Okaloosa County BOCC — December 16, 2014 — Timberview Lease Renewal 12-8-14 — reading text

CONTRACT/LEASE RENEWAL FORM October 2, 2014 Timberview Helicopters, Inc. Justin Johnson 981 Hwy 98 East, Suite 3153 Destin, FL 32541 RE: Lease Renewal Mr, Johnson: Okaloosa County Airoorts agrees to renew the subject lease, #L14-0404-AP for an additional term. The contract renewal period will be February 1, 2015 to January 31, 2016. . If you are in agreement, please sign below and return this form along with a current Certificate of Insurance listing Okaloosa County as co-insured (if applicable). COUNTY REPRESENTATIVES AUTHORIZED COMPANY REPRESENTATIVE Dept. crocs A ; Contractor. “7. ROLE CY Neltof TES Signature: Sunil Harman KE JP Date: a8 — (Lf - 7 ae we ur a Approved By Approved By: (as prescribed below on item 1) Title: [i<F Date: [el 9-20fF Approved By: {as prescribed below on item 1) Date: County Department Instructions: 1) Obtain signatures from Department Director, authorized Company Representative and then Purchasing Director <$25K and less, County Administrator <$50K and less or Board >S$50K, as necessary. If Board approval is required, the Chairman and County Administrator's signatures are required. Make sure the company provides a current Certificate of Insurance. (If applicable). 2) Keep a copy of this form for your records. 3) Send original to Purchasing Services Coordinator. If you have any questions please contact the Purchasing Director at 850-689-5960, Fax: 850- 689-5998. 11-24-14P01:43 RCVD GAS LesClypt-o2-44 CONTRACT & LEASE INTERNAL COORDINATION SHEET Contract/Lease Number: 4/4 > 4G -A a Tracking Number: /192@ (5 . ; Grant Funded: YES NOAA Contractor/Lessee Name: _t- pypdoetrties bebeegutlers Purpose ~Sea. cra Joe ceunf Date/Term:__/ - Bled Le 1. LJ GREATER THAN $50,000 Amount: ‘hs e} cher 2. LJ Greater THAN $25,000 , ( Department: Ay 3. L] $25,000 OR LESS Dept. Monitor Namex’/ Ye. Waneery [prin NK Document has been reviewed and includes any attachments or exhibits. Purchasing Review Procurement, eauremers: are. me Lote (. Date, /6- de 1 i a < ft f Purchasing Directo? or Designée Joanne Kublik a Risk Management Review Approved as written: \__ ‘ Ye ee PA X ice! IN Vs Air Date: IO-2 [4 Risk ‘Manager ordesignee ~*~ ) Kay Godwin or Krystal King County Attorney Review proved as written: anne en Me NTR Date: \O-\-14 y Attorné by Gregory T. a or Lynn Hoshihara wy 7 Following Okaloosa County approval: Contracts & Grants Document has been received: Date: Contracts & Grants Manager TATE INI YY 01/10/2014 ey th ACCORD CERTIFICATE OF AIRCRAFT INSURANCE Nene ier” HS CERTIFCATE BSSUED ASA MATTER OF INFORMATION ORLY AND COKMFERS NO RGHTS”URON THe CERTIFICATE HOLDER. THS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THS CERTIFICATE OF INSURANCE [OES NOT CONSTITUTE A CONTRACT BEIWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: Wf the cartiticate hokieris an ADUMTONAL INSURED, the polloyfios) must be endorsed, SUBROGATION (8 WAIVED, aubjact to the farms and conditions ofthe polly, cartaln pofchs may require an endorsement. A stafamant on this certificate does not confer rights to the cenificate holder In flau of such andorsament(s), . Coniaer PROCUCER NAME: AIR CAPITAL INSURANCE, LLC (HONE FAX P.O, BOX 458 iii, Be, dy (NG, Nott WICHITA, K8 87201 EMAIL AIRES: Fat PRODUCER CUSTOMER _D No aA FF aE A 10 No. TIMBERVIEW HELICOPTERS, INC. INSURER(8) AFFORDING COVERAGE % AIG No. 2142 N. S00RD. NAURER_A:U.S, SPECIALTY INSURANGE COMPANY 100%6 WELLSVILLE, KS 66092 NARA? B: NAURER CG. NURER D: NGURER EF: NGURER F: — HAVE BEEN RSUED 1 THE INSURED NAMED ABOVE FOR THE POURY MERTOS MENT WITH RESPECT TO WHICH THIS THis ST CERTEY THAT