CERTIFICATE OF INSURANCE (20)CERTIFICATE OF INSURANCE
t2
CERTIFICATE HOLDER:
City of Cleazwater
25 Causeway Boulevard
Clearwater, FL 33767
POLICYHOLDER:
Clearwater Airpark, Inc.
1000 N. Hercules Avenue
Clearwater, FL 33765
R: i
This is to certify that the following policy(s), subject to the terms, conditions, limitations and endorsemenu contained therein, and during their effective period, have been
issued by the company(s) indicated below. [n 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 liabiliry or obligation of any kind upon the undersigned or the company(s) involved.
Policy Type: PROPERTY
Insurance Company: Atlantic Specialty Insurance Company �������
Policy Number: 753023234-0000
Policy Period: August 3, 2012 to August 3, 2013
Location Covered: Clearwater Airpark, Clearwater, FL
Terminal Building Insured Value $260,000
Corporate Hangar Insured Value $312,000
Maintenance Hangar Insured Value $295,100
T-Hangars:
A Insured Value $283,600
B Insured Value $340,300
C Insured Value $378,100
H Insured Value $378,100
I Insured Value $378,100
Shade Hangars:
D
E
F
G
Multiple Hangar (2012)
Causes of Loss:
Deductibles:
Insured Value $295,400
Insured Value $295,400
Insured Value $295,400
Insured Value $295,400
Insured Value $534,000
au� 0 9 20�2
C5r�1�i�. REC.I,��C�S %��
«���� 5��� Q���
Special Form Excluding Windstorm and Hailstorm
$1,000 Each and Every Loss
THE FOREGOING EYIDENCE OF COVERAGE /S NOT VERBAT/M OF POLICY CONDlT/ONS, L/M/TAT/ONS OR LANGUAGE; THE POLICY(S� REPRESENTED
BY TH/S CERTIFICATE ARE NOT AMENDED GV A,NY WAY UNLESS SO STATED ON THIS CERT/FlCATE.
ADDITIONAL AGREEMENTS:
Loss Payable
Payments for loss covered under the Aircra8 Physical Damage coverage will be made payable to
Clearwater Airpark, Inc. and City of Clearwater in an amount not to exceed the Insured Value.
NOTICB OF CANCeLLAT10N: IN THE EVENT OF MATERIAL CHANGE OR CANCELLATION OF SAID POL[CY(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
www.avnins.com
Telephone (772) 286-0626 — Facsimile (772) 286-1108
� `��7
�
�
Authorized Signature
. .
CERTIFICATE OF INSURANCE
DATE: osioai2oi2
CERTIFICATE HOLDER:
City of Clearwater
25 Causeway Boulevard
Clearwater, FL 33767
CERTIFICATE NUMBER: i
POLICYHOLDER:
Clearwater Airpark, Inc.
1000 N. Hercules Avenue
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: PROPERTY
Insurance Company: Atlantic Specialty Insurance Company
Policy Number: 753023234-0000
Policy Period: August 3, 2012 to August 3, 2013
Location Covered: Clearwater Airpark, Clearwater, FL
Terminal Building Insured Value $260,000
Corporate Hangar Insured Value $312,000
Maintenance Hangar Insured Value $295,100
T-Hangars:
A Insured Value $283,600
B Insured Value $340,300
C Insured Value $378,100
H Insured Value $378,100
I Insured Value $378,100
Shade Hangars:
D
E
F
G
Causes of Loss:
Deductibles:
Insured Value $295,400
Insured Value $295,400
Insured Value $295,400
Insured Value $295,400
Special Form Excluding Windstorm and Hailstorm
$1,000 Each and Every Loss
THE FOREGOING EvIDENCE OF COV6RAGE IS NOT vERBATIM OF POLICY CONDlTIONS, LIMITATlONS OR LANG UAGE; THE POL/CY(S� REPRESENTE'D
BY THIS CERT/FICATE 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
TO GIVE 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER WITH THE EXCEPT[ON OF A 10 DAY NOTICE FOR NON-PAYMENT OF PREMNM.
Aviation Insurance Agency, Inc.
2580 S. E. Aviation Way, Suite 101
Stuart, FL 34996
www.avnins.com
Telephone (772) 286-0626 — Facsimile (772) 286-1108
� `��7
�
�
Authorized Signature