LEASE AND USE AGREEMENTLEASE AND USE AGREEMENT
This Lease and Use Agreement ( "Agreement ") is made and entered into this
day of be.aksnk , 2014, by and between the CITY OF CLEARWATER,
FLORIDA, a municipal corporation of the State of Florida, whose address is Post Office
Box 4748, Clearwater, FL 33758 -4748, hereinafter referred to as "Lessor" and Fields,
Inc., a corporation of the State of Florida, d/b /a BareFoot Beach House, whose address
is 332 S. Gulfview Blvd., Clearwater, FL 33767, hereinafter referred to as "Lessee ".
WITNESSETH:
That in consideration of the covenants herein contained, the granting of this
Agreement, and the sums paid and to be paid hereunder, the Lessor hereby leases to
the Lessee and the Lessee hereby leases from the Lessor, according to the terms,
conditions and covenants herein contained, the following described premises located in
the City of Clearwater, Pinellas County, Florida, to wit:
Food and beach accessory concession and restroom complex located on
the West 140 feet of the East 215 feet of the South 1/2 of Lot 17, Lot 18 and
Lot 19, Lloyd, White and Skinner Subdivision, in Section 7, Township 29
South, Range 15 East, as recorded in Plat Book 13, pages 12 and 13, of the
Public Records of Pinellas County, Florida. (Exhibit "A" — "Leased Premises"
or "Demised Premises" or "Food Concession Complex ").
THE PARTIES HERETO HEREBY FURTHER COVENANT AND AGREE AS
FOLLOWS:
1. Lease Term. The term of this Agreement is for a term of five (5) years,
beginning on the 1st day of January, 2015 and ending on the 31st day of December,
2019. As referred to in this Agreement, an "Agreement Year" is that year that
commences on the first day of January of each year and terminates on the thirty-first
day of December of each year during the term of this Agreement. Reference to the City
Manager throughout this Agreement refers to Lessor's City Manager or his designated
agent.
The City Manager, in its sole discretion, may extend this Agreement for one (1)
additional five (5) year period, on the same terms and conditions as are set forth herein
without obtaining additional approval by the Clearwater City Council.
2. Use of Premises. The Food Concession Complex is leased to Lessee
solely for the following uses and no other use can be made of the premises during the
term without the written consent of the Lessor:
a. The Lessee shall have the exclusive right to sell the following
merchandise at the Food Concession Complex defined below and as permitted by
applicable City Ordinances and State Law:
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i. Hot dogs, hamburgers, and other like hot food such as French fries,
as may be prepared using the grill and fryer;
ii. Ice cream;
iii. Cold sandwiches, both prepared and pre - packaged, cookies,
popcorn, chips and other such packaged food items;
iv. Any cold or hot non - alcoholic beverage;
v. Sundry items and other personal beach recreational and clothing
items. While not required, the Lessor encourages the Lessee to
offer healthy food items such as fruits, salads and wraps; and
vi. Gifts and seasonal merchandise.
b. The Lessee shall also have exclusive license to rent beach chairs,
lounges, cabanas, umbrellas, floats, side tables, and any other beach equipment
approved by the City Manager, subject to certain standards and restrictions as further
described herein, from the Food Concession Complex and the beach area described
herein. The equipment may be used on City -owned property. South of the westward
extension of First Street and North of the filled area used for parking, more particularly
described as:
Lots 5 through 32 including the area of beach between the platted lots to
the high tide mark, inclusive, of Lloyd, White and Skinner Subdivision (the platted
Tots are shown herein Exhibit "B" — the "Beach Equipment Rental Area "), less any
of the above - described property used now or in the future by the Lessor for other
purposes, and subject to certain concession rights held by the Hyatt Regency
Clearwater Beach Resort & Spa ( "Hyatt") to provide concessions within a facility
open to the public which provides towels, lockers, minimal beach sundries, and
other beach gear, but not including benches, beach chairs, lounges, umbrellas
and side tables. Said Hyatt facility is 1200 square feet, MOL, located directly
west of the Hyatt Regency Clearwater Beach Resort & Spa.
c. Lessee under this Lease shall act as concessionaire to provide beach
chairs, lounges, umbrellas, side tables and the level of services associated with the
Development Agreement, as amended, between the City of Clearwater and Beachwalk
Resort LLC dated 12/10/04 and recorded in the public records of Pinellas County in
O.R. Book 13996, Page 2409 ( "Hyatt Development Agreement "), said services being
required to meet certain standards which shall be set forth in this Lease as Exhibit "C ".
Failure by the concessionaire to meet the service standards set forth in Exhibit "C ", may
result in the preemption by the Hyatt of providing such services (as more particularly
provided for below) - only on that portion of beach directly west of the Hyatt property as
defined by two parallel lines running from the northern -most boundary of the Hyatt
property and the southern -most boundary of the Hyatt property west to the mean high
water mark of the Gulf of Mexico as more particularly shown on Exhibit D, attached
hereto and made part hereof ( "Hyatt Concession Area ").
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Lessee shall own, maintain and store all rental equipment used on Beach
Equipment Rental Area at Lessee's expense and shall be subject to the following
covenants and conditions:
i. If Lessee fails to comply with the standards in Exhibit C, the Hyatt
may send written notice to the Lessor specifying non - compliance,
Lessor shall immediately notify Lessee. Lessee shall have thirty
(30) days from the receipt of written notice by the Lessor to Lessee
to cure said non - compliance.
ii. In the event that the non - compliance is not cured within thirty (30)
days of receipt of written notice, the Lessee agrees that the Hyatt
may thereafter provide beach rental services including the rental of
beach chairs, lounges, umbrellas, side tables and the level of
services associated therewith, and shall retain all income derived
from the limited area described in Exhibit "D" as the Hyatt
Concession Area. This partial right of termination is in addition to
the rights of termination otherwise set forth in this Agreement, but
shall not constitute an Event of Default as defined below.
d. Solicitation: Amusement/Sound Devices. The Lessee is specifically
prohibited from hawking or other verbal solicitation of any type either at the Food
Concession Complex or the Beach Equipment Rental Area. No coin - operated
amusement devices or machines or any jukeboxes will be allowed. No inside or outside
loud speakers will be permitted.
