Okaloosa County BOCC — August 24, 2013 — American Airlines Amendment No. 1_Internal Coordination Sheet_Certificates of Insurance — reading text

Coverage C, Comprehensive General Liability. pe S bn 7, Q oclda” f eevwen By: Captive Manager Aon Insurance Managers (Bermuda) Ltd. Captive & Insurance Management Aon House | 30 Woodbourne Avenue | Pembroke HM 08 | Bermuda t +1.441.295.2220 | f +1.441.292.0217 | aon.com 6/26/2013 4AAINC / Standard / 6319 CAL 06 12 Attachment to Certificate No. 6319 and 631» : 2b. ADDITIONAL INSURED: "As required by contract, but subject to the terms, conditions and exclusions of the policy, Okaloosa County and its past, present and future officers, members, Airports Director, employees and agents is (are) included as additional insured(s) as respects operations performed by or for the named insured for all coverages evidenced on this certificate." 3b. CANCELLATION NOTICE: "In the event the Aircraft Liability, Aircraft Hull Insurance, Comprehensive General Liability, Excess Automobile Liability, Excess Employers Liability, or Excess Cargo Legal Liability & Shipper’s interest insurance described on this certificate of insurance is cancelled, non-renewed or there is a reduction in coverage/material change which affects the interest of Okaloosa County, or if this insurance is allowed to lapse for non-payment of premium, the insurers agree to provide thirty (30) days prior written notice of such cancellation, change or lapse to Okaloosa County." 5a. CONTRIBUTING INSURANCE: "As required by contract, but subject to the terms, conditions, and exclusions of the policy, the policies described on this certificate are primary without right of contribution from any other insurance which is carried by Okaloosa County." —— ACORIY Ne CERTIFICATE OF LIABILITY INSURANCE 5),50:4 DATE (MMIDDIYYYY) 8/14/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DALLAS TX 75201. EWA (AS, No: 214-969-6700 | ADDRESS: NSURER(S) AFFORDING COVERAGE NAIC # INSURER A: New Hampshire Insurance Company 23841 INSURED — AMR Corporation and its subsidiaries INSURER B: 1366502 P.O. Box 619616 _ INSURER C : Dallas/Ft. Worth Airport TX 75261 INSURER D: [INSURER E : INSURER F : COVERAGES AMRCOO1 CERTIFICATE NUMBER: 12485529 THIS IS TO CERTIFY THAT 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. REVISION NUMBER: XXXXXXX INSR TYPE OF INSURANCE {BOL BUR POLICY NUMBER MUDDY YEY Y) MM/S) LIMITS GENERAL LIABILITY EACH OCCURRENCE gs XXXXXXX NOT APPLICABLE IDAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY IPREMISES (Fa occurrence) S$ XXXXXXX | cLaims-MADE OCCUR IMED EXP (Any one person) $ XXXXXXX PERSONAL & ADV INJURY _|$ XXXXXXX = IGENERAL AGGREGATE ¢ XXXXXXX EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG |$ XXXXXXX PRO- POLICY JECT Loc $ AUTOMOBILE LIABILITY FO MBINED SINGLE MIT 1s XXXXXXX ANY AUTO NOT APPLICABLE BODILY INJURY (Per person) |$ XX XK XXX |_| ALE SYYNED PG REOUEED BODILY INJURY (Per accident]$ XX KXXXX reo auros [_|RKRYN= pes XXXXXXX $ UMBRELLA LIAB OCCUR IEACH OCCURRENCE $ XXXXXXX EXCESS LIAB ICLAIMS-MADE NOT APPLICABLE AGGREGATE $ XXXXXXX DED | RETENTION $ $ WORKERS COMPENSATION 4 WC STATU- TH: A | AND EMPLOYERS’ LIABILITY HN N |See Attached 8/1/2013 | 5/1/2014 Xx Lae LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? te EACH ACEIDENT $ l 000 000 (Mandatory in NH) IE.L. DISEASE - EA EMPLOYEE s_ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LIMIT s_1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED. CERTIFICATE HOLDER CANCELLATION See Attachment 12485529 Okaloosa County 602 - C North Pearl Street 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 POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE wv iF 2 4 [ow ct S<Faclet4t & | ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD AMR Corporation Workers Compensation 8/1/2013 - 5/1/2014 Policy # Eff. Date Exp. Date | Issuing Company States 062790658 08/01/2013 | 05/01/2014 | New Hampshire Ins Co NJ 062790659 08/01/2013 | 05/01/2014 | New Hampshire Ins Co NY 062790660 08/01/2013 | 05/01/2014 | Nat'l Union Fire Ins Co CA 062790661 08/01/2013 | 05/01/2014 | New Hampshire Ins Co FL 062790662 08/01/2013 | 05/01/2014 | New Hampshire Ins Co MN 062790663 08/01/2013 | 05/01/2014 | New Hampshire Ins Co AOS 062790664 08/01/2013 | 05/01/2014 _}| New Hampshire Ins Co KY,NC,UT 062790665 08/01/2013 | 05/01/2014 | New Hampshire Ins Co PA 062790666 08/01/2013 _| 05/01/2014 | New Hampshire Ins Co AK,AZ,GA,VA 062790667 08/01/2013 | 05/01/2014 | Nat'l Union Fire Ins Co MA,ND,OH,WA,WLWY 062790668 08/01/2013 | 05/01/2014 | New Hampshire Ins Co IN Miscellaneous Attachment : M486856 Master ID: 1366502, Certificate ID: 12485529