CERTIFICATE OF INSURANCE (11)
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CERTIFICATE OF INSURANCE
CERTIFICATE DATE: 08/02/2004 CERTIFICATE NUMBER: 04-01
CERTIFICATE HOLDER: POLICYHOLDER:
City of Clearwater Clearwater Airpark, Inc.
25 Causeway Boulevard 1000 N. Hercules A venue
Clearwater, FL 33767 Clearwater, FL 33765
This is to certify that the following policy(s), subject to the tenus, conditions, limitations and endorsements contained therein, and during their effective period, have been
issued 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:
Insurance Company:
Policy Number:
Policy Period:
PROPERTY
The Travelers
Unassigned
August 3, 2004 to August 3, 2005
Location:
Clearwater Air Park, Clearwater, FL
Property Covered:
Terminal Building, InsuredValue $110,000
Maintenance Hangar, Insured Value $220,000
Shade Hangars, Insured Value $220,000
T-Hangars, Insured Value $297,000
Multiple Aircraft Hangar, Insured Value $300,000
Deductibles:
$1,000.00 Each and Every Loss with the following exceptions: A deductible of 2% of the total insured value is
applicable to losses caused by Wind, Wind Driven Rain, Hail, Tornado or Hurricane
THE FOREGOING EVIDENCE OF COVERAGE IS NOT VERBATIM OF POLICY CONDITIONS, LIMITATIONS OR LANGUAGE; THE POL/CY(S) REPRESENTED
BY THIS CERTIFICATE ARE NOT AMENDED IN ANY WAY UNLESS SO STATED ON THIS CERTIFICATE.
ADDITIONAL AGREEMENTS:
Loss Payable
Payments for loss covered under the Aircraft Physical Damage coverage will be made payable to
Clearwater Airpark, Inc. and City of Clearwater in an amount not to exceed the Insured Value.
NOTICE OF CANCELLATION: IN THE EVENT OF MATERIAL CHANGE OR CANCELlATION OF SAID POLlCY(S), THE COMPANY(S) SHALL ENDEAVOR
TO GIVE 30 DAYS WRlITEN NOTICE TO THE CERTIFICATE HOLDER WITH THE EXCEPTION OF A 10 DAY NOTICE FOR NON-PAYMENT OF PREMIUM,
Aviation Insurance Agency, Inc.
901 S. W. Martin Downs Boulevard ~ ~ \ " (j
P.O. Box 2260, Palm City, FL 34991 (L... 0 u.JI.. Q..u.u
www.avnins.com - . -)
Telephone (772) 286-0626 - Facsimile (772) 286-1108
Authorized Signature