e. Restroom Maintenance. The Lessee is responsible for the cleanliness
and daily maintenance of the public restrooms, at Lessee's expense, including the
provision of all toiletries /supplies for public restrooms at 332 S. Gulfview Blvd and 410
S. Gulfview Blvd. Lessee shall provide bathroom attendants at the Food Concession
Complex bathrooms during peak times of the year and provide for a daily maintenance
log on when cleanliness and supplies were checked. The use of equipment or vehicles
necessary to maintain said restrooms, will be permitted in accordance with the City's
policies, as may be amended from time to time. The conditions under which the
vehicles are operated must be authorized in writing by the City Manager.
f. Business Expenses. The Lessee is responsible to provide all equipment
and supplies needed to operate the Food Concession Complex at Lessee's expense.
g. Operations; Hours. The hours of operation for the Food Concession
Complex, Beach Equipment Rental Area and restrooms at the Leased Premises shall
be no earlier than 6:00 a.m., with a minimum requirement that the Food Concession
Complex shall be open at least seventy (70) hours per week. The beach rental
equipment shall be removed from the Beach Rental Area and stored out of public view
no later than one hour after sunset. The use of equipment or vehicles on the beach will
be permitted in accordance with the City's policies, as may be amended from time to
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time by the City Manager, for distribution and pickup of beach equipment and restroom
maintenance only. No food trucks shall be permitted on the Beach Equipment Rental
Area at any time. The times for distribution and pickup and the conditions under which
the vehicles are operated must be authorized in writing by the City Manager.
3. Product Pricing. The Lessor reserves the right to review and approve
prices to be charged for all sale and rental items. A list of current prices must be
submitted within twenty (20) days of the date of this Agreement, and within twenty (20)
days of any substantial changes to food and beverage prices and beach rental prices.
4. Parking. The Lessor will provide at no charge to Lessee five (5)
parking spaces for use by Lessee's employees during the term of this Agreement, the
location of which will be at the determination of the Lessor. Lessee understands that
the approved use of these spaces is subject to change based on other municipal needs
and, therefore, Lessor reserves the right to recapture these five (5) parking spaces as
needed.
5. Rent. The Lessee hereby covenants and agrees to pay rent for the Food
Concession Complex as follows:
(a) Base Rent in equal monthly payments, which will be due and payable on
the first day of each month, an amount in accordance with the following schedule:
Years of Agreement
Total Minimum Rental Monthly Payments
1 - 5 $100,008 annually $8,334 per month
(b) Plus, as additional rent, Lessee shall pay annually at the end of each
agreement year, the percentage specified on the amount between the figures listed
below:
20% - Between $750,000 and $1 million in gross sales
22.5% - Between $1 million and $1.5 million in gross sales
25% - Between $1.5 million or more in gross sales
Lessee shall pay all amounts due as stated above within thirty (30) days of the
end of each agreement year. Lessee further agrees to provide Lessor within fifteen (15)
days of the end of each monthly period during the term of this Agreement the statement
showing the amount -of gross sales during the preceding month, as well as a signed
copy of the front and back of the Florida Department of Revenue Sales and Use Tax
Return. The statement used by the Lessee to report such sales will be in such form as
to be satisfactory to the City Manager, and must be certified as correct by the Lessee's
Chief Financial Officer, or his designee, showing the amount of gross sales at and /or
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from the Demised Premises during the monthly periods reported by the statement in the
amount of year -to -date gross sales for the calendar year.
The term "Gross Sales" as used in this paragraph 5(b) means the entire
amount of actual sales prices, whether for cash or otherwise, of all sales of food,
services, beverages, clothing, or other receipts whatsoever of all business conducted in,
on or from the premises, including mail or telephone orders received or filled at the
premises except for any beach rental transaction as defined below. No deduction shall
be allowed for uncollected or uncollectible credit accounts. Such term shall not include,
however, any sums collected and paid out for any sales or excess tax imposed by any
duly constituted governmental authority wherein Lessee is regarded as the collecting
agent. It expressly does not include any income generated from the beach rentals,
regardless of whether the BR transaction occurred at the Food Concession Complex.
6. As consideration for the license to utilize the Beach Rental Area and for
the exclusive right of beach concessions, as described herein, Lessee shall pay to
Lessor, on a monthly basis, 50% of the monthly gross sales for all beach rentals. This
payment will be due within fifteen (15) days of the preceding month. The final payment
shall be made by Lessee within fifteen (15) days of the end of Agreement term. The
Lessee will provide the Lessor, within fifteen (15) days of the end of each monthly
period during the term of the Agreement, a statement showing the amount of gross
sales during the preceding month, as well as a signed copy of the front and back of the
Florida Department of Revenue Sales and Use Tax Return. The statement used by the
Lessee to report such sales will be in such form as to be satisfactory to the City
Manager, and must be certified as correct by the Lessee's Chief Financial Officer, or his
designee, showing the amount of gross sales at and /or from the Demised Premises
during the monthly periods reported by the statement in the amount of year -to -date
gross sales for the calendar year.
The term "Gross Sales" as used in this paragraph 6 means the entire amount of
the actual sales price, whether for cash or otherwise, of all beach chairs, cabanas,
umbrellas, floats and other receipts whatsoever from all beach rental business ( "Beach
Rental Transactions ") conducted in, on or from the Leased Premises and Beach Rental
Area as per this Agreement. No deduction shall be allowed for uncollected or
uncollectible credit accounts. Such term does not include, however, any sums collected
and paid out for any sales or excise tax imposed by any duly constituted governmental
authority wherein Lessee is regarded as the collecting agent.
7. Capital Improvements. For capital improvements to restrooms and new
storage facility for Parks and Recreation vehicles /equipment:
a. Lessee shall pay the following amounts of money to Lessor
( "Capital Contribution ") for the expansion and renovations of the restrooms as
well as the construction of a new storage facility for the Parks and Recreation
Department to house vehicles being displaced by the restroom
expansion /renovations (collectively the "Renovations ", as more specifically
described in Exhibit "E ", attached hereto and made a part hereof):
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$301,000 by January 31, 2015
$100,000 by January 31, 2016
b. The City of Clearwater shall act as the project manager, be
responsible for the design and construction of the Renovations, and shall use
these funds to make the Renovations.
c. Construction of the restrooms shall be completed in two phases.
d. The Lessor shall return any Capital Contribution funds remaining
after the completion of these improvements to the Lessee, without demand,
within 60 days of Certificate of Occupancy.
e. In the event the City terminates this lease as permitted herein,
except in the event of a Lessee default and except in the instance of a partial
termination as provided for in paragraph 2(c), the City will reimburse the Lessee
on a pro -rata basis for its Capital Contribution to the Renovations as follows:
Lease Year
0 -1
1 -2
2 -3
3 -4
4 -5
Reimbursement of Capital Contribution
100% of Capital Contribution (made to date)
80% of Capital Contribution (made to date)
60% of Capital Contribution (made to date)
40% of Capital Contribution (made to date)
20% of Capital Contribution (made to date)
f. Such reimbursement shall be made within 60 days of written
request by Lessee. Upon reimbursement, Lessee shall release all claims against
the Lessor arising out of this Capital Contribution, and Lessee shall have no
further claim on the Leased Premises with respect to the Capital Contribution.
