Okaloosa County BOCC — December 2, 2014 — Clennan Sup Agrmt 2 11-17-14 — reading text

ACADAMY BLVD. SUITE 101 COLORADO SPRINGS CO 80918 POLICY NUMBER RENEWAL OF 41-LX -044062224-2/000 41-LX-044062224-1 POLICY PERIOD FROM: 07-30-14 TO: 03-23-15 At 12:01 A.M. standard time at the mailing address shown. STATE-1 SCHEDULED PROPERTY FLOATER COVERED PROPERTY Described Property Limit PORTABLE OFFICE $4,500 DEDUCTIBLE Deductible Amount $1,000 COINSURANCE Coinsurance Percentage % [X] Check if coinsurance provisions are waived COVERAGE PREMIUM $36 07-23-14 Page 5 of 6 Insured Commercial Inland Marine RENEWAL DECLARATION | NAME AND ADDRESS OF AGENCY INSURANCE COMPANY Lexington Insurance Company 99 High Street 00000 0000 Boston MA 02110 AGENCY NAME AND MAILING ADDRESS OF INSURED CLENNAN FAMILY FOUNDATION 5426 ACADAMY BLVD. SUITE 101 COLORADO SPRINGS CO 80918 TERRORISM RISK INSURANCE ACT IS INCLUDED POLICY NUMBER RENEWAL OF 41-LX -044062224-2/000 41-LX-044062224-1 POLICY PERIOD FROM: 07-30-14 TO: 03-23-15 At 12:01 A.M. standard time at the mailing address shown. $2 TOTAL INLAND MARINE PREMIUM $200 FORMS AND ENDORSEMENTS CLO100 (03-99) IM?7003 (03-00) IMN7008 (08-99) APPLYING TO COMMERCIAL INLAND MARINE COVERAGE PART AND MADE PART OF THIS POLICY AT TIME OF ISSUE: IM7000 (04-04) 96556 THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. AUTHORIZED REPRESENTATIVE 07-23-14 Page 6 of 6 Insured FORMS SCHEDULE ean an En NAME AND ADDRESS OF AGENCY 00000 0000 AGENCY INSURANCE COMPANY Lexington Insurance Company 99 High Street Boston MA 02110 NAME AND MAILING ADDRESS OF INSURED CLENNAN FAMILY FOUNDATION 5426 ACADAMY BLVD. SUITE 101 COLORADO SPRINGS CO 80918 COMMON POLICY PACKAGE 89644 ILO017 76105 PRG2040 (07-06) PRG2023 (07-05) PRG7003 (11-09) POLICY NUMBER RENEWAL OF 41-LX -044062224-2/000 41-LX-044062224-1 POLICY PERIOD FROM: 07-30-14 TO: 03-23-15 at 12:01 A.M. standard time at the mailing address shown. (06-13) ECONOMIC SANCTIONS ENDORSEMENT (11-98) COMMON POLICY CONDITIONS (02-09) FLORIDA - CANCELLATION/NON-RENEWAL ENDORSEMENT COMMERCIAL PROPERTY FORMS PR9I014 CPO0090 CP0125 IL0255 TLO1L75 CP0010 CP1030 90629 90630 90611 CP1065 CP1218 MINIMUM EARNED PREMIUM SERVICE OF SUIT FORM ESTIMATED TAXES, ASSESSMENTS AND SURCHARGES (01-91) OCCURRENCE LIMIT OF LIABILITY ENDORSEMENT (07-88) COMMERCIAL PROPERTY CONDITIONS (02-12) FLORIDA CHANGES (02-12) FLORIDA CHANGES - CANCELLATION & NONRENEWAL (09-07) FLORIDA CHANGHS - LEGAL ACTION AGAINST US (06-07) BUILDING AND PERSONAL PROPERTY COVERAGE FORM (06-07) CAUSES OF LOSS - SPECIAL FORM (02/07) COMMERCIAL PROPERTY COVERAGE ADDL COVERAGE~-EQUIPMN (02-07) ADDITIONAL COVERAGE - EQUIPMENT BREAKDOWN (03-06) INTEGRATED PROPERTY INSURANCE SOLUTIONS WINDSTORM (10-12) FLOOD COVERAGE ENDORSEMENT (10-12) LOSS PAYABLE PROVISIONS COMMERCTAL INLAND MARINE FORMS CLO100 IM7003 IM7008 IM7000 96556 07-23-14 (03-99) COMMON POLICY CONDITIONS (03-00) SMALL TOOLS FLOATER (08-99) SCHEDULE OF COVERAGES - SMALL TOOLS FLOATER (04-04) CONTRACTORS EQUIPMENT COVERAGE Page 1 of 1 SIGNATURE OF AUTHORIZED REPRESENTATIVE Insured POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE (COVERAGE INCLUDED) Coverage for acts of terrorism is included in your policy. You are hereby notified that under the Terrorism Risk Insurance Act, as amended, that you have a right to purchase insurance coverage for Losses resulting from acts of terrorism, as defined in Section 102(1) of the Act: The term "act of terrorism" means any act that is certified by the Secretary of the Treasury - in concurrence with the Secretary of State, and the Attorney General of the United States - to be an act of terrorism; to be a violent act or an act that is dangerous to human Life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. Under your coverage, any losses resulting from certified acts of terrorism may be partially reimbursed by the United States Government under a formula established by the Terrorism Risk Insurance Act, as amended. However, your policy may contain other exclusions which might affect your coverage, such as an exclusion for nuclear events. Under the formula, the United States Government generally reimburses 85% of covered terrorism Losses exceeding the statutorily established deductible paid by the insurance company providing the coverage. The Terrorism Risk Insurance Act, as amended, contains a $100 billion cap that Limits