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Okaloosa County BOCC — May 15, 2013 — AOL Agarwal to Greenway 5-14-13 — reading text
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30,000 $ ,i II i
LIAB. TOTAL: $~S~
ITEM 5. Description of Aircraft and Physical Damage Coverage hereunder: '1 11 ,
rI' I
F.A.A.
REG. SEATS INm' D
AIRCRAFT NO. YEAR MAKE AND MODEL TYPE CREW PASS. V
1. N828M 1980 BEECH 55 BARON LAND 1 5 $15 '100
PHYS I CAL DAMAGE DEDUCTIBLE~ II I
COVERAGE PREMIUM
NIL ON FIRE AND
NOT IN MOTION IN M
T
N
thE
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1. F: ALL RISK: GROUND & FLIGHT $ 1,840 $ 100 $ W~ 0 i
PHYSICAL DAMAGE TOTAL: $1,840 POLICY PREMIUM: st'l 5
ST SURTAX: \'!!S' 1
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OLD REPUBLIC INSURANCE COMPANY
DECLARATIONS
POLICY NUMBER AV 11412201 PAG 2
ITEM 6. Pilots: When in flight the aircraft will be piloted only by the'
following pilots, provided he/she has a valid pilot's certificate and a
valid medical certificate, each appropriate to the flight and the aircr
RODNEY GREENWAY;
ANY PRIVATE, COMMERCIAL OR ATP PILOT, WITH MULTI ENGINE AND INSTRUMENT
RATINGS PROPERLY CERTIFICATED BY THE FAA HAVING A MINIMUM OF 1,500 TOT
I
LOGGED FLYING HOURS, 500 OF WHICH HAVE BEEN IN MULTI ENGINE AIRCRAFT, .
INCLUDING NOT LESS THAN 50 HOURS IN THE SAME MAKE AND MODEL AIRCRAFT IN D,
HEREIN.
ITEM 7. The aircraft will be used for PLEASURE & BUSINESS
Endorsements forming a part of this policy on effective date in Item 2 e
AV518(06-09) , AV375(03-04), AV453(06-00) , AV460(09-04), AV437(12-04) ,
AV469(09-04) , AV822(02-92), 2000a(03-01), AV48C(01-07), PA313 (02-05) ,
PDPAM(01-08), CTXGA(01-08), GFMEX(08-11).
ITEM 8. LOSS PAYABLE: Any loss under coverage F or G is
may appear to the named insured and/or
AS ENDORSED
ITEM 9. The named insured is and shall remain the sole and
owner of the aircraft and the aircraft is not subject to any C.J'~~"'~/4
other than as indicated in Item 8.
PRODUCER: AIRSOUTH INSURANCE, INC.
POST OFFICE DRAWER 6727
DOTHAN AL 36302
Countersigned 2 Phoenix Aviation Managers, I
By __~__~__~~~______~~~-. Approved by ~~~~~~~~~~~~~14~
(Authorized Representative)
PAM-AV1A (0786)
I CONTRA CT & LEASE 1
r INTERNAL COORDINATION SHEET I
ContrllctlLease Number: 1.,. i. JiS-l)OI3 -:8f' Tracldng Number: Sll../ )
ContuctorlLcssee Name: It"""'~ fbilC.t~
Purpose: A:t$:~ t.,...,.. -f-l> R.-I.AICj&"_~
Date/Term: il.-l ,- "J..!f'" ~GREATER TBAN $10,000
Amount:
ff..
,.r
3, ~tf, If) y'''''''' ,'"'' ~ .L .. 0 $10,000 OR LESS
Department: ft'~ tf",. . . .ts Dept. Monitor NaJlle: _ 0 ""'~..{ ~....... y
Purchasing Review
Date; ~_B.v;,-:.J
. . . __
I')_ _
Risk Mtvt.Qgement RI!JJ1.ew
APP~
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Risk ~nqemellt irector
County A.ttorney Review
Following Ohloosil County Board ofCc'Unry Commissioners approval:
Contract & GI'4J1t Review
Document has been appropriately.reviewed and is executable:
Contracts & Grants Manager
Date:
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REVISED BY Bce 3-21~OO