8. Annual Gross Sales. The Lessee agrees to submit an audited certification
of annual gross sales, as certified to by a Certified Public Accountant, within thirty (30)
days of the end of each calendar year. The scope of the audit must include the
Lessee's compliance with the terms of the Agreement to disclose the gross sales at or
from the demised premises. The statement shall be prepared according to generally
accepted accounting principles and practices, showing in all reasonable detail the
amount of gross sales during the prior Agreement year. The Lessee also agrees to
provide at the same time as the statement regarding annual gross sales, pertinent
depreciation and amortization schedule as filed with the Internal Revenue Service for
the prior year.
9. Amounts Due from Lessee to Lessor. Any amount due from Lessee to
Lessor under this Agreement which is not paid when due shall bear interest at the
maximum allowable legal rate from date due until date paid, together with a late charge
of 5% of any amount due, to cover Lessor's extra expenses involved in collecting such
delinquency; provided that such interest and late charges shall be automatically
reduced by such amount as necessary to cause such charges to be in compliance with
usury laws. The late charge must be paid within 30 days of the day the delinquent
payment was due.
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10.0bservance of Laws and Ordinances; Encumbrances; Assignment.
a. Lessee agrees to observe, comply with, and execute promptly at its
expense during the Lease Term, all laws, rules, requirements, orders, directives, codes,
ordinances and regulations of governmental authorities and agencies and of insurance
carriers which relate to its use or occupancy of the Leased Premises. The Lessee
hereby covenants and agrees to make no unlawful, improper or offensive use of the
leased premises.
b. Lessee further covenants and agrees not to assign, mortgage, pledge,
hypothecate or sublet this Agreement in whole or in part without the prior written
consent of Lessor. The consent of Lessor to any assignment, mortgaging, pledging,
hypothecating, or subletting shall be at the Lessor's sole discretion, and shall not
constitute a waiver of the necessity for such consent to any subsequent assignment,
mortgage, pledging, hypothecating or subletting. This paragraph shall be construed to
include a prohibition against any assignment or subletting by operation of law. If this
Agreement is assigned, or if the premises or any part thereof are sublet or occupied by
anybody other than Lessee, Lessor may collect rent from the assignee, sub - tenant or
occupant, and apply the net amount collected to the rent herein required, but no such
occupancy or collection shall be deemed a waiver of this covenant, or the acceptance of
the assignee, sub - tenant or occupant and tenant, or a release of Lessee from the
further performance by Lessee of covenants on the part of Lessee herein contained. If
at any time during the term of this Agreement, any or all of the corporate shares of
Lessee shall be transferred by sale, assignment, bequest, inheritance, operation of law
or other disposition so as to result in a change in the present effective voting control of
Lessee by the person, persons or entity which presently is the ultimate owner of a
majority of such corporate shares on the date of this Agreement, lessee shall promptly
notify Lessor in writing of such transfer and shall provide to Lessor the name, address,
financial statement and business experience resume for the immediate preceding five
(5) years of the proposed assignee. This information shall be in writing and Lessor, at
its sole discretion shall have the option of accepting the proposed assignee and can
charge a reasonable fee to Lessee for processing such request. Lessee can request a
transfer under this provision for no more than once in an agreement year unless
specifically consented to in writing by Lessor.
c. If the new owner is a private or public corporation, Lessor shall promptly
advise Lessee if it has any objections thereto and the reasons therefore. Lessor may
terminate this Agreement any time after such change in control by giving Lessee ninety
(90) days prior written notice of such termination. Lessee shall not permit any business
to be operated in or from the premises by any concessionaire or Licensee.
d. The Lessee hereby covenants and agrees to promptly and continuously
comply with all regulations and order of the Health Department and health officers of the
local, state and national governments; and Lessee hereby covenants and agrees to
keep, operate, and maintain the concession in such a manner as to include any
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warnings of major violations or notices to show cause being issued by a regulatory
agency authorized to inspect the premises under Florida Statute 509 as it presently
exists or as it may be amended. In addition, Lessee agrees to forward to Lessor a copy
of each inspection report issued in accordance with Florida Statute 509 as it presently
exists or as it may be amended, within fifteen (15) days of receiving any such reports.
The Lessee shall submit a copy of the approved renewal of Health Department
certificate within (thirty) 30 days after renewal.
11. Taxes; Licenses: Permits. Lessee agrees that it will promptly pay all ad
valorem real property taxes and personal property taxes that may be assessed against
the Leased Premises during the term of this Agreement (excluding any taxes assessed
for the public restrooms at both 332 S. Gulfview and 410 S. Gulfview Blvd.). Lessee
further agrees that it will pay if applicable, any state sales tax due on the rental payment
made by the Lessee to the Lessor and that it will pay all other taxes, including, but not
limited to, occupational license, beverage license, and permits relating the operation of
the business conducted on the leased premises, which are required by law. It is further
agreed by the Lessor that nothing herein shall obligate Lessee to pay or to reimburse
Lessor for the payment of assessments for permanent improvements, including but not
limited to sidewalks, sewers, and streets, that would normally accrue to the Demised
Premises.
12. Utilities. The Lessee hereby covenants and agrees to pay all bills for
electrical current, gas, water, sewer, heat, refuse collection and other services to the
premises when due including all operating costs for the renovated restroom facilities at
the Food Concession Complex, and the restrooms at 410 S. Gulfview Blvd. Said
utilities shall be directly billed to the Lessee and be individually metered for the
premises. Any deposits for such utilities shall be the sole responsibility of the Lessee.
13. Contemplated Renovations. The Lessor will coordinate proposed phased
improvements to the restroom facilities with the Lessee. The Lessor will construct
improvements to the restrooms in a timely manner including all ADA requirements.
Phase I of these renovations are anticipated to be completed by January 1, 2016.
Phase II shall be completed by January 1, 2017.
