Okaloosa County BOCC — May 17, 2016 — AOL Div Prom to Mr. Smith — reading text

%AW fl-/ 0/7’// é * \\ a a s % 5, .0 2y -v ''''''''' ~OELA cO.w Peuanue ACORD k.-—/ CERT IFICATE OF LIABILITY INSURANCE DATE (MMWDD/YYYY) 4/27/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DNL BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, ¥ AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES TE A CONTRACGT BETWEEN THE ISSUING INSURER(S), AUTHORIZED IMPORTANT: If the cetificate holder is an ADDITIONAL INSURED, the the terms and conditions of the policy, certain p certificate holder in ligu of such endorsement(s) olicies may require an endorsement. A statement on this cortificate does not confer rights io the policy(ies) must be endorsed. If SUBROGATION I8 WAIVED, subject to PRODUCER Liufau MeCall Insurance Group L ——srr ) PH&’.JI‘}EQL&(D: (8?(“)) 460~7480 | A% n): (850) 460-7295 36008 Fmerald Coast Pkwy AmiEss, James@lmigflorida. com e Suite €01-8 ] INSURER(S) AFFORDING COVERAGE | NAIC # Destin FL. 32541 INSURERA:Covington Specialty Insurance Co. . INGURED INSURER 8 Robaxt & Snith INSURER C ¢ P O Box B46 »@SQRERD: - i INSURERE: S S Starksville M8 38760 INSURER F ; COVERAGES CERTIFICATE NUMBER:CL1642700262 REVISION NUMBER: THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LIST! INDICATED. - NOTWITHETANDING ANY REQUIREMENT, TERM CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSU EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS 8 ED BELOW HAVE BEEN.ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS RANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSH ADDL/SUBR CEEE T Y E, ’ LR TYPE OF INSURANGE 1 POLICY NUMBER (fifi;flmfi}fim}& LIMTS X | COMMERCIAL GENERAL LIABILITY EACH OCGURRENCE . 14 1,000,000 il Mk ; . SRR S L R skl A | GLAIMS-MADE b{] OCCUR Lfifli flé ME KISES {EEED’W‘ EWGD resl |8 100,000 1 X TBD 5/15/2016 | 5/15/2017 | mED EXP (Arycreperson) | § 5,000 - — - PERSONAL & ADVINJURY. | 8 1,000,000 | GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 3 2,000,000 X |pouev | J5B% | Jiee PRODUCTS = GOMPIOP AGG | § _BHCL OTHER: Employss Befiefits $ AUTOMOBILE LIASILITY &oMgg;éEEflsWGLE [£17]7 S ANY AUTO BODILY INJURY. {Per persony | $ TTIALLOWNED - [T ) seeepuleEn | e ; . . AUTes i 7 ATee ; BODILY INJURY:(Per accident} | § ] _| wrEp awros | e beiogi MAGE 5 | $ {UMBRELLALIAB | | gecur | EACH OCCURRENCE $ - . [ FXCESSLIA 1 CLAIMS-MADE AGGREGATE $ T = - ! = oeo | | Reventions - § WORKERS COMPENSATION I TPER T IO ANIX EMPLOYERS' LIABILITY vIin L. istarue | {ERT i} ANY PROPRIETORIPARTNERIEXECUTIVE | E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? | NIA - - {Mandatory in NH} - E.L DISEASE - EA EMPLOYEE § I yas, deseribe undar o DESCRIPTION OF OPERATIONS balow EL DISEASE - POLICY LIMIT | § { ] DEECRIPTION OF OPERATIONS T LOUATIONS / VEHICLES (ACORD 101, Additional Remarks Bohedule, may be attachad if more space is requlred) Airplane hangar located at 1001 Airport Rd; Destin, FL 32541. Annual premiwe is $1,171.17 paid in full. Okaloowa County is listed as additional insured. CERTIFICATE HOLDER CANCELLATION Okaloosa County 5749 A 0ld Bethel Rd Crestview, ¥FL 32536 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUG7 PROVISIONS, i AUTHORE; REFRESENTATY ACORD 25 (2014/01) INS025 (201401) The ACORD name and logo are regi¥tered marks of AC © 1988-2014 ACORD CORPORATION. All rights reserved. D o I8 DATE (MM/DOTYYY ACORD EVIDENCE OF PROPERTY INSURANCE 4/27/2026 THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENGE OF INSURANGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE 13SUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. ) AGENCY [BHORE " (850) 460-7450 | company Liufau McCall Insurance Group Covington Specialty Insurance Company 36008 Emerald Coast Pkwy 8381 Dix Ellis Trail Buite 601-B Suite 100 Destin FL 32541 , Jacksonville FIL. 32256 FAX o (850) 460-7455 |Ema james@imigflorida.com COpE: [ sus cone: GiSTomering; 00001060 o , o , I : INSURED LOAN NUMBER POLICY NUMBER Rebert A Smith ) k) - ] 7 P O Box 846 ERFECTIVE DATE EXPIRATION DATE {_ CONTINUED l;r;mL - 5/15/2018 5/15/2017 L!Lj TERMINATED) IF CHECKED Btarksville M8 39760 THIS REPLACES PRIOR EVIDENGE DATED: PROPERTY INFORMATION LOCATION/DESCRIPTION Airplane hangar located at 1001 Airport Rd. Destin,FL 32541 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING -ANY REQUIREMENT, TERM OR CONDITION. OF ANY CONTRAGT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAY BE 1SSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 18 SUBJEGT TO ALL THE TERMS, EXCLUSIONS AND COND(TIONS OF SUGH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COVERAGE INFORMATION ) COVERAGE / PERILS { FORMS _ o AMOUNT OF INSURANCE .| DEDUCTIBLE Building $100,000 £5,000 REMARKS {mncluding Special Conditions) Annual premium $1,171.17 paid in full. Okalocssa County is listed as additional insured. 