Okaloosa County BOCC — July 2, 2013 — Resort Development of Naples Cay - Hangar Renewal — reading text

INFORMATION PERILS INSURED | | BASIC | BROAD | | SPECIAL | x | wW/H EXCLD COMMERCIAL PROPERTY COVERAGE AMOUNT OF INSURANCE: $ 136540.00 DED:1000 AOP YES| NO |N/A ([] BUSINESS INCOME = [_] RENTAL VALUE If YES, LIMIT: | | Actual Loss Sustained; # of months: BLANKET COVERAGE If YES, indicate value(s) reported on property identified above: $ TERRORISM COVERAGE Attach Disclosure Notice / DEC IS THERE A TERRORISM-SPECIFIC EXCLUSION? IS DOMESTIC TERRORISM EXCLUDED? LIMITED FUNGUS COVERAGE lf YES, LIMIT: DED: FUNGUS EXCLUSION (If "YES", specify organization's form used) REPLACEMENT COST x AGREED VALUE COINSURANCE x lf YES, 80% EQUIPMENT BREAKDOWN (If Applicable) lf YES, LIMIT: DED: ORDINANCE OR LAW __ - Coverage for loss to undamaged portion of bldg ~ Demolition Costs If YES, LIMIT: DED: - Iner. Cost of Construction If YES, LIMIT: DED: EARTH MOVEMENT (If Applicable) lf YES, LIMIT: DED; FLOOD (if Applicable) If YES, LIMIT: DED: WIND / HAIL (If Subject to Different Provisions) lf YES, LIMIT: DED: PERMISSION TO WAIVE SUBROGATION IN FAVOR OF MORTGAGE HOLDER PRIOR TO LOSS CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ADDITIONAL INTEREST MORTGAGEE |__| CONTRACT OF SALE LENDERS LOSS PAYABLE NAME AND ADDRESS Okaloosa County Airport Authority 602C N Peal Street LENDER SERVICING AGENT NAME AND ADDRESS Crestview, FL 32536 AUTHORIZED REPRESENTATIVE Paula Barritt/PAULA <n ee ACORD 28 (2009/12) Page 1 of 2 © 2003-2009 ACORD CORPORATION. All rights reserved. INSQ28 (nn919) 04 Tha ACORN nama and Inan ara ranietarad marke af ACARN CHARTIS AEROSPACE INSURANCE SERVICES, INC. CERTIFICATE OF INSURANCE THIS IS TO CERTIFY TO: OKALOOSA COUNTY AIRPORT ATTN: DAVID MINER 1701 STATE ROAD 85N ELGIN, FL 32542 THAT THE FOLLOWING POLICY/IES OF INSURANCE HAS/HAVE BEEN ISSUED TO: AIRCRAFT OPERATORS, INC. 30 RUDNICK LANE DOVER, DE 19901-4912 AIRCRAFT POLICY NO. AV 007744212-03 POLICY PERIOD: From August 18, 2012 to August 18, 2013 INSURANCE COMPANY NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA LIABILITY COVERAGES LIMITS OF LIABILITY EACH PERSON EACH OCCURRENCE Bodily Injury Excluding Passengers $ $ Property Damage $ XXXX $ Passenger Bodily Injury $ $ Single Limit -- IN cluding Passengers, $ XXXX $ 2.000.000 PHYSICAL DAMAGE COVERAGE: PHYSICAL DEDUCTIBLES: IN-MOTION REGISTRATION INSURED DAMAGE NOT INGESTION NUMBER MAKE AND MODEL = YEAR VALUE COV. IN-MOTION MOORING N642WA PIPER PA31-350 CHIEF 1979 $ 500,000. F $ NIL $ NIL $ $ $ $ $ $ $ $ $ PHYSICAL DAMAGE Coverage Indentified F. Ground & Flight G.NotIn Flight =H. NotIn Motion OTHER COVERAGES/CONDITIONS/REMARKS THiS POLICY INCLUDES WAR HULL AND WAR LIABILITY COVERAGES. THE COMPANY AGREES TO PROVIDE CERTIFICATE HOLDER WITH THIRTY (30) DAYS (TEN (10) DAYS IF FOR NON-PAYMENT OF PREMIUM) NOTICE OF CANCELLATION. A certificate of insurance is issued as a matter of information only and confers no rights upon the certificate holder. A certificate of insurance does not amend, extend, or alter the coverage, terms, exclusions, conditions, or other provisions afforded by the policies referenced therein. If the policy referenced above is cancelled before the expiration date, notice of cancellation shall be provided to the certificate holder if such notice of cancellation has been included within this policy and/or endorsements attached thereto. Certificate No.___ 4 | ah July 19, 2013 TJP Date of Issue (Authorized Representative) CAV30 (06/12) RECEIVED APR 04 2013 , ed [ CONTRACT & LEASE INTERNAL COORDINATION SHEET Tracking Number: 877-13 Contract/Lease Number: Lox-oHe- Ap Contractor/Lessee Name: hese rt bev € Marks ley , PRE zrp! 67 Rewrewsh of Lease PU GREATER THAN $10,000 Date/Term: b£ wn (Gf ~ a3 [] $10,000 OR LESS #5 290,70 ~yoor plos tx s Dept. Monitor Name: fa vlad walasé Purpose: Aysount: Department : A rpev ts > x L/S Purchasing Review Procurement requirements are met: Oza Date: ws M3 Cottratts/Lease Coordinator Risk Management Review WOME We - Wai. Date: 4} 4 if Ss Risk Management Director 7 " County Attorney Review Date: fs Cotity Attorney Following Okaloosa County Board of County Commissioners approval: Contract & Grant Review Document has been appropriately reviewed aud is exectitable: Date: Contracts & Grants Manager REVISED BY BCC 3-21-00