14. Clearwater Marine Aquarium Display. The Lessee shall provide a
maximum of 6 foot by 6 foot and minimum 4 foot by 4 foot shadowbox display space to
the Clearwater Marine Aquarium for public information about the aquarium, its mission
and location.
15. Waste. Lessee will use biodegradable materials whenever feasible.
16. Maintenance; Capital Repairs. Lessee shall keep the foundation, outer
walls, roof and buried conduits of the Leased Premises in good repair. Lessee shall
keep the inside of said premises and the interior doors, windows and window frames of
said premises in good order, condition and repair and shall also keep the premises in a
clean, sanitary and safe condition in accordance with law and in accordance with all
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directions, rules and regulations of governmental agencies having jurisdiction. The
Lessee shall be responsible for providing all light bulbs used on the premises. The
plumbing facilities shall not be used for any other purposes than that for which they are
constructed and no foreign substances of any kind shall be thrown therein, and the
expense of any breakage, stoppage or damage resulting from the violation of this
provision shall be borne by the Lessee. The heating and air - conditioning system and
plumbing facilities shall be under the control of Lessee, and Lessee agrees that all
operation, upkeep, repairs and replacements will be at Lessee's expense. In the event
Lessor pays any monies required to be paid by Lessee hereunder, Lessor shall demand
repayment of same from Lessee and Lessee shall make payment within ten (10) days
of receipt of said demand. Lessee's failure to make such repayment within the ten (10)
day period shall constitute a default under the terms of this lease and unpaid amounts
shall become additional rent due. Lessee will provide all equipment necessary for the
operation of the Food Concession Complex and Beach Equipment Rental. In addition
to the items in paragraph 6 the Lessee will pay all normal day - to-day repairs and
maintenance costs, being certain that any material used in repair and maintenance will
be equal to or better than that originally provided, and all required insurance premiums.
In general Lessee shall, at their expense, at all times during the term of this agreement,
keep the premises and all improvements and facilities in good order, repair and
condition. Notwithstanding this paragraph 16, nothing in this Lease shall obligate
Lessee for any maintenance or capital repairs to the bathroom at 410 S. Gulfview Blvd.
17. Trash. Lessee will be responsible for picking up and disposing of all trash,
garbage, and other debris, whether or not initiated from the sales of the food complex,
within 100 feet of the Leased Premises. Lessee is authorized to place trash cans in the
immediate area of the Leased Premises, said trash cans to be maintained by the
Lessee.
18. Insurance; Indemnification. The Lessee shall, at its own cost and
expense, acquire and maintain (and, if applicable to this Agreement, cause any sub-
lessees, contractors, and /or subcontractors to acquire and maintain) during the term
with the Lessor, sufficient insurance to adequately protect the respective interest of the
parties. Coverage shall be obtained with a carrier having an AM Best Rating of A -VII or
better. In addition, the Lessor has the right to review the Lessee's deductible or self -
insured retention and to require that it be reduced or eliminated.
a. Specifically the Lessee must carry the following minimum types and
amounts of insurance on an occurrence basis or in the case of coverage
that cannot be obtained on an occurrence basis, then coverage can be
obtained on a claims -made basis with a minimum three (3) year tail
following the termination or expiration of this Agreement:
i. Commercial General Liability Insurance coverage in the
minimum amount of $1,000,000 (one million dollars) per occurrence
and $2,000,000 (two million dollars) general aggregate.
ii. Commercial Automobile Liability Insurance coverage for any
owned, non - owned, hired or borrowed automobile is required in the
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minimum amount of $1,000,000 (one million dollars) combined
single limit.
iii. Unless waived by the State of Florida, statutory Workers'
Compensation Insurance coverage in accordance with the laws of
the State of Florida, and Employer's Liability Insurance in the
minimum amount of $100,000 (one hundred thousand dollars) each
employee each accident, $100,000 (one hundred thousand dollars)
each employee by disease and $500,000 (five hundred thousand
dollars) aggregate by disease with benefits afforded under the laws
of the State of Florida. Coverage should include Voluntary
Compensation, Jones Act, and U.S. Longshoremen's and Harbor
Worker's Act coverage where applicable. Coverage must be
applicable to employees, and volunteers, if any.
iv. If the Lessee is using its own property or the property of Lessor in
connection with the performance of its obligations under this
Agreement, then Property Insurance on an "All Risks" basis with
replacement cost coverage for property and equipment in the care,
custody and control of others is required. Lessee understands that
the Lessor shall not insure or self- insure loss of any kind to
Lessee's personal property and Lessee is solely responsible for
such losses regardless of cause.
v. The Lessor will maintain Property Insurance and Flood
Insurance (if applicable) on a replacement cost basis on the
building(s) or structure(s). The Lessor reserves the right to insure
the property through self- insurance or any other insurance method
at its discretion during the term of this Lease. Lessee agrees to
reimburse the Lessor for such yearly cost of Property Insurance
and Flood Insurance premiums. The Lessor shall bill the Lessee by
providing invoices in the applicable increments. The current term of
insurance is October 1 to October 1. Lessee also agrees to
reimburse the Lessor for any deductibles or self- insurance co -pays
in the event of a property or flood Toss.
vi. The Lessor will maintain Boiler and Machinery Insurance if the
buildings or structures include boiler(s), pressure vessel (s) or air
conditioning /heating equipment. The Lessor reserves the right to
insure the Boiler and Machinery items through self insurance or any
other insurance method at its discretion during the term of this
Lease. Lessee agrees to reimburse the Lessor for such yearly cost
of Boiler and Machinery Insurance premiums. The Lessor shall bill
the Lessee by providing invoices in the applicable increments. The
current term of insurance is October 1 to October 1. Lessee also
agrees to reimburse the Lessor for any deductibles or self -
insurance co -pays in the event of a loss.
vii. The above insurance limits may be achieved by a combination of
primary and umbrella /excess liability policies.
