CERTIFICATE OF INSURANCE (10)
PHOENIX
PHOENIX A VIA nON MANAGERS, INC.
Certificate of Insurance
City Of Clearwater
Post Office Box 4748
Clearwater, Florida 33618
This is to certify to
(Certificate Holder):
RECEIVED
DEe 2 3 2003
Clearwater Airpark, Inc.
David King
1000 N. Hercules Avenue
Clearwater, Florida 33765
POLICY PERIOD: FROM:
OLD REPUBLIC INSURANCE COMPANY
The following policy(ies)
have been issued to:
OFFICIAL RECORDS AND
lEGISLATIVE SRVCS DEPT
TO:
AIRCRAFT POLICY NO:
INSURANCE COMPANY:
LIABILITY COVERAGES:
LIMITS OF LIABILITY
EACH PERSON EACH OCCURRENCE
....,$
$
$
$
$ XXX)(
uO
o
o
o
o
----.$-
$ XXX)(
$
$ XXX)(
$
Bodilylnjul)' ,
Property Damage
Passenger Bodily Injury
Single Limit Including Passengers,
with Passenger Liability Limited to:
ALL RISKS GROUND AND IN-FLIGHT
DEDUCTIBLES
IN-MOTION
$
$
PHYSICAL DAMAGE COVERAGE:
INSURED
VALUE
$
$
DESCRIPTION OF AIRCRAFT
FAA
NUMBER YEAR
NOT IN-MOTION
$
$
MAKE & MODEL
o As respects any Aircraft Owned and Operated by the Named Insured and covered under the above referenced Policy
POLICY PERIOD: FROM: October 1, 2003 TO: October 1, 2004
OLD REPUBLIC INSURANCE COMPANY
AP 7164 07
AIRPORT POLICY NO:
INSURANCE COMPANY:
LIABILITY COVERAGES:
[8J Comprehensive General Liability
[8J Completed Operations I Products Liability
o Not Applicable
[8J Hangarkeepers Liability
o Premises Medical Payments
Deductibles: Hangarkeeper's Liability
Premises Liability
LIMITS OF LIABILITY
each person $1,000,000.
each person $1,000,000.
$
each person $
$
$500,000.
$
$
$100,000.
each occurrence *
each occurrence *
property damage *
each occurrence *
property damage *
each loss
each accident
$
$100,000.
$
$**
$
each aircraft
each person
each loss
each claim with respect to Property Damage
. Refer to the Policy, an Annual Aggregate limit may apply to some coverages.
This Certificate Holder is:
o Included as a Loss Payee for Aircraft Physical Damage Coverage.
o Provided Breach of Warranty Coverage on Aircraft Physical Damage Coverage not to exceed 90% of the Insured Value.
~ Is included as an Additional Insured on Airport LiabilityCoverage but only with respect to operations of the Named Insured.
o Is provided a Waiver of Subrogation, but only as respects Aircraft Physical Damage Coverage.
OTHER COVERAGES/CONDITIONS/REMARKS:
** Deductibles: $2,500. Piston Aircraft / $10,000. Turbine Aircraft.
Provision has been made to give the Certificate Holder thirty (30) days Notice of Cancellation - ten (10) days for nonpayment of premium of any policy
above, however, the Company assumes no responsibility for the failure to provide such notice. This Certificate does not change in any way the actual
coverages provided by the policy(ies) specified above.
\
'fJieniX Avi f
Date: 12/9/20 3
Aviation Insurance Agency
561-286-0626
skg/
Agency Name:
Agency Phone:
rI ;-1..4 1990 Vaughn Road, Suite 350, Kennesaw, GA 30144. (770) 590-4950 · Fax: (770) 590-0599
(:) ~ l(!; ~ '-...\.. '- c'L6t2. <<.. ,.' .'
~ ~ W( ltt~ f"\.s~(2( r (~ .. AviCG-fl'o- J (U. S fL-