Okaloosa County BOCC — February 11, 2013 — Destin Landings lease agreement, certificate of insurance and internal coordination sheet — reading text

850-651-7164 J Attn: David Miner SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. dA AUTHORIZED REPRESENTATIVE . ‘ Anna Kingman Ayes , ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD © 1988-2009 ACORD CORPORATION. All rifts reserved. NOV-19-e@61e 17:54 From: 8307921144 Pase:1/71 | FALCON INSURANCE AGENCY OF HOUSTON, INC. AVIATION INSURANCE SPECIALISTS P.O. BOX 489, HUMBLE, TEXAS 77347-0489 Office (281) 540-8822 * Fax (281) 540-8222 * (800) 880-8822 | REVISED CERTIFICATE OF INSURANCE ‘THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. This is to certify that policies listed below have been issued to the lusured camed below and are in force at this time. Notwithstanding any requirement of uny contract or other document with respect tu which this certificate may he issued or may pertain, the coverage provided by the policies described herein is subject to all the terms, conditions and exclusions of such policies. This is to certify to: Okaloosa County Airport Commission Attn: David E. Miner 1701 State Road 85 North Eglin AFB, Florida 32542-1413 that: Mike Mosing and Eagle Aero Inc 115 Wembley Road Lafayette, LA 70503 is at this date insured for the Limits of Coverage stated below Aircraft: 1982 Christian Eagle, N69EA 1981 L39ZA, N401ZA insurance Company: U.S. Specialty Insurance Company Kinds of Coverage Policy Number Expiring Date Limit of Coverage Aircraft Liability - Combined Liability for Bodily Injury and SA132749-11 10/09/13 $1,000,000 Each Occurrence Property Damage Incl. Passengers with Passengers sublimited To $100,000 cach person Aircraft Physical Damage Amount of Insurance All Risks Ground and Flight SA132749-11 10/09/13 $ 60,000 (N69EA) $400,000 (N401ZA) INSURING AGREEMENTS Okaloosa County Airport is named as an additional insured, but only with respect to liability arising out of Okaloosa County Airport’s ground storage or tiedown of the insured aircraft. We agree that in the event of cancellation of the policy(ies), we will endeavor to give the party to whom this certificate is issued 30 days Notice of such Cancellation, but the company(ies) shall not be liable in any way for failure to give such notice. Date: November 19, 2012 FALCON INSURANCE AGENCY OF HOUSTON, INC. : Bag eo Original: Okaloosa Coanty Airport ec: Mike Mosing and Eagle Aero Inc ec: U S Specialty Insurance Co > FALCON INSURANCE AGENCY OF HOUSTON, INC. ( PO Box 489 Humble, TX 77347-0489 INSURANCE Phone: 281-540-8822 * Fax: 281-540-8222 CERTIFICATE OF INSURANCE Certificate Holder: Named Insured: Okaloosa County Airport Clara L. Mosing c/o Mike Mosing and Okaloosa County Board of County Commissioners 115 Wembley Rd. Attention: David E. Miner Lafayette. LA 70503 1701 State Road 85 North Eglin AFB. FL 32542 Insurance Company [ USAIG-Dallas Policy Number | _ B-MOSO0S5H Policy Effective Date Policy Expiration Date 07/20/12 | 07/20/13 ead Description of Aircraft 1977 Beech Bonanza A36. N989BM 1946 Piper J-3 Cub, N88380 Type of Coverage Limit of Coverage reraft Physical Damage: All Risks Ground and Flight N989BM $169,000 Insured Value N88380 $22.500 Insured Valuc Aircraft Liability: Single Limit Property Damage and Bodily Injury $1,000,000 Each Occurrence including Passengers Policy Territory: USA. its territories and possessions. Canada, Mexico. Central America, the Bahama Islands and the Islands of the West Indies. or while enroute between these places. Special Provisions The following policy provisions are granted in favor of the Certificate Holder: 1. Additional Insured, but only for claims of bodily injury, mental anguish or property damage and specifically excluding claims for personal injury that result from the policyholder’s ownership, maintenance or use of the insured aircraft. 2. 30 days Notice of Cancellation, except 10 day notice with respect to non-payment of premium, or less notice for War Risks or TRIA. In any event, the there is no assumption of responsibility for failure to give such notice. Notice This certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This certificate does not amend, extend or alter the coverage afforded by the policies specified. This certificate of insurance does not constitute a contract between the issuing insurer(s) authorized representative or producer, and the Certificate Holder. This certificate is not valid unless signed by an authorized agent. The policies of insurance listed above have been issued to the Named Insured above for the Policy Period indicated. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this Certificate may be issued or pertain, the insurance afforded by the policies described herein is subject to all of the terms, exclusions, and conditions of such policies. .ggregate Limits shown may have been reduced by paid claims. Revised 1/25/2012 Authorized Agent signature Leta, <foprinene Date: 7. Jp G/1i—- CC: USAIG-Dallas