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b. Other Insurance Provisions:
i. Prior to the execution of this Agreement/Contract, and then
annually upon the anniversary date(s) of the insurance policy's
renewal date(s) for as long as this Agreement/Contract remains in
effect, the Lessee will furnish the Lessor with a Certificate of
Insurance(s) (using appropriate ACORD certificate, SIGNED by the
Issuer, and with applicable endorsements) evidencing all of the
coverage set forth above and naming the Lessor as an "Additional
Insured" on the Commercial Liability Insurance policy. In addition
when requested in writing from the Lessor, Lessee will provide the
Lessor with certified copies of all applicable policies. The address
where such certificates and certified policies shall be sent or
delivered is as follows:
Lessor of Clearwater
Attn: Parks and Recreation Department
P.O. Box 4748
Clearwater, FL 33758 -4748
ii. Lessee shall provide thirty (30) days written notice of any
cancellation, non - renewal, termination, material change or
reduction in coverage.
iii. Lessee's insurance as outlined above shall be primary and non-
contributory coverage for Lessee's negligence.
iv. Lessee agrees that the Lessor reserves the right to appoint legal
counsel for any and all claims that may arise related to this
Agreement or performance under this Agreement.
v. Lessee shall defend, indemnify, save and hold the Lessor, its
employees, officers, or directors harmless from any and all claims,
suits, judgments and liability for death, personal injury, bodily injury,
or property damage, arising directly or indirectly, including legal
fees, court costs, or other legal expenses; except, for such claims
of, or damages resulting from, gross negligence, or willful, wanton
or intentional misconduct of the Lessor or its employees, officers, or
directors or for statutory violation or punitive damages, except and
to the extent the statutory violation or punitive damages are caused
by, or result from, the acts or omissions of the Lessee or any of the
Lessee's employees, representatives, or agents.
vi. The stipulated limits of coverage above shall not be construed
as a limitation of any potential liability to the Lessor, and
failure to request evidence of this insurance shall not be
construed as a waiver of Lessee's obligation to provide the
insurance coverage specified.
19. Destruction of Premises. If at any time during the term of this Agreement,
the building or premises or any part, system or component hereof (herein the "Demised
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Premises ") shall be damaged or destroyed, said Demised Premises and any additions
or improvements thereto, shall be promptly repaired or rebuilt or restored to the
condition as good as the same was immediately prior to such damage or destruction at
the Lessee's risk and expense, utilizing Insurance proceeds as required hereunder, and
in accordance with plans and specifications mutually agreed upon by the Parties at the
time; or if none can be agreed upon, then in accordance with the original plans and
specifications and any subsequent plans and specifications for any additions or
improvements constructed prior to the damage. The work of restoration or rebuilding
shall be in full compliance with all laws and regulations and government ordinances
applicable thereto. The insurance proceeds shall be paid to the Lessor, and such
proceeds will be used for the repair or restoration. Lessor shall retain control and
oversight of the rebuilding as the property owner. Any cost of repairs or restoration in
excess of the insurance proceeds shall be borne by the Lessee. Any insurance
proceeds in excess of the cost of repairs or restoration shall belong to the Lessee.
During the period of such partial damage or destruction, the monthly guaranteed
rent shall abate until commencement of business, after receipt of all building permits,
whichever is sooner. Lessor shall not unreasonably withhold building permits Lessee
applies for which are necessary to repair such damage or destruction.
The Lessee will be allowed to operate a mobile or portable service during the
time of repair or reconstruction in accordance with the law, and upon approval from the
City Manger at which point Base Rent is due and payable by Lessee.
If the Demised Premises shall be totally destroyed or so damaged as to render it
practically useless during the term of this Agreement, then and in that event, the Lessor
may terminate this Agreement as of the date of such damage, or upon thirty (30) days
written notice to the Lessee. Should Lessor choose not to rebuild, Lessor shall still be
entitled to applicable insurance proceeds as compensation for the Leased Premises
asset.
20. Default; Remedies. Lessor, at its option, may exercise any of the
remedies provided in Subsection 1 of this paragraph, except as otherwise provided
herein, upon the happening of any one or more of the following events ( "Events of
Default ").
a. Events of Default shall be any of the following actions by Lessee:
i. Lessee's default in the payment of any rental or other sums due for
a period of five (5) days after the due date;
ii. Lessee's continued default with respect to any other covenant of
this Agreement for a period of fifteen (15) days after receipt of written notice of
such default by Lessee from Lessor, provided that if such default reasonably
required more than fifteen (15) days to cure, there shall be no Event of Default if
Lessee has commenced correcting action within the fifteen (15) day period and is
diligently pursuing such action;
[GM 14 -1801- 112/146894/1 ] 12
iii. There shall be filed by or against Lessee in any event pursuant to
any statute wither of the United States or of any state, a petition in bankruptcy or
insolvency or for reorganization or arrangement, or for the appointment of a
receiver or trustee of all or a portion of Lessee's property, or if the Lessee makes
an assignment by operation of law, or if Lessee makes application to Lessee's
creditors to settle or compound or extend the time for payment of Lessee's
obligations, or if execution, seizure, or attachment for a period of 120 days.
Failure to remove the levy, seizure or attachment within the 120 day period shall
actuate the default provided by this paragraph and the bond posted shall be
forfeited.
iv. Lessee's vacating or abandoning the premises, unless in the event
of casualty or destruction at which point, the provision of Section 19 shall prevail.
v. Lessee's intentional understating gross sales by more than three
(3) percent in sales reports given to Lessor and not otherwise corrected by
annual audited statements provided to the City. An error occurring by reason of
computer malfunction, typing, or other similar clerical error shall not be
considered a default within the meaning of this paragraph.
b. Lessor, at its option, may exercise any one or more of the following
remedies which shall be cumulative.
i. Terminate Lessee's right to possession under this Agreement and
reenter and take possession of the premises, resetting or attempt to relet shall
only involve a prospective tenant capable of providing comparable or better type
services, at such rent and under such terms and conditions as Lessee may deem
best under the circumstances for the purpose of reducing Lessee's liability, and
Lessor shall not be deemed to have thereby accepted a surrender of the
premises, and Lessee shall remain liable for all rents and additional rents due
under this Agreement and for all damages suffered by Lessor because of
Lessee's breach of any of the covenants of this Agreement. Said damages shall
include, but not be limited to, charges for removal and storage of Lessee's
property, remodeling and repairs, leasing, commissions and legal fees, and loss
of prospective percentage rentals by Lessor. Said prospective percentage rents
shall be calculated on the basis of Lessee's gross sales for the immediately
preceding twelve (12) month period or for the period, adjusted on an annualized
basis, commencing with the first day of this Agreement if this Agreement has not
been in effect for twelve (12) months. In addition to its remedies hereunder,
Lessor may accelerate all fixed rentals due under this Agreement, in which event
the Lessee shall be liable for all past due rent, accelerated rent and damages as
described above; however with respect to the accelerated rent, Lessor shall
receive only the present value of such accelerated rent. At any time during
repossession and resetting pursuant to this subsection, Lessor may, by delivering
written notice to Lessee, elect to exercise its option under the following
subsection to accept a surrender of the premises, terminate and cancel this
Agreement, and retake possession and occupancy of the premises on behalf of
Lessor.
[GM 14- 1801- 112/146894/1 ] 13
ii. Declare this Agreement to be terminated, whereupon the term
hereby granted and all right, title and interest of Lessee in the premises shall end
and Lessor may re -enter upon and take possession of the premises. Such
termination shall be without prejudice to Lessor's right to collect from Lessee any
rental or additional rental which has accrued prior to such termination together
with all damages, including, but not limited to the loss of prospective percentage
rentals, suffered by Lessor because of Lessee's breach of any covenant under
this Agreement.
Exercise any and all rights and privileges that Lessor or may have
under the laws of the State of Florida and /or the United States of America.
c. Additionally, the City may terminate this Lease in the event it determines,
at a duly constituted City Council meeting, that the Leased Premises are required for
any other municipal purposes by giving ninety (90) days written notice of such intended
use, following which this Lease shall terminate in every respect, and both parties shall
be relieved of any further obligations hereunder, except that Lessee shall be
responsible for all monies due and owing hereunder at the time of such determination
resulting from the operation hereof, together with any other monies due in accordance
with this Lease.
21. Alterations and Improvements. Lessee shall secure prior written
approval from Lessor for modifications or remodeling of existing facilities or for the
construction of any new facilities, such approval not to be unreasonably withheld or
delayed. The terms remodeling or modifications as used herein shall include only those
events requiring the issuance of a building permit. It is agreed that the existing
improvements, together with any improvements constructed by Lessee during the term
of this Agreement on the demised premises, shall become the property of the Lessor
upon the expiration or termination of this Agreement; provided, however, that said
reference to improvements herein contemplates improvements to the real estate which
become a part of the land as distinguished from personal property utilized by the
Lessee. Lessee shall, at Lessee's expense, remove all of Lessee's personal property
and those improvements made by Lessee which have not become the property of the
Lessor, including trade fixtures and the like. All property remaining on the Premises
after the last day of the term of this lease shall be conclusively deemed abandoned and
may be removed by Lessor and Lessee shall reimburse Lessor for the cost of such
removal.
22. Lessee shall, at his expense, at all times during the terms of this
Agreement, keep the leased premises and all improvements and facilities thereon in
good order, condition, and repair. It is specifically understood by Lessee that the Lessor
has the right to inspect the leased premises and improvements at any time to ensure
that the premises and improvements are indeed in good order, condition and repair.
Upon the termination or expiration of this Agreement, Lessee shall repair any and all
damages to the premises caused by the removal by Lessee of personal property.
[GM 14- 1801 -112 /146894/1 ] 14
23. Upon the termination or expiration of the Agreement for whatever cause,
the Lessee shall have fifteen (15) days to remove, at his own expense, its equipment,
signs, insignia, and other indicia of its tenancy or use.
24. Lessee shall have no power or authority to permit mechanic's or
materialmen's liens to be placed upon the Premises in connection with maintenance,
alterations, or modifications. Lessee shall, within fifteen (15) days after notice from
Lessor, discharge any mechanic's liens for materials or labor claimed to have been
furnished to the Premises on Lessee's behalf. Lessee agrees to indemnify and save
harmless the Lessor by reason of any mechanic's lien which has not been discharged
and which may be asserted as a claim against the leased property, and to furnish
Lessor a good and sufficient bond signed by a reputable bonding company doing
business in Florida, which bond shall be in an amount equal to 100 percent (100 %) of
the cost of construction of the contemplated improvements to the demised premises.
25. Eminent Domain. If the whole or any part of the premises hereby leased
shall be taken by any public authority under power of eminent domain, then the term of
this lease shall cease on the part so taken from the date title vests pursuant to such
taking, and the rent and any additional rent shall be paid up to that day, and if such
portion of the Demised Premises is so taken as to destroy the usefulness of the
premises for the purpose for which the premises were leased, then from that day the
Lessee shall have the right to either terminate this lease or to continue in possession of
the remainder of the same under the terms herein provided, except that the rent shall be
reduced in proportion to the amount of the premises taken. The parties agree that the
Lessee shall not be entitled to any damages by reason of the taking of this leasehold, or
be entitled to any part of the award for such taking, or any payment in lieu thereof.
26. Lessee acknowledges that it, it's applicants for employment, employees,
or volunteers, work or will work with children, the elderly, or the disabled. Therefore, if
not otherwise required to conduct background checks by law, Lessee voluntarily agrees
to register with the Florida Department of Law Enforcement ( "FDLE ") to participate in
the Volunteer & Employee Criminal History System ( "VECHS ") for background checks,
as authorized by the National Child Protection Act ( "NCPA "), as amended, and Florida
Statute 943.0542 (1999), as may be amended from time to time. Lessee agrees to
secure the highest level of background screening available under VECHS, and that this
level of background screening is necessary to effectively screen out those not suitable
for contact with children, the elderly or the disabled. Lessee voluntarily agrees to
require such screenings in accordance with the processes and procedures set forth by
the FDLE and the FBI in order to secure criminal history information on its employees,
volunteers and applicants. The Lessee acknowledges that the VECHS program is not
available to entities currently mandated to obtain background checks by statute or other
law. Lessee shall pay all costs associated with such background checks and will submit
an Affidavit of Criminal Background Screening in substantially the form attached hereto,
and incorporated herein, as Exhibit "F ". Lessee shall secure releases from screened
parties, use said criminal history information only as permitted by law, and shall
unilaterally make the determination of a screened parties' fitness and suitability for
[GM14- 1801 - 112/146894/1] 15
working with children, the elderly or the disabled. Lessor shall not be required to make
such a determination under any circumstance. Lessee shall submit the Affidavit of
Criminal Background Screening to Lessor prior to beginning its operations under this
agreement. if for any reason, including denial of eligibility by the Florida Department of
Law Enforcement, Licensee is unable to secure background checks in accordance with
the VECHS program, Licensee shall secure the highest level of background screening
allowed by law.
27. Lessee agrees to provide CPR training and certification for at least one
employee on site per shift.
