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Okaloosa County BOCC — July 2, 2013 — AOL Rankin Hangar — reading text
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not change in any way the actual coverages
provided by the policy(ies) specified above.
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
CERT NO.; 16989785 CLIENT CODE: 36278 Leslie Riskin 9/22/2013 12:24:10 PM Page 3 of 3
ADDENDUM/DOO
StarNet Insurance Company
This endorsement changes the policy please review carefully
ADDITIONAL INSURED ENDORSEMENT — AIRCRAFT LIABILITY
Itis hereby understood and agreed that the policy is amended as follows:
The following is included as an Additional Insured under Aircraft Liability coverages, but only with
respect to the operations of the Named Insured.
Schedule:
Okaloosa County Airports
602-C N. Pearl Street
Crestview, FL 32536
All other terms and conditions remain unchanged.
This endorsement is part of your Policy and takes effect on the effective date of your Policy,
unless another effective date is shown below.
Date Issued: July 12, 2013
Policy Number: BA-12-09-00139
Issued To: Emerald Coast Aero, LLC
Effective Date: July 12, 2013
Endorsement No.: 15
SLEEP,
Authorized Signature
AL 74 246 04 10
© 2010 StarNet Insurance Company Page 1 of 1
Includes material copyrighted by Insurance Services Office, Inc., with its permission
CONTRACT & LEASE INTERNAL COORDINATION SHEET
G1e- 13
Contract/Lease Number: £02 O18 Y-P Tracking Number: Gals
Contractor/Lesses Name: Merk. Ma Re pkey Gront Funded: YES__ NOS
Pro. ( Hanger \ dy Kinerald Coast Aero Lic
1. [) GREATER THAN $50,000
Purpose:
Date/term: [714 = 0%
Amount: "3,425 0 _plys tox annvnlly 2. [XL GREATER THAN $25,000
Department:___ ft pets 3. 7] $25,000 OR LESS
\
Dept. Monitor Name: f\a vind wr! rer
Document has been reviewed ond includes any attachments or exhibits,
Purchasing Review
Pr ni requirements are met:
Date: bh9f3
Chastig Director or designee
Risk Management Review
Risk Manager or designee
we
County AHomey Review
tpyed AS written:
Ab/ 13
ed Dote:
Couhty’Attorney =““\
Fallowing Okaloosa Caunty approval:
Contract & Grant
Document hos been received:
Date: __.
Contracts & Grants Manager