Okaloosa County BOCC — February 7, 2017 — PCP Aviation Amendment Three — reading text

GLAIMS-MADE AGGREGATE 3 pED | | REYENTION$ § WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ' ER ANY PROPRIETORPARTNEREXECUTIVE &L BAGH ACGIDENT $ OFFICER/MEMBER EXCLUDELDY N/ (Mandutory in NH) %L DISEASE « EAEMPLOYEE] § 4, deacitba pa—— D%scmpnon OF OPERATION bejaw . E.L DISEASE - FOLICY LMIY | § HANGAR - 1007 AIRPORT R, BLOGK &, LQT 3, DESTIN, FL 32541 Okaloosa County ls llstad as Addltlanal Insured as respacts General Liabillty. DESCRIFTION OF QPERATIONS / LOCATIONS / VEHIGLES (ACORD 101, Addillanal Remarke Schadule, may ba attachad If more apace [a requirad) GERTIFIGATE HOLDER CANCELLATIO]‘:IW Okaloosa Counly 5749 A Old Bethel Road Crestview, FL 32636 EHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED REFORE THE EXPIRATION DATE THEREQF, NOTIGE WILL BE DELIVERED IN AGCORDANGCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) © 198B-2014 ACORD CORPGRATION. All rights reserved. The ACORD nama and logp are ragisterad marks of ACORD Jul. 29, 2016 10:59AM . ACORLY h—-—"""" CERTIFICATE OF PROPERTY INSURANCE No. 0069 P 3 PMGDONALD DATE (MMIDD/YYYY) 712912016 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFQRDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRAGT BETWEEN THE ISSUING INSURER(S), AUTHORIZED [f this certificate 1s belng prapared for a party who has an Insurable interezt in the property, do not use this form. Use AGORD 27 or AGORD 28, PRODUGER CONTACT NAME: Acentrla, Inc - Daztin Office THENE ey (850) 650-1950 [ Fa% oy (BS0) 850-9288 46434 Gulfstarr Drive ET : Dostin, FL 32541 ADDRESS: Eustonca m: PEPAVIAT-0 INSURER[S) AFFORDING COVERAGE NAIC # (NSURED wsurera:Lloyds INSURER B ¢ PCP Avlatlon LLC fka GP Alr, LLC INGURERC ¢ 42 Business Centre Dr Suite 101 . Miramar Beach, FL 326560 INSURERD ¢ INSURERE : INSURERF GOVERAGES GERTIFICATE NUMBER: REVISION NUMBER: 1 1 Block 5, Lot §, Destin, FL SEE ATTAGHED AGORD 101 LOGATION OF PREMISES / DESCRIPTION OF PROPERTY (AHach AGORD 164, Addiilonal Remarks Schedatn, If mare space ia raquirad) THIS IS TO CERTIFY YHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABQVE FOR THE PQLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRAGT OR OTHER DOGUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE |SSUED OR MAY PERTAIN, THE INSURANGE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH PQLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ieR TYPE OF INSURANGE POLIGY NUMBER DT e} | gy | COVERED PROPERTY umiTs | X | propERTY BUILDING § A [causesoriass |oeoucrietes |JAX104724 081172018 | 08M1/2017 PERBONAL PROPERTY | BASIC BUILONG || pusiess vcomE | AROAD TONTENTS d : EXTRA EXPENSE & X | srECIAL RENTAL VALUE R EARTHQUAKE DLANKETRUILDING | WIND BLANKET PERS PROP | ¢ " FLooo BLANKETBLDGE PP | 4 X | Replacament [ % [Hangar 5 350,000 ¥ | 80% Cotnsuran & ___J INLAND MARINE TYPE OF POLICY | $ CAUSES OF LOSS P | namio PERILS POLICY NUMBER [ | " 5 BED 5 TYPE OF POLICY : - § 8 BOILER % MACHINERY | [ EQUIBYENT BREAKDOWN - . - 5 $ HPEGIAL CONDITIONS / OTHER COVERAGES (Allach ACORD 101, Addifenal Ramarke Sehadule, If mora ¢ pace la requirad) CERTIFICATE HOLDER CANCELLATION Okaloosa Counly §749 A Old Bathal Road Crastylew, FL 32536 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE GANGELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0 i Gt ACORD 24 (2009/09) ©1805-2008 ACORD CORPORATION, All rights reserved. The ACORD name and logo are reglstered marks of ACORD ) ® ACORD V CERTIFICATE OF AIRCRAFT INSURANCE DATE (MMIDD/YYYY) 4/14/2016 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 have ADDITIONAL INSURED provisions or 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 hoider in lieu of such endorsement(s). PRODUCER CONTACT AirSouth Insurance Agency PHONE FAX P.O. Drawer 6727 bIC, Mo Extl: [ € wox Dothan, AL 36302 ADDRESS; PRODUCER INSURER({S) AFFORDING COVERAGE % NAIC # '”su“[;: CP LLGC INSURER A : StarNet Insurance Company 100 40045 Aviation INSURER B : 42 Business Centre Drive, Unit 101 ) Miramar Beach FL 32550 INSURERC ; INSURER D : INSURER E : INSURER F © THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVI INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRA! CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. E BEEN |SSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD CT OR OTHER DOCUMENT WiTH RESPECT TO WHICH THIS HEREIN 1S SUBJECT TO ALL THE TERMS, REVISION NUMBER: POLICY INFORMATION CERTIFICATE NUMBER: 29463354 s POLICY TYPE " LINE OF BUSINESS SUBGODE ‘ || INousTRIALAD | # PLEASURE & BUS |_| COMMERCIAL |/ | AIRPLANE L HELICOPTER MIXEDFLEET | | EXCESS L_J QUOTA SHARE NON-OWNED LIABILITY ONLY /| HULL & LIABILITY HULL ONLY AIRCRAFT INFORMATION | | ACORD 333, Aircraft Schedule attached YEAR | MAKE MODEN SERIAL NUMBER REGISTRATION NUMBER 1978 | Piper PA-31 N3oowpP TERRITORY: United States of America, Canada, Bahaman Islands, Caribbean Istands or Mexico AIRCRAFT COVERAGES INSURER LETTER | POLICY NUMBER EFFECTIVE DATE | EXPIRATIONDATE | ADDITIONAL INSURED? (Y/N) | SUBROGATION WAIVED? (Y / N} A BA-16-04-00224 4/14/2016 4/14/2017 Y N COVERAGE OPTIONS LT . APPLIES TO LIMIT APPLIES TO AIRCRAFTHULL L . : 676,000 $ AIRGRAFTLIABILITY ty $ 1,000,000 | BAOCE § EAPER $ EA PASS % AGGR MEDICAL PAYMENTS | | INGLUDING CREW $ 10,000 | EAPER EXCLUDING CREW ' COVERAGE CODE DESCRIPTION OPTIONS Lt APPLIES TO LIMIT APPLIES TO L $ $ N $ $ | ] $ $ ] s ) p | $ $ $ $ DESCRIPTION OF OPERATIONS { REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CANCELLATION CERTIFICATE HOLDER 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 P /2 CF N dadors—. / / / Kris Parsons ACORD 21 (2016/03) The ACORD name and ID% 29463354 | Master Certificate | para Harrison | 4/24/2016 12:13:11 PM (EDT) © 2009, 2015 ACORD CORPORATION. All rights reserved. o are registered marks of ACORD page 1 of 2 AGENCY CUSTOMER ID: LOC#: N A CO,RD@ ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY NAMED INSURED - . PCP Aviation LLC AirSouth Insurance Agency 42 Business Centre Drive, Unit 101 POLICY NUMBER Miramar Beach FL 32550 BA-16-04-00224 CARRIER NAIC CODE |__ StarlNet Insurance Company 40045 EFFECTIVE DATE: 4/14/2016 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 21 FORM TITLE: Cerlificate of Aircraft {03/16) HOLDER; Okaloosa County ADDRESS: 602 C North Pearl Street Crestview FL 32536 Additional Inmsured Provision: Scheduled Person or Organization: It is agreed that the Certificate Holder is included as an Additional Insured under Aircraft Liability Coverages, but only to the extent of liability imposed upon the Additional Insured solely as the result of an act or omission of the Named Insured or its employees in connection with the Named Insured’s Aircraft operations, subject to all policy terms, limits, conditions and exclusions. The Company's rights of recourse: This Certificate does not provide coverage for the Additional Insured with respect to claims arising out of their legal liability as manufacturers, repairers, modification, suppliers or servicing agents and shall not operate to prejudice the Company's rights of recourse against the Additional Insured as manufactures, repairers, modification, suppliers or servicing agents where such rights of recourse would have existed had this Certificate not been affected under this policy. terms or conditions of any contract or other document the Insurance afforded Notwithstanding any requirements, limits and with respect to which the Certificate may be issued or may pertain, by the policy(ies) described herein is subject to all the terms, conditions, exclusions of such policy. The Company has made the provision to give the Certificate Holder prompt notice of cancellation of any policy above. But, the Company assumes no responsibility for failure to provide such notice. This Certificate does not change in any way the actual coverages provided by the policy(ies) specified above. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM 29463354 | Master Certificate | Dara Harrison | 4/14/2016 12:13:11 PM (PDT) | page 2 of 2