CERTIFICATE OF INSURANCE (16)
CERTIFICATE OF INSURANCE
CERTIFICA TE DATE: 08/03/2007 CERTIFICATE NUMBER: 07-05
CERTIFICATE HOLDER: POLICYHOLDER:
City of Clearwater Clearwater Airpark, Inc.
25 Causeway Boulevard 1000 N. Hercules Avenue
Clearwater, FL 33767 Clearwater, FL33765
This is to certify that the following policy(s), subject to the tenns, 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 wilI 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:
Insurance Company:
Policy Number:
Policy Period:
PROPERTY
The Employer's Fire Insurance Company
753-01-78-08-0001
August 3, 2007 to August 3, 2008
RECEIVED
AUG 08 2007
Clearwater Airpark, Clearwater, FL
Terminal Building Insured Value $260,000
Corporate Hangar Insured Value $312,000
Maintenance Hangar Insured Value $275,600
T-Hangars:
A
B
C
H
I
Shade Hangars:
D
E
F
G
Location Covered:
Causes of Loss:
Deductibles:
OFFICIAL RECORDS AND
'EGISLATlVE SRVCS DEPT
Insured Value $202,800
Insured Value $223,600
Insured Value $244,400
Insured Value $244,400
Insured Value $244,400
Insured Value $192,400
Insured Value $192,400
Insured Value $192,400
Insured Value $192,400
Special Form Excluding Wind and Hailstorm
80% Coinsurance Clause
$1,000 Each and Every Loss
THE FOREGOING EVIDENCE OF COVERAGE IS NOT VERBATIM OF POLICY CONDITIONS, LIMITATIONS OR LANGUAGE; THE POL/CY(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
TO GIVE 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER WITH THE EXCEPTION OF A ] 0 DAY NOTICE FOR NON-PAYMENT OF PREMIUM.
Aviation Insurance Agency, Inc. ~
900 S. Federal Highway, Suite 309 ~a~ ' ^_
Stuart, FL 34994 lA.. to...J ~
www.avnins.com
Telephone (772) 286-0626 - Facsimile (772) 286-1108
Authorized Signature