28. This lease and the rights of the Lessee hereunder are hereby made
subject and subordinate to all bona fide mortgages now or hereafter placed upon the
said premises by the Lessor and any other owner provided, however, that such
mortgages will not cover the equipment and furniture or furnishings on the premises
owned by the Lessee. The Lessee further agrees to execute any instrument of
subordination which might be required by mortgagee of the Lessor.
29. Lessor covenants and agrees that upon payment by Lessee of the rents
herein provided, and upon observance and performance by Lessee of all the covenants,
terms and conditions required of the Lessee by the Agreement, Lessee shall peaceably
and quietly hold and enjoy the leased premises for the term of the Agreement without
hindrance or interruption by Lessor.
30. Notices hereunder shall be given only by registered letter and shall, unless
otherwise expressly provided, be deemed given when the letter is deposited in the mail,
postage prepaid, addressed to the party for whom intended at such party's address first
herein specified or to such other address as may be substituted therefore by proper
notice hereunder.
To Lessee:
Fields, Inc.
332 S. Gulfview Blvd.
Clearwater, FL 33767
Attn: Lisa Chandler
Steve Chandler
To Lessor:
City of Clearwater
P.O. Box 4748
Clearwater, FL 33756 -4748
Attn: Kevin Dunbar
Director of Parks and Recreation
31. If the Certified Public Account providing the annual audit required in this
Agreement is not an independent Certified Public Accountant, Lessee at the City
Manager's option, agrees to make all records of gross sales pertaining to this
Agreement available to an independent Certified Public Accountant chosen by the City
Manager, for the purpose of confirming the fair representation of the previously
submitted audits. Any such audit provided for in this paragraph may not go back for
more than three (3) years. If an Independent Certified Public Accountant, chosen by the
Lessor, audits the business operated hereunder, and finds that a fair representation of
the gross revenues understates Agreement revenue due the Lessor, the cost of the
[GM 14- 1801- 112/146894/1 ] 16
independent audit shall be borne by the Lessee; if the independent audit confirms the
fair representation of the Lessee or overstates Agreement revenue due to the Lessor,
the Lessor shall pay for the audit.
32. No sign of any type will be posted, erected, hung or otherwise placed in
view of the general public so as to advertise any product or identify the Food
Concession Complex unless permitted by the City of Clearwater Code of Ordinances,
as they now exist or as they may be amended, and unless authorized and approved by
the City Manager or their designee. However, the Lessee shall provide menu -type
board or boards to be placed inside the food concession area so that they will be plainly
visible to the public and list the food and drink items for sale with their corresponding
prices. Lessee also will place a sign inside the food concession area so it will be plainly
visible to the public, which states that the concession area and beach rentals are
operated by Lessee and not Lessor. The Lessor will be responsible for signs at the
entrance of the restrooms indicating appropriate gender. A sign denoting the price list
of all beach equipment rentals must be posted by the Lessee at the entrance to the
Food Concession Complex as well as at one other point must post from which the rental
of beach equipment has heretofore been authorized.
33. Restroom facilities must be kept clean and sanitary at all times and are
subject to inspection by Lessor. No coin - operated toilets or other coin - operated devices
will be allowed in the aforementioned restroom facilities except upon written
authorization of the City Manager. Lessee agrees to notify immediately the Lessor's
Police Department at any time the Lessee becomes aware of any activity that is a
violation of a law in the area of the Food Concession Complex.
34. Lessee's exclusive right, as referenced in Section 4 of this Agreement, to
rent beach equipment from the leased premises does not deny members of the public
the right to bring their own equipment for personal use.
35. All sales shall be recorded on a POS system and shall be maintained
three (3) years for review by Lessor's auditor. The Lessee shall maintain an adequate
set of books and records of its operation of the business of renting beach equipment
and the sale of food, beverages and sundries, and his books and records must be
provided to the City Manager upon request.
36. Public Records. Lessee shall comply with Lessor's requests for
documents to fulfill a public records request, as may be required by Fla. Statute 119. All
requests for public records will be administered by Lessor.
37. The Lessee will additionally provide Two Thousand Five Hundred
($2,500.00) Dollars per year of this Agreement to the Clearwater Beach Patrol
Lifeguards, in furtherance of supporting the safety of visitors to Clearwater Beach;
payable by January 30th for each year of the Agreement.
[GM14- 1801- 112/146894/1 ] 17
38. Lessee shall not advertise any business not operated at, on, or from the
premises without the prior written consent of the City Manager or their designee.
39. Lessee shall keep and provide a copy of their standards of operation to
Lessor within thirty (30) days of the date of this Agreement. Standards of operation
should include process for money collection and accounting thereof; as well as items
such as dress code, equipment repair and replacement, training program for
employees, maintenance training and customer relations.
Since the Lessee and Lessor are in a relationship to serve the needs of the
public and at the same time be as profitable as possible for both parties, the Lessor
reserves the right to not only review standards of operations and internal controls but
also to make suggestions and recommendations for improvement.
40. To keep beach rental equipment in "new or as new condition ". Lessee
shall provide a replacement and repair schedule for all rental equipment covered by this
agreement. New beach rental products, if offered, must be approved by the City
Manager prior to offering to the customers.
41. Each Party shall be responsible for its own attorneys' fees and costs in the
collection of any delinquent rent or additional payments or in the enforcement of any
provision of this Lease.
42. Miscellaneous.
a. The Lessor shall have the unrestricted right of assigning this lease at any time,
to a subsequent owner, and in the event of such assignment, the Lessor shall be
relieved of all liabilities hereunder.
b. This contract shall bind the Lessor and its assigns or successors, and the
Lessee and assigns and successors of the Lessee.
c. It is understood and agreed between the parties hereto that time is of the
essence of this contract and this applies to all terms and conditions contained herein.
d. It is understood and agreed between the parties hereto that written notice sent
by certified or registered mail, or hand delivered to the premises leased hereunder, shall
constitute sufficient notice to the Lessee, and written notice sent by certified or
registered mail or hand delivered to the office of the Lessor shall constitute sufficient
notice to the Lessor, to comply with the terms of this contract.
e. The rights of the Lessor under the foregoing shall be cumulative, and failure on
the part of the Lessor to exercise promptly any rights given hereunder shall not operate
to forfeit any of the said rights.
