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, � <br /> . <br /> �' AIRPORT' LIABILITY POLICY <br /> DECLARATIONS -PART ONE <br /> Company: <br /> U.S. SPECIALTY INSURANCE COMPANY UA00167344-05 <br /> Your Policy Number: <br /> • Administrative offices: 13403 Northwest Freeway, prior Policy Number: UA00167344-04 <br /> • Houston, TX 77040 <br /> ITEM NAMED INSURED AND ADDRESS YOUR AGENT'S NAME AND ADDRESS Individual <br /> � Skydive City, Inc. Falcon Insurance Agency, Inc. � <br /> P. O. Box 291388 Q Partnership <br /> Kerrville,TX 78029 or Joint <br /> 4241 Sky Dive Lane Venture <br /> Zephyrhills, FL 33542 � <br /> Other <br /> 2 POLICY PERIOD: 12:01 a.m. standard time at o�1r above address FROM: 02/18/2015 TO: 02/18/2016 <br /> 3' BUSINESS OF NAMED INSURED: I <br /> 4 PART OCCUPIED BY NAMED INSURED'S <br /> LOCATION OF AIRPORT INSURED BY THIS PC�LICY NAMED INSURED INTEREST <br /> ZEPHYRHILLS MUNI, ZEPHYRHILLS, FL Portion Tenant <br /> 5 LIMITS OF INSURANCE, COVERAGES AND PREMI MS:This insurance is only with respect to the following coverage(s) ' <br /> for which a premium charge is shown in the premium c�lumn.Absence of a premium charge means that no insurance is i <br /> provided by the policy for that coverage. , <br /> LIMITS OF INSURANCE COVERAGES PREMIUM <br /> $ 100,000 Each Person AIRPO T <br /> $ 1,000,000 Each Occurrence A BODIL�' INJURY AND PROPERTY DAMAGE LIABILITY $ 1,500 <br /> $ 2,000,000 A re ate <br /> $ Any One Aircraft <br /> $ Each Occurrence C HANG I RKEEPER'S LIABILITY <br /> $ Deductible <br /> 4 COVERAGES APPLICABLE TO ALL AIRPORT( ) 1NSURED BY THIS POLICY <br /> LIMITS OF INSURANCE, COVERAGES AND PREMII�MS:This insurance is only with respect to the following coverage(s) <br /> 5 for which a premium charge is shown in the premium cl lumn.Absence of a premium charge means that no insurance is <br /> rovided b the olic for that covera e. <br /> LIMITS OF INSURANCE I COVERAGES - PREMIUM <br /> $ Each Person PROD�CTS COMPLETED OPERATIONS HAZARD <br /> $ Each Occurrence B BODIL INJURY AND PROPERTY DAMAGE LIABILITY <br /> $ A re ate <br /> $ Each Person p MEDI�AL PAYMENTS $ <br /> $ Each Occurrence <br /> 6 Premium for Endorsement s 0 <br /> Forms and Endorsements attached: TOTAL POLICY PREMIUM 1,500 <br /> Form Name Form Version Form Title Form Premium <br /> 20210 (08/10) FLORIDA CHANGES-C NCELLATION AND NONRENEWAL <br /> 20702 (04/11) ASBESTOS EXCLUSIOI� <br /> 20001 (08/10) AIRPORT POLICY CONQITIONS <br /> 20003 (08/10) AIRPORT LIABILITY PO I ICY JACKET <br /> 20002 (08/10) Document Nurnber: 575269 Page 1 of 2 <br />