THE POLICIES DF IISURANCE LISTED BELOW INDICATED. NOTWIIHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY COM TRACT OR OTHER DOCU i EIN tS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBER HER EXCLUSIONS AND CONOITIONS OF 8UGH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ROLIGY INFORMATION CERTIFICATE NUMBER: REVISION NUM BER: [ FOUCY THRE (NE CF ORNERE SQONE DUSTRAL PLEASURE & X) COMMERTIN AIRPLANE XK) HELICOPTER MikELY FLEET EXCERS. QUOTA AD BUS SHARE NON-OWNED [7] PT IABILTY FSC] HULL & ABILITY TULL ONLY . ONLY ARGRAFT INFORMATION i | ACORD 333, Aircraft Schedule attached TER ME RRaEA SERINE” NUMER FERSTRATION ROMER 2004 | ROBINSON R44 fl N7512N TERRITORY: AIRCRAFT COVERAGES (RELRER TEER FIT TER: PRESS TIVE “TATE EXIRATOW INTE ALOMIONA RREDREDT (WTN) BUEROGATION WAIVELI? (Y7N} RW00181830-00 04/01/2014 04/01/2015 Y N COMRACKE OPTIONS UMIT APPLIES TQ uMIT APPUES TO . | AIRisk Ground and = $ 300,000 — 1 $ 7,000 [Dad - Notin mation ARORAFT HULL [| Flight AGREED VALUE § 30,000 | Ded. - tn motion x | Including Fassangers RY 7,000,000 [RA ack: 5 EA PER AIRGRAFT LIABILITY —_ 4 100,000 } cApAsa $ AGGR X | RATINGS CHEW ; 70,000 =a) e) ENTS —_ A PEI , EA ooC MEDIAL AAYM CLUDING CREW § 5,000 | BAPER $ COVERAGE CODE DERCRIPTION OPTIONS LIMIT" APPLEB TO LIMIT APPLIES TO h 3 5 BS 5 ih Hy 5 > ih _ ‘) KB DESCRIPTION OF OPERATIONS / REMARKS (Aftach ACORD 104, AdditlonaiRemarks Schedule, if more s paca is required) Carttisata older s Inchided aa an Additional is ured. CERTIFICATE HOLDER CANCELLATION DRALOQUC COUNTY ETTOUND ANY DE Tilly ABOVE ESCORTED POLICIES BE CANCELLED BEFORE THE 602-6 NORTH PEARL Z¥PIRATLON DATE THEREOF, NOTICE WILL BE DELIVERED tN . CRESTVIEW, FL 32546 AG CORDANCE WITH THE POLICY PROVISIONS. POTHORZED RE i ACCORD 21 (2008/1 The ACORD nama and logo are registered marks of ACORD ACORIS CERTIFICATE OF AIRCRAFT INSURANCE BATE WHOS o1/10/2014 THS CERTIFCATE IS BSUED AS AMATTER GF INFORMATION ONLY AND COKFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THs CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUNG INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT; if the certificate holdarts an ADOMIONAL INSURED, the polley(las) must bo endoraad. SUBROGATION [S WAIVED, au bjoct to the terms and condkons of the poly, carta polkies may raquke art andorsament. A statement on thks certificate doas not confar rights to the certificate holder in lleu of such entlorsament(s), CCHITET FROCLICER NAME: AIR CARITAL INSURANCE, LLG, BHONE FAX INE) Rta Ea (NC, Nah RO, BOX 458 WICHITA, KS 67201 E-MAIL ADDRERS: emer PRODUCER OQUSTTMER [1 Ne ANBERVIEW HELICOPTERS, INC INSURER() AFFORDING COVERAGE % NAIC No, 2142 N. 300RD. N&URER A: U.S, SPECIALTY INSURANGE COMPANY 1G1% WELLSVILLE, KS 66092 NSRER B: NEURER C. NARER D: _NSURER Es THE POLICY Psi ila NQURER Fs HES TO CERTIFY NAT INE POLICIES OF INSTANCE LISTED BELOW HAVE FEEM TSSUES TS M1 THSURED NAMEL ABOVE FOR 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 AFFOROED 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. POUCY INFORMATION CERNFICATE NAV BER: REVISION NUMBER: TRE GENEGS TACT RUCY Pe INDUSTRIAL. TEASORG XN] Sao MERCIA AIRPLANE % | RERCOPTER MIXED FLEET EXCESS QUOTA AD BUS : SHARE To Non-GwwEn [7 = LIABILITY = JX} HULL & LNRiLCY HULL ONLY ONLY AIRGRAFT INFORMATION | | ACORD 333, Alrcraft Schedule attached TOR WRE MACCEL BERL NOME FEES TATION WORMERS 2004 ROBINSON R44 Ii N7371T FERRT ORY - ARRCRAFT COVERAGES RARER TEER FOUCY NOWETE FRE TIVE CATE BARATION THE FUTATIONA NSURED? (7 7H) SUBROGATION WAVED? (TTR) RW00181830-00 01/01/2044 01/01/2018 Y N CORRAGE OPTIONS LMIt APPLIES TO uMiT APPUES TO x JATRisk Ground and R3 300,008 $ 7,GU0 ~[Bad. « Notin