[GM 14- 1801 -112 /146894/1 ] 18
f. It is hereby understood and agreed that Lessee shall use no signs in
connection with the premises hereunder, except existing signs and signs inside the
building, which signs shall be subject to the prior approval of the Lessor.
g. It is understood that no representations or promises shall be binding on the
parties hereto except those representations and promises contained herein or in some
future writing signed by the party making such representations or promises.
h. It is hereby agreed that if any installment of rent or any other sum due from
Lessee is not received by Lessor within five (5) days after such amount shall be due,
Lessee shall pay to Lessor a late charge equal to five percent (5%) of such overdue
amount. The Lessor shall not be required to accept any rent not paid within five (5) days
subsequent of the date when due absent the simultaneous payment of this late charge.
The requirement for a late charge set out herein shall not be construed to create a
curative period or a grace period for the timely payment of rent.
i. The invalidity or unenforceability of any portion of this lease shall in nowise
affect the remaining provisions and portions hereof.
j. The Lessee herewith covenants and agrees that no hazardous materials,
hazardous waste, or other hazardous substances will be used, handled, stored or
otherwise placed upon the property or, in the alternative, that such materials, wastes or
substances may be located on the property, only upon the prior written consent of the
Lessor hereunder, and only in strict accord and compliance with any and all applicable
state and federal laws and ordinances. In the event such materials are utilized,
handled, stored or otherwise placed upon the property, Lessee expressly herewith
agrees to indemnify and hold Lessor harmless from any and all costs incurred by Lessor
or damages as may be assessed against Lessor in connection with or otherwise relating
to said hazardous materials, wastes or substances at anytime, without regard to the
term of this lease. This provision shall specifically survive the termination hereof.
k. The laws of the State of Florida shall govern this Lease, and any action
brought by either parry shall lie in Pinellas County, Florida.
IN WITNESS WHEREOF, the parties hereto have set their hands and seal this
ah� day of U te V,)W, , 2014.
Countersigned: CITY OF CLEARWATER
�WY Vo_f k�of
George N. Cretekos William B. Horne, II
Mayor City Manager
Approved as to form: Attest:
[GM 14-1801-112/146894/1] 19
Approved as to form:
Laura Lipowski Mahony
Assistant Cityaiagex Attorney
WI MESS
gnature
gel,. ?- /c1 r
Print Name
Si nature
Print N e
Cl ete, � By:
Attest:
it
Rosemarie Call
City Clerk
FIELDS, INC.
gnature
slu 44 A. yA.)Eriee..D
Print Name
ur
Print Name
5ty1
[GM 14- 1801- 112/146894/1 ] 20
Steven F. Chandler, President
isa M. Chandler, Secretary
LOCATION MAP
Exhibit A
Clearwater
Prepared by:
Engineering Department
Geographic Technology Division
100 S. Myrtle Ave, Clearwater, FL 33756
Ph: (727)562-4750, Fan: (727)5264755
www.MyCleanvater.com
Map Gen By: JB
MAP 1:
FOOD CONCESSION AND
RESTROOM COMPLEX BUILDING
Reviewed By: TM
Date: 3/3/2014
Grid #: 276A
S -T -R: 08- 29s -15e
Document Path: V: \GIS \Engineering\Location Maps 1REP 1.mxd
LOCATION MAP
Exhibit B
LL
Clearwater
u.
Prepared by:
Engineering Department
Geographic Technology Division
100 S. Myrtle Ave, Clearwater, FL 33756
Ph: (727)562-4750, Fax: (727)526-4755
www. M y C le a rw ate r. co m
MAP 2:
LLOYD, WHITE, AND SKINNER SUBDIVISION
LOTS 5 - 32
W E
S
Scale: N.T.S.
Map Gen By: JB
Reviewed By: TM
Date: 3/3/2014
Grid #: 276A
S -T -R: 08- 29s -15e
Document Path: V: \GIS \Engineering \Location Maps \RFP2.mxd
Exhibit C
HYATT CLEARWATER BEACH RESORT
BEACH CONCESSION CRITERIA QUALITY STANDARDS
FURNITURE (100)
Chaise lounge
Manufacturer: Tropitone Spinnaker chaise lounge chair with arms (Model #159932) (if
suitable for beach use)
Otherwise: Steamer /Deck Chair — Canvas
Manufacturer: Harrison & Todd
UMBRELLAS (60)
Aluminum pole
Cast aluminum stand -alone bases
Manufacturer: Galtech: Market Umbrella — 9' (or equal)
Sunbrella Fabric (mildew resistant/UV resistant)
CUSTOM BEACH CABANAS — 78" X 84" X 64" (40)
Marine grade fabric
SIDE TABLES (25)
Cast Aluminum _ 22" round x 17"
Manufacturer: Tropitone (or equal)
UNIFORMS
Tropical Shirt with Khaki shorts and skirt
White tennis shoes with white ankle socks
EMPLOYEES (2)
Properly groomed hair
Clean - shaven or well- groomed facial hair
Clean, neat overall appearance
Professional, courteous attitude
KEY ISSUE
Ability t� charge hotel guests on room account
LOCATION MAP
Exhibit D
L Clearwater
Prepared by:
Engineering Department
Geographic Technology Division
100 S. Myrtle Ave, Clearwater, FL 33756
Ph: (727)562-4750, Fax: (727)5264755
www. M y C le a rw ate r. co m
MAP 3:
LLOYD, WHITE, AND SKINNER SUBDIVISION
LOTS 5 - 32 AND HYATT HOTEL BOUNDARY
Map Gen By: JB
Reviewed By: TM
Date: 3/3/2014
Grid #: 276A
S -T -R: 08- 29s -15e
N
S
Scale: N.T.S.
Document Path: V: \GIS \Engineering \location Maps \RFP3.mxd
Exhibit E
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EXHIBIT "F"
AFFIDAVIT OF CRIMINAL BACKGROUND SCREENING
LESSEE NAME:
DATE:
By signing this form, I am swearing or affirming that all individuals employed by
(Lessee) or providing services to
City under the Lease Agreement on behalf of Lessee on City property have been
background screened in accordance with the background screening requirements set
forth in Lease Agreement and been deemed eligible by Lessee to provide services as
described in Lease Agreement. The information contained in this Affidavit is up to date
as of the date this Affidavit is furnished to City Parks and Recreation Department per
the requirements of Section 26 of the Lease Agreement.
All individuals providing services under the Lease Agreement on City property are listed
below. Each individual shall be identified by name, birth date and date deemed eligible.
(List of Individuals)
Signature of Affiant
Sworn to and subscribed before me this day of , 20
Notary Public
My Commission Expires:
My signature, as Notary Public, verifies the Affiant's identification has been validated by
[GM14- 1801- 112/146894/1 ] 26