Okaloosa County BOCC — December 2, 2014 — Ludwig Sub Lease Rigdon 11-18-14 — reading text

BAPER $ EA PASS $ AGGR / | INCLUDING CREW MEDICAL PAYMENTS + $ 5,000 | EAPER EXCLUDING CREW ; COVERAGE CODE DESCRIPTION OPTIONS LIMIT APPLIES TO = | LIMIT APPLIES TO |_| |_| $ $ $ $ | [| $ $ $ $ || | $ $ $ $ DESCRIPTION OF OPERATIONS / REMARKS (Attach ACORD 101, Additional Remarks Schedule, if more space is required) *Landlord --See Attached Remarks Schedule-- CERTIFICATE HOLDER CANCELLATION Rigdon Family Giving Trust Hangar* 4502 Olde Plantation Place Destin FL 32541 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 ed \ weed Tony Park ACORD 21 (2009/12) CERT NO.: 22396554 Natalie Strahl 11/18/2014 2:30:29 PM {PST} Page 1 of 3 © 2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE ISSUED CERTIFICATE OF INSURANCE 11/18/2014 ADDENDUM (Schedule of Aircraft) CERTIFICATE HOLDER: NAMED INSURED: Rigdon Family Living Trust Hangar Rigdon Family Giving Trust Hangar* dba Rebel Services, LLC 4502 Olde Plantation Place 4502 Olde Plantation Place Destin FL 32541 Destin FL 32541 This is to certify that the following policy(s), subject to the terms, conditions, limitations and endorsements contained therein, and during their effective period, have been issued by the company(s) indicated below. In the event of material change or cancellation of said policy(s), the company will endeavor to notify the certificate holder, but failure to do so shall impose no liability or obligation of any kind upon the undersigned or the company(s) involved. N Number Year Make Model Serial No. Crew Pax Hull Value Liability Limit N717TR 1982 Cessna 550 1 7 $795,000.00 $10,000,000.00 Bramar Associates 2135 Golden Hill Road Paso Robles, CA 93446-2285 805.237.0666 805.237.0690 CERT NO.; 22396554 Natalie Strahl 11/18/2014 2:30:29 PM (PST) Page 2 of 3 AVIATION ADDENDUM (Schedule of Aircraft) @ ACCORD ADDITIONAL REMARKS SCHEDULE Page AGENCY CUSTOMER ID: LOC #: of AGENCY Berkley Aviation (A Berkley Company) POLICY NUMBER CARRIER NAIC CODE NAMED INSURED Rigdon Family Living Trust Hangar dba Rebel Services, LLC 4502 Olde Plantation Place Destin FL 32541 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 21 FORM TITLE: ACORD 21 ((12/09)) CERTIFICATE HOLDER: Rigdon Family Giving Trust Hangar* ADDRESS: 4502 Olde Plantation Place Destin FL 32541 conditions and exclusions. Notwithstanding any requirements, exclusions of such policy. The Company has to provide such manufacturers, repairers, modification, manufactures, repairers, modification, cancellation of any policy above. But, Additional Insured Provision: Scheduled Person or Organization: Certificate Holder is included as an Additional Insured under Aircraft Liability Coverages, but only to the extent of liability imposed upon the Additional Insured solely as the result of an act or omission of the Named Insured or its employees in connection with the Named Insured’s Aircraft operations, subject to all policy terms, limits, Notice of Cancellation Provision: 30 day's The Company's rights of recourse: This Certificate does not provide coverage for the Additional Insured with respect to claims arising out of their legal liability as suppliers or servicing agents and shall not operate to prejudice the Company's rights of recourse against the Additional Insured as suppliers or servicing agents where such rights of recourse would have existed had this Certificate not been affected under this policy. (10 day's for non-payment of premium) prior written notice to the Certificate Holder in the event of material change in the policy or in the event the policy is cancelled by the Company. terms or conditions of any contract or other document with respect to which the Certificate may be issued or may pertain, the Insurance afforded by the policy(ies) described herein is subject to all the terms, conditions, limits and made the provision to give the Certificate Holder prompt notice of the Company assumes no responsibility for failure notice. This Certificate does not change in any way the actual coverages provided by the policy(ies) specified above. It is agreed that the ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERT NO,: 22396554 Natalie Strahl 11/18/2014 2:30:29 PM (PST) Page 3 of 3 ADDENDUM/DOO Dave Miner From: Krystal King Sent: Thursday, November 13, 2014 4:32 PM To: Dave Miner Subject: RE: Certificate of Insurance Per our conversation, the lessee, Rigdon Family Trust needs to show insurance. So if Rigdon Family Trust is doing business as Rebel Services then the insured needs to be listed as Rigdon Family Trust DBA Rebel Services. hispstal tieg Okaloasa County Risk Management (8a0)689-0977 Fax (800)689-0973 Please note: Due to Florida's very broad public records laws, most written communications to or from County employees regarding County business are public records available to the public and media upon request. Therefore, this written email communication including your email address, may be subject to public disclosure. From: Dave Miner Sent: Thursday, November 13, 2014 2:49 PM To: Krystal King Subject: Certificate of Insurance Krystal: Please review the attached sub lease and certificate of insurance and let me know if | can send this to the Board for approval. Thank you. Dave David E. Miner Properties and Leases Okaloosa County Airports (850) 651-7160 Ext. 4 www.flyvps.com "Please note: Due to Florida's very broad public records laws, most written communication to or from County employees regarding County business are public records, available to the public upon request. Therefore, this written e- mail communication, including your e-mail address, may be subject to public disclosure."