
liabilities, damages, losses and costs, including, but not limited to, reasonable
attorneys' fees and paralegals' fees, to the extent caused by the negligence,
recklessness, or intentionally wrongful conduct of the Lessee or anyone
employed or utilized by the.Lessee in the performance of this Agreement. This
indemnification obligation shall not be construed to negate, abridge or reduce
any other rights or remedies which otherwise may be available to an
indemnified party or person described in this paragraph. This section does not
pertain to any incident arising from the sole negligence of Collier County.
4. Z Automobile Liability $1,000,000 Each Occurrence;Bodily Injury&Property Damage,
Owned/Non-owned/Hired;Automobile Included
5. Z Other insurance as ❑Airport Liability Insurance $ Per Occurrence
noted: bodily injury and property damage
❑ Hangarkeepers Liability $ Per Occurrence per
aircraft including premise liability
Aircraft Liability Insurance $ Per Occurrence
bodily injury and property damage
❑Pollution Liability Insurance $ Per Occurrence
bodily injury and property damage
0 Property Insurance—Replacement Cost-All Risks of Loss
Center Ring Circus,inc.
Page 1
11li
W 111,
Umbrella/Excess Liability
I. $5,000,000 Each Occurrence
2. 55,000,000 Aggregate
3, To apply on a following form basis over underlying Employers Liability,
Automobile Liability or General Liability.
6 Li L e$s e r shall ensure that all sub-lessees comply with the same insurance requirernents that he is required to
meet, The same Lessee shall provide County with certificates of insurance meeting the required insurance
provisions.
Collier County must be named as"ADDITIONAL INSURED'on the Insurance Certificate for Commercial
Generai liability where required
8, 7 The Certificate Holder shall be named as Collier County Board of County Commissioners,OR, Board of
County Commissioners:n Collier County,OR Collier County Government,OR Collier County.The Certificates of
insurance must state the name of the lease and location of the teased property,
9. 7 Thirty(30)Days Cancellation Notice required.
RIC 9/28/2016
Lessee's Insurance Statement
We::nderstand the insurance requirements of these specifications and that the evidence of insurability may be
feciiired within five(5)days of the award of this Lease agreement.
L.Lbyvt.5 OV 1,-6\e\Cenn
Name of Pit m . < . . . , Dale \ •‘\ \-7
,..sat..
Lessee Signature (--, c (1." ' i Ti,
Print Narre ,(--:.0•T k 't->, CY\k--,‘ e2 t
I nsurance Agency ge.(_..‘61........\\ --sn,,tux74, 11 V
Agenc,Name ak-N_P\ou.... - e— Telephone Number 2,63.c131 7)095
,---
,:e'!rer Rag Circus,Inc Page
16G1
Exhibit B Insurance and Bonding Requirements-Airport Facility Leases
❑ Aviation Tenant ❑ Non-Aviation Tenant
Insurance/Bond Type Required Limits
1. ❑Worker's Compensation Statutory Limits of Florida Statutes, Chapter 440 and all Federal Government
Statutory Limits and Requirements
2. ® Employer's Liability $500,000 single limit per occurrence
3. ►/ Commercial General Bodily Injury and Property Damage
Liability(Occurrence Form)
patterned after the current $1,000,000 single limit per occurrence, $2,000,000 aggregate for Bodily Injury
ISO form Liability and Property Damage Liability. This shall include Premises and
Operations; Independent Contractors; Products and Completed Operations and
Contractual Liability
1. $2,000,000 General Aggregate
2. $2,000,000 Products/Completed Operations
3. $1,000,000 Personal and Advertising Injury
4. $1,000,000 Each Occurrence
5. $5,000 Medical Payments
6. Coverage will be included for all activities including but not limited to the
following: Grandstands or bleachers, Amusement Devices of any type,Animals
- any animal whether owned, non-owned, rented or hired, Fireworks, Parades,
Aircraft of any type, Concerts or Music events and Motorized vehicles being
used in any type of activity
4. ❑ Indemnification To the maximum extent permitted by Florida law, the Lessee shall indemnify
and hold harmless Collier County, its officers and employees from any and all
liabilities, damages, losses and costs, including, but not limited to, reasonable
attorneys' fees and paralegals' fees, to the extent caused by the negligence,
recklessness, or intentionally wrongful conduct of the Lessee or anyone
employed or utilized by the Lessee in the performance of this Agreement. This
indemnification obligation shall not be construed to negate, abridge or reduce
any other rights or remedies which otherwise may be available to an
indemnified party or person described in this paragraph. This section does not
pertain to any incident arising from the sole negligence of Collier County.
4. ®Automobile Liability $1,000,000 Each Occurrence; Bodily Injury&Property Damage,
Owned/Non-owned/Hired;Automobile Included
5. ® Other insurance as ❑Airport Liability Insurance $ Per Occurrence
noted: bodily injury and property damage
❑ Hangarkeepers Liability $ Per Occurrence per
aircraft including premise liability
❑Aircraft Liability Insurance $ Per Occurrence
bodily injury and property damage
❑ Pollution Liability Insurance $ Per Occurrence
bodily injury and property damage
❑ Property Insurance—Replacement Cost-All Risks of Loss
Center Ring Circus,Inc.
Page 1
1 6 G 1
Umbrella/Excess Liability
1. $5,000,000 Each Occurrence
2. $5,000,000 Aggregate
3. To apply on a following form basis over underlying Employers Liability,
Automobile Liability or General Liability.
6, Ej Lessee shall ensure that all sub-lessees comply with the same insurance requirements that he is required to
meet, The same Lessee shall provide County with certificates of insurance meeting the required insurance
provisions.
7 Z Collier County must be named as"ADDITIONAL INSURED on the Insurance Certificate for Commercial
General Liability where required
8, C] The Certificate Holder shall be named as Collier County Board of County Commissioners,OR, Board of
County Commissioners in Collier County,OR Collier County Government OR Collier County.The Certificates of
Insurance must state the name of the Lease and location of the leased property.
9 0 Thirty(30) Days Cancellation Notice required.
RIC 9/28/2016
Lessee's Insurance Statement
We understand the insurance requirements of these specifications and that the evidence of insurability may be
required within five(5)days of the award of this Lease agreement.
1-1...0y176OV LOWC151•1
Name of Firm Date .6\
Lessee Signature n
Print Name Vt 'Ot '( -
Insurance Agency 3 geoek-vk-%an."- A...v_/ytt _ 1.V
Agent NameP1
"ToA" Telephone Number 2.63.45131 770CILS
- -
Center Ring Circus,Inc.
Page 2