CERTIFICATE OF INSURANCE - AIRPORT LIABILITY (2)
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AIRPORT LIABILITY
ADDITIONAL INSURED
CERTIFICATE OF INSURANCE
Policy Number UA00153043-01
issued by U.S. Specialty Insurance Company of Houston Texas was issued to:
Named
Insured
And
Address
CLEARWATER AIRPARK, INC.
1000 N. HERCULES AVENUE
CLEARWATER, FL 33765
This certificate of insurance neither
affirmatively or negatively amends,
extends or alters the coverage afforded
by the Policy described herein
And is in force from 04/25/2007 to 04/25/2008 . The insurance afforded by the policy is only with respect to
the Coverages for which a limit is shown under the Limits of Liability column.
Airport: CLEARWATER AIR PARK
LIMITS OF LIABILITY COVERAGES
$ Each Person
$ 1,000,000 Each Occurrence A AIRPORT
$ 2,000,000 Aggregate BODIL Y INJURY AND PROPERTY DAMAGE LIABILITY
$ 100,000 Each Person 8 PRODUCTS COMPLETED OPERATIONS HAZARD
$ 1,000,000 Each Occurrence BODILY INJURY AND PROPERTY DAMAGE LIABILITY
$ 1,000,000 Aggregate
.. .,
$ 250,000 AnyOne Aircraft
$ 1,000,000 Each Occurrence C HANGARKEEPERS LIABILITY
$ 5,000 Deductible
$ 3,000 Each Person 0 MEDICAL PAYMENTS
$ 3,000 Each Occurrence
In the event of cancellation of the above described Policy. the company, if possible, will notify the Certificate Holder, shown
below, 10 days prior to such cancellation.
CERTIFICATE ISSUED TO:
CITY OF CLEARWATER
25 CAUSEWAY BOULEVARD
CLEARWATER,FL 33767
U.S. SPECIALTY INSURANCE COMPANY
P.O. Box 797408, Dallas, TX 75379-7408
EXECUTED THIS 27th DAY OF Apr
By
, 2007
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Authorized Representative
The Certificate holder is included as an additional insured but only with respect to liability arising out of the Named
Insured's maintenance or use of the airport.
This is a Memorandum of Insurance and not a Policy of Insurance and no action may be brought hereunder. It is furnished
only as evidence that the Insurance Policy described herein has been issued by this company.
USS 20012 AL(01/06)
Avemco Insurance Company
411 Aviation Way, Suite 100
Frederick, MD 21701
CERTIFICATE OF INSURANCE
THIS CERTIFICATE IS ISSUED TO:
Date: 04/30/2007
Clearwater Air Park
Po Box 4748
Clearwater, FL 34618-4748
--DESCRIPTIVE SCHEDULE--
POLICYHOLDER:
Sherif I. Sirageldin
Unit 402
88005 Overseas HWY#9
Islamorada, FL 33036
POLICY NUMBER: 010109542906
POLICY
PERIOD
To: 05/03/2008
11 :59:59 P.M.
1975 CESSNA 177RG
(local time at policyholder's address)
From: 05/04/2007
12:00:01 A.M.
INSURED AIRCRAFT: 177WS
LIMITS OF LIABILITY: (125301)
$ 100,000 each person
$ 1,000,000 property damage
$ 1,000,000 each accident
The most current date shown in the top right corner is the most current certificate for this insured property,
and replaces all certificates, if any, previously issued under this Policy number or any other Policy number.
LIABILITY - Bodily Injury
(Including Occupants)
and Property Damage
This Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the coverage
afforded by the Policy. It is issued as a matter of information only and confers no rights upon the certificate
holder.
DISTRIBUTION:
Avemco Insurance Company
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Authorized Representative
Certificate Holder
Policyholder
NC-F1-1253(10/01/1998)
Copy for the facility where your aircraft is based
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The Certificate Holder shown on the front of this Certificate is an insured person under that definition
of the Policy. However, they are an insured person only for their liability arising out of their agreement
to let another insured person store or use the insured aircraft on their airport. THE CERTIFICATE
HOLDER IS NOT AN INSURED PERSON WHEN THEIR LIABILITY ARISES OUT OF THEIR MANU-
FACTURE, REPAIR, SERVICE, SALE OR USE OF THE INSURED AIRCRAFT.
We also agree to waive our recovery rights against the Certificate Holder for loss to your insured
aircraft (you do, too).
We will notify the Certificate Holder when this Policy is cancelled. Notice will be sent at least 30 days
before the cancellation date. Only 10 days' notice (or that notice required by your state, if more) will be
given if we cancel for nonpayment of premium.
If the Certificate Holder has other liability insurance, that insurance shall apply first. The addition of this
Certificate Holder as an insured person does not increase the Limits of Liability on this policy.