Okaloosa County BOCC — June 21, 2016 — Timberview Helicopters, Inc. Amendment One 6-9-16 — reading text

HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY INFORMATION CERTIFICATE NUMBER: REVISION NUMBER: POLICY TYPE TINE OF BUSINESS SUBCODE NDUSTRIAL PLEASURE & COMNERCIAL ARPLANE < | FELICOPTER WIRED FLEET EXCESS QUOTA AD O ae X O B SHARE ™1 NON-OWNED LIABILITY HULL & LIABILITY HULL ONLY O oy X U AIRCRAFT INFORMATION 1 i ACORD 333, Aircraft Schedule attached YEAR MAKE MODEL SERIAL NUMBER REGISTRATION NUMBER 2008 ROBINSON HELICOPTER R44 1l N76VG COMPANY TERRITORY: AIRCRAFT COVERAGES NSURERLETTER POLICY NUMBER EFFECTIVE DATE EXFIRATION DATE ADDITIGNAL INSURED? [Y7N) SUSROGATION WAIVED? (V7 N) RWO00181830-02 05/06/2016 01/01/2017 N COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO ALLRISK GROUND AND FLIGHT [§ 250,000 5 1,000 Ded. - Not in motion ARCRAFT HULL 5| ALL RISK GROUND ONLY AGREEDVALUE| o5 00 Ded. - In mofion = | DABILITY 3 71,000,000 EAGCT 5 EAPER AIRCRAFT LIABILITY AGGR $ 100,000 EAPASS A NCLUDING CREW 3 MEDICAL PAYMENTS E - 5,000 EAPER & 20,000 EAOCC O | EXCLUDING CREW COVERAGE CODE DESCRIPTION OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO DESCRIPTION OF OPERATIONS / REMARKS (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is included as an Additional Insured. CERTIFICATE HOLDER EANCELLATION Okaloosa County, §749A Old Bethel Rd., Crestview Rd, 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 ACORD 21 (2009/12) © 2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Dave Miner From: Krystal King Sent: Thursday, June 09, 2016 10:05 AM To: Dave Miner Subject: RE: Timberview Helicopters, Inc. - policy #RW00181830-02 They look good to me. Aryetad iy fkaloosa County Risk Management (830)688-0877 Fax (850)G88-0873 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: Wednesday, June 08, 2016 3:57 PM To: Krystal King Subject: FW: Timberview Helicopters, Inc. - policy #fW00181830-02 Importance: High Krystal: I just received the COls for Timberview. Are these OK so | can send this to the Board for approval? Dave From: Oleeta Byrne [mailto:oleeta.byrne@aircapitalins.com] Sent: Wednesday, June 08, 2016 3:49 PM To: Dave Miner Cc: 'justinjright@sbcglobal.net'; Mike Stenson Subject: RE: Timberview Helicopters, Inc. - policy #8W00181830-02 Importance: High 6/8/16 Mr. Miner: I am not sure what Mr. Johnson sent to you as there was not an attachment to your email to me. However, attached you will find copies of certificates issued on 5/26/16 in favor of Okaloosa County for proof of insurance on all three (3} of Insured’s helicopters and sent directly to Timberview. If this is not what you need, please contact me directly. Thank you! Oleeta From: Dave Miner [mailto:dminer@co.okaloosa.fl.us] Sent: Wednesday, June 08, 2016 3:35 PM To: Oleeta Byrne Cc: justinjright@sbcglobal.net’; Mike Stenson Subject: RE: Timberview Helicopters, Inc. - policy #RW00181830-02 Importance: High Ms. Byrne: | received this from Mr. Johnson but | do not need his policy. Please send me a certificate of insurance per his agreement with Okaloosa County. Thank you. David Miner Airports Administration Properties and Leases From: justinjright@sbcglobal.net [mailto:justinjright@sbcglobal.net) Sent: Wednesday, June 08, 2016 3:15 PM To: Dave Miner Subject: Fwd: Timberview Helicopters, Inc. - policy #RW00181830-02 Thank you Justin Begin forwarded message: From: Oleeta Byrne <oleeta.byrne @aircapitalins.com> Date: June 2, 2016 at 9:13:22 AM CDT To: "justinjright@sbcglobal.net" <justinjright@sbcglobal.net> Subject: Timberview Helicopters, Inc. - policy #RW00181830-02 6/2/16 Good Morning Justin: Attached is your copy of endorsement effective 55/26/2016 to the captioned policy that is adding Okaloosa County, 5749A Old Bethel Rd., Crestview Rd, FL 32536 as Additional Insured. Please attach this endorsement to your policy as they together form your contract of insurance. if you have any questions or need additional information, please let us know. We appreciate your business. Oleeta Oleeta Byrne, CISR Air Capital Insurance, LLC Phone: 316-491-2242 Fax: 316-858-1994 Toll Free: 877-224-0967