U.S. Government reimbursement as well as insurers' liability for losses resulting from certified acts of terrorism when the amount of such losses exceeds $100 billion in any one calendar year. If the aggregate insured Losses for all insurers exceed $100 billion, your coverage my be reduced. The portion of your annual premium that is attributable to coverage for acts of terrorism is $ 4, and does not include any charges for the portion of losses covered by the United States Government under the Act. Policy No. 41-LX-044062224-2 Named Insured CLENNAN FAMILY FOUNDATION 96556 (2/08) copyright 2007 National Association of Insurance Commissioners 07-23-14 Page 1 of 1 POLICYHOLDER NOTICE Thank you for purchasing insurance from a member company of American International Group, Inc. (AIG). The AIG member companies generally pay compensation to brokers and independent agents, and may have paid compensation in connection with your policy. You can review and obtain information about the nature and range of compensation paid by AIG member companies to brokers and independent agents in the United States by visiting our website at www.aig.com/producercompensation or by calling 1-800-706-3102. 91222 (04-13) Insured Dave Miner From: Krystal King Sent: Thursday, November 13, 2014 4:05 PM To: Dave Miner Subject: RE: Insurance Yes this COI is fine. Krystal hing Okaloosa County Risk Management (BoU)6B9-5977 Fax (850)89-0973 Please note: Due to Florida’s very broad public records laws, most written communications to or from County employees regarding County business are public records available to the public and media upon request. Therefore, this written email communication including your email address, may be subject to public disclosure. From: Dave Miner Sent: Thursday, November 13, 2014 11:50 AM To: Krystal King Subject: RE: Insurance Krystal: Please review the attached CO] for Mr. Clennans aircraft. Please let me know if all insurance requirements have been met so | can send this Amendment to the Board for approval. Thank you. Dave From: Krystal King Sent: Monday, November 03, 2014 2:18 PM To: Dave Miner Subject: RE: Insurance The lease also requires them to carry $1 million of Aircraft and Public Liability (General Liability) which is not listed in the attached documents. hngstal trap Okalaosa County Risk Management (Bo0)89-9977 Fax (Boll)b89-0973 Please note: Due to Florida's very broad public records laws, most written communications to or from County employees regarding County business are public records available to the public and media upon request. Therefore, this written email communication including your email address, may be subject to public disclosure. From: Dave Miner Sent: Monday, November 03, 2014 12:32 PM To: Krystal King Subject: Insurance Krystal: Please review the attached insurance information and let me know if it is OK. The insurance is for an amendment to a hangar lease for Block 4 Lot 2 at the Destin Airport, Clennan Family Foundation. Contract and Lease Internal Coordination tracking number 1139-15. Thank you. Dave David E. Miner Properties and Leases Okaloosa County Airports (850) 651-7160 Ext. 4 www.flyvps.com "Please note: Due to Florida's very broad public records laws, most written communication to or from County employees regarding County business are public records, available to the public upon request. Therefore, this written e- mail communication, including your e-mail address, may be subject to public disclosure." CONTRACT & LEASE INTERNAL COORDINATION SHEET Contract/Lease Number: LOD’ = COarle “ A c Tracking Number: /! BG AS Contractor/Lessee Name: (Basan Shon dhe Sinndlakeg.. i Purpose Cpt actor eh, Ex auatiiteh das pate/term: 9° | % - 2030 1, L] Greater THAN $50,000 Amount: # {0,566 | Gem wud 2. L] GREATER THAN $25,000 Department: 1 P 3. L_] $25,000 or Less Document has been reviewed and includes any attachments or exhibits. Purchasing Review Joanne Kublil Risk Management Review Approved as written: ; od 7 _f _ (\ L_, ie : rf oy ; Kul ra) or f NR Date: 1 ~| YY | Y 7 ¥ T Risk Managey or designee 6 Kay Godwin or Krystal King County Attorney Review Approved as written: oy ae eaeeee al Date: (t [ NE | \M County“Attorney x Gregory T. Stewart or Lynn Hoshihara coal terete ere meena Following Okaloosa County approval: Contracts & Grants Document has been received: Date: Contracts & Grants Manager