DECLARATIONS PAGE AV538-4598 FOR CHARTER AIRCRAFT-1984 AEROSPATIALE AS 350B
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PART 2
Policy Number
AV 538-45981
DECl-A~ATlONS
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PREVlOUS POLICY NO. _ NEW'
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This page with "Policy Provisions - Port I" Form AV 2066-G and 011 endorsements ottoched hereto completes this numbered aviation
physical damage and liability policy, issued by the company os indicated by on "X" in the box to the left of the company's name (herein-
after called the Company),
~NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.
D THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA
D AMERICAN HOME ASSURANCE COMPANY
ITEM 1. H.C. T .. Inc. and Peter Azzarelll
NAMED INSURED
Post Offlce Box 9097. Tampa. FlGrlda ')&1&
ADDRESS
ITEM 2. Policy Period: From April 9. I'" to April 9. 1"0 12:01 A.M.
Stondard Time at the address in Item 1, The insurance afforded is only with respect to such and so many of the following coverages os ore
indicated by specified premium charge 01' charges. The limit of the company's liability against such coverage shall be as stated herein,
subject to 011 of the terms of this policy having reference thereto. If more than one aircraft is insured hereunder the terms of this policy
shall apply separately to each.
ITEM 3. LIMITS OF LIABILITY LIABILITY INDEX FOR COMPANY USE
Liability Coverages EACH PERSON EACH OCCURRENCE PREMIUMS
A. Bodily Injury-excluding Passenaers $ $ $
B. Property Damage XXXX
C. Passenger liabi Iity
D. Single limit- In c1uding Passengers XXXX ',000,000.
with Passenger liability N/A 2,9SO.
limited internally to: XXXX
E. Medical Expense Including Crew 2,-'00. "nnft Incl.
.
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L1AB. TOTAL $ 2,"0.
,
ITEM 4. Description of Aircraft and Physical Damage Coverage hereunder: DEDUCTIBLES
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F. A, A. YEAR SEATS INSURED PHYSICAL PHYSICAL NOT IN IN MOTION,
CERT. MAKE AND MODEL DAMAGE DAMAGE MOTION INGESTION.
NO. BUILT CREW PASS, VALUE COY. PREMIUMS OR MOOR!.~
N"'^C Aeromatlale AS .3'08 .. I , $ '00.000. F $ 11.000. UO.o,_ 1l0JlDD-
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Physical Damage Coverage Identified G, All Risks: Not In Flight, PHYSICAL POLICY
F, All Risks: Ground & Flight. H. All Risks: Not In Motion. DAMAGE $ 11,000. PREMIUM $ 13,9'0.
TOTAL
ITEM 5. When in flight the aircraft will be piloted only by
As Endorsed
ITEM 6. The aircraft will be used only for the purposes indicated by "X" below (see Definitions),
O"PLEASURE ANDI ~"CHARTER/ II:: I
BUSINESS", ~AIR TAXI" L-j"COMMERCIAL"
o AS ENDORSED
HEREON
ITEM 7. LOSS PAYABLE: Any loss under coverage F, G and H is payable as interest may appeor to the named Insured and
Nil
Countersigned
April ,
Panama City, Florida
The named insured is and sholl remain the sole owner of the aircraft and the aircraft is not subject to any encumbrance other
than os indicated herein.
D.G. Carroll (( Company, Inc., Post Office Box 2393'9 Jacksonville. FL 32241
U AIG Aviation, Inc.
D AIG Aviation Insurance Services
19~ 0 AIG Aviation (Canada), Inc.
o AIG Aviation (Illinois) Corporation
D AIG Aviation (Texas), Inc.
D
ITEM 8.
Producer
at
By
(AUTHORIZED REPRESENTATIVE)
Approved by
(AVIATION MANAGERS)
AV 2066,G ('2/SS)
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IAMENDATORY ENDORSEMENTI
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Applicable only if so indicated by an "X" in the box ta the left of the appropriate paragrapn:
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o 1. The following is hereby included as an additional Insured:
...........
, \:~~T~~:l T/-
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o 2. The following, who is the registered owner of
additional Insured:
is hereby included as an
o 3. The following is hereby included as on additional Insured, but only as respects Liability Coverages:
:K}( 4. The following is hereby included as an additional Insured, but only as respects operations of the Named
Insured:
City of Clearwater
o 5. The following is hereby included os an additional Insured under Liability Coverages, but only as respects
operations of the Named Insured:
o 6. The Company hereby waives its right of subrogation against the following as respects loss 'or damage
arising under Physical Damage Coverage as set forth under this policy; provided, however, that this
waiver shall not prejudice the Company's right of recourse for damages arising from the manufacture,
repair, sale or servicing of the aircraft by the following:
o 7.
Nothing herein contained shall vary, alter, waive or extend any of the terms, provisions, representatians, conditions
or agreements of the policy other than as above stated.
This endorsement becomes effective May 31. 1989 to be attached to and hereby made a part
of Policy No. A V 538-4598 issued to H.C. T.. Inc.. etal
This endorsement shall not be valid unless approved by the Aviation Managers of the Company.
Endorsement No. 3
XIX AIG Aviation, Inc.
o AIG Aviation Insurance Services
o AIG Aviation (Canada), Inc.
o AIG Aviation (Illinois) Corporation
o AIG Aviation (Texas), Inc.
o
Date of Issue 06/05/89(as)
By
~/
AVIATION MANAGERS
AV,29 (11,881
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