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DATE(MMlDLVYYI'1� <br /> .dt����� CERTIFICATE OF AVIATION LIABILITY INSURANCE oJ,r�rs <br /> i THI�ICATE IS ISSUEDAS A fVIATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND,IXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED , <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER I <br /> IMPORTANT:If the certlflcate holder Is an ADDITIONAL INSURED,the policy(les)must be endors�.If SUBROGATION IS WAIVED,subJect to I <br /> the tertns and condftlons ofthe pollcy,cerlain policles may requlre an endorsement A statementon thls certlflcate does not confer righis to the <br /> certificate holder in lieu ofsuch endorseme s. � <br /> CONTACT � <br /> PRODUCER NAME. � <br /> Falcon Insurance Agency,I�C. PHONE F� ' <br /> P.O.Box 291388 ac.No.�a. ac,No: <br /> Kerrville,TX 78029 E-MAIL PDDRESS: <br /> RODUCER CUSTOMERIDhb. <br /> INSURED INSURER(S)AFFORDING COVER4GE % NAIC No. I <br /> 5kydive City,Inc. wsuReR n.U.S.SPECIALT'INSURANCE COMPANY ioo�, I <br /> 4241 Sky Dive Lane INSURER B ' <br /> Zephyrhilis,FL 33542 INSURERC <br /> INSURER D <br /> INSURER E <br /> INSURER F <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED.NONVITHSTANDING ANY REQUIREAAENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT UYITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> AIRPORT&FBO LIABILITY COVERAGES CERTIFlCATE tdUMBER: REVISION NUMBER: <br /> INSURER LETTER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE ADDITIONAL INSURED7(Y/N) SUBROGATION WAI ED7(Y/N) <br /> UA00167344-06 02/18/2016 02/'18/2017 Y N <br /> COVERAGE OPTIONS LIMIT APPLIESTO LIMIT APPLIESTO <br /> $ 100,000 BIEnPER $ PD <br /> PREMISIS LIABILITY <br /> $ 1,000,000 �,OCC $ 2,000,000 AGGR <br /> PREMISES MEDICAL PAYMENT $ EA PER $ EA OCC <br /> $ BIEAPER $ AGGR <br /> PRODUCTS LIABILITY EXTENDED <br /> $ EA OCC <br /> COMPLETED $ BIEAPER $ AGGR <br /> OPERATIONS F�C7ENDE0 <br /> LIP,BILITY $ EA OCC <br /> INCLUDI NG TAXI <br /> HANGERKEEPERS <br /> LEGAL LIABILITY IN FLIGHT $ EAAIRCRAFT $ EA OCC <br /> $ <br /> $ FA OCC $ AGGR <br />, $ FA OCC $ AGGR <br /> INCLUDED EXCLUDED <br /> COVERAGE <br /> CODE DESCRIPTION OPTIONS LIMIT APPLIESTO LIMIT APPLIESTO <br /> $ $ <br /> DESCRIPTION OF OPERATIONS!REMARKS(Attach ACORD 101,Addftlonal Remarks Schedule,If more space Is requlred) <br /> ZEPHYRHILLS MUNI,ZEPHYRHILLS, FL <br /> