Okaloosa County BOCC — July 6, 2016 — AOL Stanley Gordon B 8 L 5 for Agenda — reading text

coverages as respects operations of the Named Insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE GANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Okaloosa County ACCORDANCE WITH THE POLICY PROVISIONS. 5749 A OId Bethel Road AUTHORIZED REPRESENTATIVE iew, FL 32536 Crestview, FL 3253 Tucker Wenk Deeter © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NO.: NAB4043264 ATTACHED TO CERTIFICATE # 1 Cerlificate # 1 CERTIFICATE OF INSURANCE THIS IS TO CERTIEY. TO: Qkaloasa County 5749°A Old Bethel:Road Crostview FL 32536 THAT THE FOLLOWING POLICY OF INSURANCE HAS BEEN ISSUED TO: JSG Aviation, LLC c/o Jeffrey Gordon 715 Alta Vista Road Louisville, KY 40299 POLICY NUMBER: NAB4043264 POLICY PERIOD: From December 21, 2015 To December 21, 2016 INSURANCE COMPANY: Catlin Insurance Company, Inc. DESCRIPTION OF COVERAGES AND LIMITS OF LIABILITY: Please refer to attached schedule which is incorporated as a part hereof. Additional Insured: Thie Estate of Stanley: J. Gordon; Jr. The ‘above Certificate Holder s included as an:Additional Tnsured 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 Operations. Subject to Date Change Recognition Endorsement. Data included in this Certificate valid as of June 23, 2016. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions and conditions of such policies. Shouid the described policy be cancelled before the expiration date hereof, the issuing company will endeavor to give 30 days (10 days for non-payment) notice to the certificate holder named herein. However, failure to mail such notice shall not impose any obligation nar any liability of any kind upon the Company, its representatives or agents. By: W”'J Date of Issue: June 24, 2016 W. Brown & Associates Insurance Services Certificate No.. 1 Page 1 of 2 POLI CY NO.: NAB4043264 ATTACHED TO CERTIFICATE # 1 SCHEDULE OF AIRCRAFT DESCRIPTION OF AIRCRAFT No. [FAA Cert# |Serial # Year/Make/Model Insured Value 1 |N700KM 158 2000 Socata TBM 700B EFIS $1,000,000 PHYSICAL DAMAGE COVERAGE Deductibles No. Not In Motion In Motion Physical Damage Coverage 1 $2,500 $2,500 F. All Risk Basis AIRCRAFT LIABILITY COVERAGES Single Limit Bodily Injury Passenger Passenger Liability Limited To No. & Property Damage Liability Each Person Each Occurrence 1 $1,000,000 Included XXXX XXXX MEDICAL EXPENSES No. Including Crew Each Person Each Occurrence 1 Yes $5,000 $30,000 Certificate # _1_ Page 2 of 2 : &%T E 26255 American Drive ' Southfield, MI 48034-6112 N Tel: (800) 482-2726 CERTIFICATE OF INSURANCE THAT THE FOLLOWING POLICY/IES OF INSURANCE HAVE BEEN ISSUED TO: JSG Aviation, LLC, 715 Alta Vista Road, Louisville, KY 40299 POLICY NO. NDD0864773-01 POLICY PERIOD: From April 1,2016 To April 1, 2017 Coverage only applies as indicated by a specific limit and deductible. Limits of Liability A. Aircraft Liability Single Limit for Bodily Injury and Property Damage Including Passengers Liability $_1,000,000. each occurrence with Passenger liability Limited to $__100,000. each passenger B. Medical Expense Including crew $ 5,000. each passenger C. Physical Damage to Your Aircraft Deductibles Physical Not in ID Number Year Make and Model Agreed Value Damage motion In motion N526CC 2014 CubCrafters Carbon $ 260,000. F $ 100. $ 500. Cub (wheels) $ 8 $ $ 5 3 $ $ $ 5 $ $ 5 $ $ PHYSICAL DAMAGE Coverage Identified F. All Risk Basis G. Al Risk Not In Motion 7 S INSURED AS RESPECTS TO THE OPERATION OF THE INSURED AIRCRAFT. IN THE EVENT OF CANCELLATION, THIRTY (30) DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT OF PREMIUM) SHALL BE PROVIDED FOR THE ABOVE CERTIFICATE HOLDER. The Aviation Managers have made provision to give the certificate holder prompt notice of cancellation of any policy above. But, the Aviation Managers assume no responsibility for failure to provide such notice. This certificate does not change in any way the actual coverages provided by the policy/ies specified above. Certificate No. 3 ~ - [ -*( fi \ Y i ; < X Date of Issue: 6/24/2016 BY (Authorized Representative) 5105 Al 1010 Page 1 of 1 0611712016 13:24 Henk Aviation Insurance (FAX)8472352559 P.002/003 POLICY NO.: NABG001920 ATTACHED TO CERTIFICATE # 1 CERTIFICATE OF INSURANCE THIS 1S TO CERTIFY TO: Oskaloosa County Contracts & Legse Coordinator 602-C N Pearl Strest Crastview FLL 32536 THAT THE FOLLOWING POLIGY OF INSURANCE HAS BEEN ISSUED TO: WD Aviation, Inc. and §. Jay Gordon c/o S, Jay Gordon 240 Gulf Shora Dr., #6533 Deastin, FL 32541 POLICY NUMBER: NABG001920 POLICY PERIOD: From June 20, 2016 To Juhe 20, 2017 INSURANCE COMPANY: American Alternative Insurance Corp, DESCRIPTION QF COVERAGES AND LIMITS OF LIABILITY: Please refer to attached schedule which Is Incorporated as a part hersaf. The above Certlficate Holder is included as an Additional Insured but only to the extent of liability imposed upen the Addittonal insured salely as the result of 2n act or omission of the Named [nsured or its employses In connaction with the Named Insurad's Operations. Subject to Date Change Recognition Endorsement. Data included in this Certificate valid as of June 20, 2016. This certificate of insurance is not an Insurance polley and does not amend, extend or alter the coverage afforded by the policy llsted hereln. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certlflcate of Insurance may bs Issued or may pertain, the Insurance atforded by the pelicy descrlbed hereln la subjsct to all the ferms, exclusions and conditions of such policles, Should the described policy b cancslled before the expiration date hereof, the issuing company wil endeaver to give 30 days (10 days for non-paymeant) notice fo the certificate holder named harein, However, failure to mail such notlee shaill nat Impose any obligation nar any liability of any kind upon the Company, its representatives or agsnts. By: W‘MJ Date of Issue: Juna 17, 2018 W. Brown & Assoclates Insurance Services - Cortificate No.; 1 1 4 Certificate # 1 Page 1 of 2 0601712016 13:24 Wenk Aviatioh Insurance (FAX)8472352559 P.003/003 POLICY NQ.: NABGDD1920 ATTACHED TO CERTIFICATE # 1 SCHEDULE OF AIRCRAFT DESCRIPTION OF AIRCRAFT No, [FAA Cert# {Serinl # Year/Make/Mada| Ingured Value 1 NE25WD 525A0107 2002 Cessna Citation C.J2 525A $2,700,000 PHYSICAL DANMAGE COVERAGE Daductiblas Na. Not In Motion in Motion Physical Damage Coverage 1 NIl NII F. All Rlsk Basls AIRCRAFT LIABILITY COVERAGES Single Limit Bodily Injury Passanger Paszzanger Liabliity Limited To No. & Property Damage Liability Each Petgon Each Qcourrance 1 $5,000,000 Included KAXK XUXX MEDICAL EXPENSES Na, Including Crew Each Parson Each Occurrence 1 Yes $8,000 §48,000 Cartificate # 1_ Page 2 of 2