Okaloosa County BOCC — July 2, 2013 — Delta Certificate of Insurance — reading text

OF INSURAN INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CON CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN | EXCLUSIONS AND CONDITIONS OF SUCH POLIGIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS S$ SUBJECT TO ALL THE TERMS, INSR ADDL|SUBR EI L LTA TYPE OF INSURANCE NSA | WYD POLICY NUMBER (UMIDDIVYYY) (MMYDDIVYYY) LIMITS | GENERAL LIABILITY EACH OCCURRENCE $ T TED " COMMERCIAL GENERAL LIABILITY OAT ee urence) | $ E CLAIMS-MADE OCCUR MED EXP (Any one person) $ ! |_| PERSONAL & ADV INJURY | $ ae GENERAL AGGREGATE $ - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $ wn POLICY FRO: LOC 8 5 COMBINED SINGLE LIMIT Ss) | AUTOMOBILE LIABILITY Oe dant § . bay auto a ar | -BOBILY-INJURY-(Per-persan).-|-$- .- _-._- ALL OWNED SCHEDULED BODILY INJURY (Per accident) | $ - NON-OWNED PROPERTY DAMAGE $ ~ HIRED AUTOS AUTOS (Per accident) 2 $ fol C UMBRELLALIAB | X |occur SIL 1-745T Taei2o12 ‘(12/212013 | each occuRRENCE ; 1,000,000 X | EXCESS LIAB CLAIMS:MADE AGGREGATE $ DED | | RETENTION $2 $ B. | WORKERS COMPENSATION WLR C4 7128675 (AOS) 02/01/2013 02/01/2014 We SNS Oth AND EMPLOYERS’ LIABILITY VIN A | any PROPRIETOR/PARTNER/EXECUTIVE NA SCF C471 28687 (WI) o2101/2013 | 02/01/2014 E.L. EACH ACCIDENT $ 1,000,000 A | fuandateryiNNH) WLR C471 28699 (MN) ozo12013 /0201/2014 | ey. pIScASE- EA EMPLOVEE § 7,000,000 If yes, describe und A_| DESCRIPTION OF OPERATIONS below WLR C4 7128705 (AZ,CAMA) ozov2013 {02/01/2014 | &.. DISEASE - POLICY LIMIT | $ 1,000,000 A {Specific XSAVC Employers Liab, WCUC471 28663 (GA) 02/01/2013 02/01/2014 WC : Statutory SIR: $1,000,000 EL ; $1,000,000 Acc/Aggr. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION OKALOOSA REGIONAL AIRPORT ATTN: MR. JOHN MORRIS 1701 HIGHWAY 85 NORTH EGLIN AFB, FL 32542 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 of Marsh USA Inc. Manashi Mukherjee Monnsohé Slate mengee ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD { { Workers’ Compensation and Employers’ Liability Polley Named Insuced Endorsemeot Number DELTA AIR LINES, INC. 1030 DELTA BOULEVARD Poticy Number DEPARTMENT 858 Syinbok WLR Number. 647128675 Policy Period Effective Date of Endorsement — 02-01-2013 TO 02-01-2014 02-01L+2013 : issued By (Name of Insurance Company} INDEMNITY INS, CO. OF NORTH AMERICA inaert the polley number, The rentalnder of the infornration Is to ba completed only when this endorsement is (gsued subseauent to the preparatlos of ihe policy. THIS ENDORSEMENT CHANGES THE POLICY OF INSURANCE. PLEASE READ IT CAREFULLY. ; PROVIDE REQUIRED NOTICE OF CANCELLATION TO ANOTHER ENTITY This endorsement modifies insurance provided under the fotlawing: A Schedule* Entity Ne, Of Days All entities or persons holding certificates of ___. for nonpayment of premium insurance reflecting the policy SEE wWc999999 FOR SCHEDULE OF ENTITIES 90 __ for all other reasons Ye not shown on this endorsement, will be shown in the Declarations. ~~ *Information required to camplete this Schedule, 8. Provisions ff this insurance {s terminated or cancelled, whether af your request of ours, We Schedule with prier written notice of such termination or cancellation within f Schedula, above. will provide the entity shown in the he number of days shown in the All other terms, conditions and exclusions of this Policy remain unchanged. Kill, Wa Authorized Agent SOI? WE 99 04 36 (4/06) Page 1 of 1