CERTIFICATE OF INSURANCE (13)
CERTIFICATE OF INSURANCE
CERTIFICATE DATE: 08/03/2005 CERTIFICATE NUMBER: 04-12
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 terms, 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 erideavor 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
St. Paul Travelers
Unassigned
August 3, 2005 to August 3, 2006
Location:
Clearwater Air Park, Clearwater, FL
Property Covered:
Terminal Building, Insured Value $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 5% of the total insured value (subject
to a minimum of$5,000.00) applicable to losses caused by Wind, Wind Driven Rain, Hail, Tornado or Hurricane
, . <,. .. ,." .'. ,,'
THE FOREGOING EVIDENCE OF COVERAGE IS NOT VERBA TIM OF POL/CY CONDITIONS, LIMITATIONS OR LANGUAGE; THEPOLICY(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 PoLiCY(S), THE COMPANY(S) SHALL ENDEAVOR
'fo GIVE 30 DA YS W~ITTEN NOTICE TO THECERTIFICA TE HOLDER WITH THE EXCEPTION OFA 10 DAY NOTICE FOR NON;PA YMENT OF PREMIUM,
Aviation Insurance Agency, Inc,
900 S.Federal Highway, Suite 309 ~~~. 'l ,J.J ^. _ . _ .
Stuart, FL 34994 LA... ,.....J UJJ... ~
www.avnins.com
Telephone (772) 286-0626 - Facsimile (772) 286-1108
Authorized Signature