Okaloosa County BOCC — July 11, 2017 — Amendment One Triangle Leasing MT — reading text

%OI\QI‘E(I:%E%SINGLE LIMIT s ANY AUTO BODILY INJURY (Perperson} | $ OWNED ECHEDULED } AUTOS ONLY BODILY INJURY (Per sccident) | $ PROPERTY DAMAGE - E{Fr DS ONLY R&NO NLY |_{Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE s DED ‘ I RETENTION § $ WORKERS COMPENSATION PER QTH- AND EMPLOYERS' LIABILITY vIN i STATUTE ] ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L IDENT PFFICERIM&M;I\IER EXCLUDED? NIA L. EACH ACCIDEN 5 E.L. DISEASE - EA EMPLOYEE] § If yes, describe under DESCRIPTION OF OPERATIONS betow E.L. DISEASE - POLICY LIMIT | § A |Aviation Policy X 360AC-767358 101412016 | 10/14/2017 Liability 2,000,000 Medical 5,000 P R-THRBG1 BB IflCi.Es WOL Additional Remarks Schedule, may be attached if more space is required) £l CERTIFICATE HOLDER CANCELLATION Okaloosa County Dave Miner 5479 A Old Bethel Rd Crestview, FL 32536 OAKALOS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREQF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Joe L. Lester | ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD USAIG All-Clear (A Several Liability Combination Policy) Additional Insured(s)/Products Exclusion/Notice of Cancellation The "Who's covered” section of your policy, under “Your Liability Coverage,” shall include Okaloosa County, but only for claims of bodily injury, mental anguish or property damage and specifically excluding claims for personal injury that result from your ownership, maintenance or use of airport premises. We won't cover Okaloosa County for claims arising out of their liability as a manufacturer, seller, handler, distributor or service facility of any product or service sold, handled, distributed or provided, if we or the Aviation Managers cancel your policy for any reason other than nonpayment of premium, we agree fo give thirty (30) days notice before the cancellation date, fo the following person(s) or organization(s): Okaloosa Gotinty 5749A Old Bethel Road Crestview, FL 32536 However, the "Cancellation” provisions stated above shalf not be less than the required statutory limits. This endorsement does not change any of your coverage except as stated above. It is effective on the date and hour shown below, local Standard Time at the "Policyholder's” address. Policy Issued to: DRC Flyers, LLC 17 360AC-767358 June 23, 2017 at 12:01 A.M. Endorsement No. Policy No. Date and hour endorsement takes effect Approved: United States Aviation Underwriters, Inc., Aviation Managers By M\:T\ r)a\/\of 368-0310 (360)