Okaloosa County BOCC — 2013 meeting #1141 (date undetermined) — Hangar Renewal HGR — reading text

ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COVERAGE INFORMATION COVERAGE [ PERILS / FORMS AMOUNT OF INSURANCE DEDUCTIBLE Premise 011 Building 001 BUILDING(HANG. 280006 2500) (oo) CoN ! ine) Rie I Wi = REMARKS (Including Special Conditions) = GADd 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 NAME AND ADDRESS |__| MORTGAGEE | X | ADDITIONAL INSURED LOSS PAYEE LOAN# Okaloosa County Jack Allen 602C North Pearl Street AUTHORIZED REPRESENTATIVE Crestview, PL 32536 aa... i Co gip en ACORD 27 (2009/12) . . © 1993-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD L. XL. Group ‘ Insurance Reinsurance One World Financial Center 200 Liberty Street, 3 Floor New York, New York 10284 P: 212-915-7000 F: 212-945-0829 CERTIFICATE OF INSURANCE This Is To Certify To: Okaloosa County C/O Jack Allen 602C North Pearl Street Crestview, FL 32536 That The Following Policy(ies) OF = Maraja, LLC Insurance Have Been Issued To: 5320 Kennon Lane Bossier City, LA 71112 Policy Number: UA00008504AV13A Policy Period: From: _ May 22, 2013 To: May 22, 2014 Insurance Company: XL Specialty Insurance Company Liability Coverages Limits of Liability Each Passenger Each Occurrence Combined Single Limit Bodily Injury and Property Damage Including Passengers p XXX $ 2,000,000 Physical Damage Coverage: All Risks, Ground and In-Flight: Registration Make Insured Deductibles Number & Model Year Value In Motion Not In Motion N516NC Cessna 208 Caravan | 2008 $1,800,000 As Per Policy | As Per Policy Other Coverages/Conditions/Remarks: The certificate holder is included as Additional Insured under liability coverages, but only with respect to operations of the Named Insured. tn the event of cancellation, non-renewal or material changes of the policy(ies), the Company will provide the certificate holder 30 days notice prior of such cancellation and or material change. Certificate No. 3 Date of Issue May 22, 2013 A, _ ey A oe “sy jp. et hae Authorized Representative Noiwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the Insurance afforded by the policies described herein Is subject all terms, exclusions and conditions of such policies. This certificate does not amend, extend or otherwise alter the coverages afforded by tha policies described herein. Limits may have been reduced by paid claims, Certificate of Insurance 1 ©, 2011, XL America, Inc. GAIN 61: 80VE1L-7E-90 RECEIVED APR 04208 #- 2-13 CONTRACT & LEASE INTERNAL COORDINATION SHEET Contract/Lease Number: LOG o2ss fiP Tracking Number: 6-13 H6-R B? 6% roeetmerts Lee. EYP S- 1f Contractor/Lessee Name: Pewew eh af Lease pate‘Tarm: S719 AOS 74 GREATER THAN $10,000 & tus tox [_] $10,000 OR LESS Amount: Rated PO an Yer plus Dept. Monitor Name: Devld malate Purpose: Department: Aor port's y-t3 [ Purchasing Review eT Dg. are met: CL EE pate: 44/a/iz Contricts/Lease Coordinator | Risk Management Review Approved as wi | WY/ Date: YiL L So | Risk Management Director County Attorney Review pa L124 1S * Follawing Okaloosa County Board of County Commissioners approval; Contract & Grant Review Document has been appropriately reviewed and is executable: Date: Contracts & Grants Manager REVISED BY BCC 3-21-00