CERTIFICATE OF INSURANCE (18)CERTIFICATE OF INSURANCE
CERTIFICATE DATE: 04/20/2010 CERTIFICATE NUMBER: to-01
CERTIFICATE HOLDER: POLICYHOLDER:
City of Clearwater Clearwater Airpark, Inc.
25 Causeway Boulevard 1000 N. Hercules Avenue
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 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: AVIATION GENERAL LIABILITY
Insurance Company: StarNet Insurance Company through Berkley Aviation, LLC
Policy Number: BA-10-04-00116
Policy Period: April 25, 2010 to April 25, 2011
LOCATION Clcatwatcr Air Park
Clearwater, FL
PREMISES LIABILITY $1,000,000 Each Occurrence
THE FOREGOING EVIDENCE OF COVERAGE IS NOT VERBATIM OF POLICY CONDITIONS, LIMITATIONS OR LANGUAGE; THE POLICY(S) REPRESENTED
BY THIS CERTIFICATE ARE NOT AMENDED IN ANY WAY UNLESS SO STATED ON THIS CERTIFICATE.
ADDITIONAL AGREEMENTS;
Additional Insured 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.
NOTICE OF CANCELLATION: IN THE EVENT OF MATERIAL CHANGE OR CANCELLATION OF SAID POLICY(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.
Aviation Insurance Agency, Inc.
2580 S.E. Aviation Way, Suite 101 ?
Stuart, FL 34996 Q?
www.avnins.com
Telephone (772) 286-0626 - Facsimile (772) 286-1108
Authorized Signature