motion ARCRART PULL wae Flight — AGREED VALUE $ 30,000 Dad. « In motion x | Including Pas sengare $ 7,000,000" PEA GGT $ EA PEK AIRGRAET LIABILITY a $ 100,000 | cAPass $ AGOR - X | NUON CREW 0.000 MEDICAL PYYMENTS stent A PER 2 BA ONC MEDICAL SXCLUDING CREW $ 5,000 | EAPER 3 , : COVERAGE . CODE DEECRIPTION OPTIONS LIMIT APPLIES TO LIMIT APPUES TO a a i tb 5 3} 7 ; i a i a A 5 DESCRIPTION OF OPERATIONS /REMARKS (Attach ACORD 101, Additional Remarks Schedule, If more s pace Is rec Wad) Carlittals Polder is elite asin Additional nsurac, CERTIFIGATE HOLDER hain [ON Ss TRAC COONTY 802-6 NORTH PEARL CRESTVIEW, FL 42836 SITOULD AVY CF TE ANUVE BENG RIED POLICIES EE CANCELCED HEFORE TIT: EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN INS CORDANCE WITH THE POLICY PROVISIONS. POTIGZED fT ESRATATIVE “ mo oh, ) Com dheceer ttn, ©2000 ACORD CORPORATION. All rights reserved. ACORD 21 (ANKY12) The ACORD name and logo are registered marks of ACORD Al ih cn Te AC ORI CERTIFICATE OF AIRCRAFT INSURANCE o10/2014 Keeani” THS CERTIFICATE 8 ISSUED AS AMATTER OF INFORMATION ONCY AND CONFERS NO RGHTS UPON THE CERTIFICATE HOLDER THS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES FELOW. THS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE SSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: Ifthe certificate holderia an ADDITIONAL INSURED, the pofiey(ias} must be ondoranid fF SUBROGATION 18 WAIVED, aubject to fhe tanms and conditions ofthe policy, oarlain packs may require an aucorsement, A statament on this certificate doas not confer rigs to the: certificate holder in lleu of such encdorsement(s), CONIAST FROQUCER Nai AIR CAPITAL INSURANCE LLC, FE FAX P.O. BOX 458 1M in BA (NC, Not: WICHITA, KS 67201 B-tMAll, ADORED: FED ee PRODUCER CUSTOVER, D Na TIMBERVIEW HELICOPTERS, INC. INSURER(S) AFFORDING COVERAGE % NAIC Na 2142 N, 300RD. NOURER A: U.S, SPECIALTY INSURANCE COMPANY 100% WELLSVILLE, KS 66092 MARFR 8: NOURER C NOURER 1D: NEURER E! , NSLRER Fs THISTS 16 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED [O TAR INSURED NAMED ABOVE FOR THE POLICY PERTOD (INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OF OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAID CLAIMS, POLICY INFORMATION —— NUM BER: REVISION NUMBER: FOUGY “WE TRE OF SNEGS BODE GUST RAL PEERS R XY EORMERTIA AIRPLANE XP HERCORTER Mixe FLEET BRCESS AUTH SHARE x AID BUS ~~] NON-OWNED LIABILITY HULL & WARILITY HULL ONLY ONLY er eer ee AIRCRAFT INFORMATION | | ACORD 333, Alrcraft Schedule attached AR WE RTE SERAT ROMER FESETRATION RUA 2010 ROBINSON | R44 N211TB TERRITORY: AIRCRAFT COVERAGES TORE TEER FOICY ROMEER BRE TIVE TE SORATION GWE AONUMA NORE (TN SUBROGATION WAIVED? TY TH) RW00181830-00 01/01/2014 | 01/01/2015 Y N COMRAGE QPTIONS UMIT APPLIES TO UMIT . APPLIES TO x [Al Risk Ground and 5 300,000 $ 1,000 | Ban. - Notin motion ARCRAFT HULL po Fine L- AGREED VALUE 3 40.000 | Dad.~ tn motion x | Inchiding Passengars Ra 7,000,000 | RA GCC $ EA PER AIRCRAFT LIABILITY 4 | % 400,000 | capass $ AGGR X | RONG CREW it |—4 aperran ° OC} MEDCAL AYMENTS RCLLOING CREW $ 5,000 | EA PER $ 20,000 fea onc COVERAGE _ CODE CEBORIPTION OPTIONS LIMIT’ APPLIES TO LIMIT APPUES TO | b y fl 5 | 3 p i 5 » Hf -_ 4 h DESCRIPTION OF OPERATIONS /REMARKS (Aitach ACORD 10", Additional Remarks Scheclula, if more s pace Ia re cui iret) Certiicate Holdar te ineluchodas ain Additional ngured. ANCELL ATION CERTIFICATE HOLDEM TRALCORA COUNTY SHOULD ANY OF ITE ABOVE DESCRIBE PUTICIEN GEO MCELLED HEFORE TE 8026 NORTH PEARL EXPIRATION OATE THEREOF, NOTICE WILL SE OELIVERED IN CRESTVIEW, FL 32536 WCGCORDANCE WITH THE POLICY PROVISIONS, ATTHORZED PERT EBENTATIVE — ens ae ~y Cm ahr t een @