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 X | ADDITIONAL INSURED Ckaloosa County || tosspavee 5749 A 01d Bethel Rd LOAN# Crestview, FL 32534 AUTHGRIZES REPR7T ACORD 27 {2009/12) @ Ygss-zo(‘itxcoran CORPORATION. All rights reserved. IN8027 (200912)02 The ACORD name and logo are registered marks of ACORD GLOBAL AEROSPACE o, (% 4 GLOBAL AEROSPACE, INC C FE R T 1 T C A T E o F I N S U R A N C E THIS CERTIFICATE IS GIVEN AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ADDRESSEE. Date: April 19, 2016 This is to certify to: that the policies listed below have been issued to the following for the period indicated by One of More Member Companies of Global Aerospace Pool through Global Aerospace, Inc: Okaloosa County Robert Smith 5749 A Old Bethel Road P.O. Box 846 Crestview, FL 32536 Starkville, MS 39760 Policy No: 10174310 Policy Period: From January 23, 2016 to January 23, 2017 COVERAGES: Aircraft Liability Limits of Liability Single Limit Bodily Injury and Property Damage $1,000,000 $100,000 Liability Including Passengers Each Occurrence Each Passenger AIRCRAFT: Year, Make and Model of Aircraft Identification No. 2004 BEECH A36 N364BG It is agreed that only as respects any written agreement between the Named Insured and the certificate addressee and entered into as a prerequisite to the use of an airport by the Named Insured: 1. As respects any aircraft; a) Described in this certificate, b) Which is the subject of the extended insurance provisions of Insuring Agreement V. TEMPORARY USE OF SUBSTITUTE AIRCRAFT; or ©) Which is the subject of the extended insurance provisions of Insuring Agreement VII. AUTOMATIC INSURANCE FORNEWLY ACQUIRED AIRCRAFT for which insurance is afforded by Liability Coverage D - Single Limit Bodily Injury and Property Damage Liability and the maintenance or use of the premises in or upon which the aircraft is stored, the definition of Insured includes the certificate addressee, but only with respect to its liability because of acts or omissions of the Named Insured and to no greater extent than the scope of the insurance afforded by this policy. 2. Unless otherwise indicated in this policy, the policy shall not apply to any assumption of the liability of the certificate or airport authority described in the Schedule by the Named Insured for bodily injury or property damage caused by an occurrence arising out of any service performed by or on behalf of the certificate addressee. 3. In the event the policy is cancelled by the Company, thirty (30) days prior written notice shall be given to the certificate addressee, 4, The Company waives any right to recovery it may have against the certificate addressee because of payments it makes for physical damage in accordance with Insuring Agreement Il - PHYSICAL DAMAGE COVERAGES, but only to the same extent that the Named Insured has waived its right of recovery for such physical damage against such person or organization. GW_Z005 : Page 1 of 2 5. The insurance the policy provides to the certificate addressee is primary insurance, without right of contribution from insurance purchased by the certificate addressee, only if the written agreement between the Named Insured and the certificate addressee contains an express requirement that the insurance operate in that manner. 6. Premises Liability is included in the Limits of Liability shown as the Each Occurrence Limit. 7. The insurance afforded applies separately to cach Insured against whom claim is made or suit is brought, except with respect to the limits of the Company's Hability. Notwithstanding 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 to all the terms, exclusions and conditions of such policies. This certificate does not amend, extend or otherwise alter the coverages afforded by the policies described herein. Limits may have been reduced by paid claims. GLOBAL AEROSPACE, INC. BY: GW_Z005 Page 2 of 2 ADDITIONAL INSURED - GOVERNMENT OR AIRPORT AUTHORITY In consideration of the payment of the premium for this policy, it is agreed that only as respects any written agreement between the Named Insured and the government or airport authority described in the Schedule and entered into as a prerequisite to the use of an airport by the Named Insured: 1. Asrespects any aircraft: (a) Described in Item 4 of the Declarations, (b) Which is the subject of the extended insurance provisions of Insuring Agreement V. TEMPORARY USE OF SUBSTITUTE AIRCRAFT; or (c) Which is the subject of the extended insurance provisions of Insuring Agreement VII. AUTOMATIC INSURANCE FOR NEWLY ACQUIRED AIRCRAFT for which insurance is afforded by Liability Coverage D - Single Limit Bodily Injury and Property Damage Liability and the maintenance or use of the premises in or upon which the aircraft is stored, the definition of Insured includes the government or airport authority described the Schedule, but only with respect to its liability because of acts or omissions of the Named Insured and to no greater extent than the scope of the insurance afforded by this policy. 2. Unless otherwise indicated in this policy, the policy shall not apply to any assumption of the liability of the government or airport authority described in the Schedule by the Named Insured for bodily injury or preperty damage caused by an occurrence arising out of any service performed by or on behalf of such government or airport authority. 3. Inthe event the policy is cancelled by the Company, thirty (30} days prior written notice shall be given to the government or airport authority described in the Schedule. 4. The Company waives any right to recovery it may have against the government or airport authority described in the Schedule because of payments it makes for physical damage in accordance with Insuring Agreement lil - PHYSICAL DAMAGE COVERAGES, but only to the same extent that the Named Insured has waived its right of recovery for such physical damage against such government or airport authority. _ 5. The insurance this policy provides to the government or airport