CERTIFICATE OF INSURANCE
City of Clearwater
\llIJ Cordon Wills
(' kat Ilalel', FL
CERTIFICATE OF INSURANCE
CERTIFICATE NUMBER: 4652
POLICYHOLDER:
Civil Air Patrol
Office of Corporate Counsel
105 S, Hansel St.
Maxwell AFB, AL 36112
CERTIFICATE DATE: 04/10/2003
CERTIFICA TE HOLDER:
1--.
This is III ecru I)' thai the following policy(s), subject to the terms, conditions, limitations and endorsements contained therein, and during their effective period, have been
Issucd by the company(s) indicated below, In the event of material change or cancellation of said policy(s), the company will endeavor to notify the certificate holder, but
failure to do so shall impose no liability or obligation of any kind upon the undersigned or the company(s) involved,
Policy Type: AIRPORT
Insurance Company: Old Republic Insurance Company
Policy Number: AP690407
Policy Period: September 1,2002 to March 1,2004
Premises Liability - All Locations
Deductible:
$l,OOO,OOOEach Occurrence / $2,000,000 Aggregate
$2,500 Each and Every Loss
THE FOREGOING EVIDENCE OF COVERAGE IS NOT VERBATIM OF POLICY CONDITIONS, LIMITATIONS OR LANGUAGE; THE POLIcr(S) REPRESENTED
BY THIS CERTIFICA TE ARE NOT AMENDED IN ANY WA Y UNLESS SO STA TED ON THIS CERTIFICA TE.
ADDITIONAL AGREEMENTS:
Additionllllnsured
City of Clearwater is included as an Additional Insured for Liability Coverages, but solely with
respect to operations of the Named Insured, subject to all policy terms and conditions.
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NOTICE OF CANCELLATION: IN THE EVENT OF MATERIAL CHANGE OR CANCELLATION OF SAID POL/CY(S), THE COMPANY(S) SHALL ENDEAVOR
TO GIVE 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER WITH THE EXCEPTION OF A 10 DAY NOTICE FOR NON-PAYMENT OF PREMIUM,
AI~g
25548 Gencsec Trail Road
Golden. Colorado 8040 I
(303) 526-5300 telephone (303) 526-5303 fax
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Authorized Signature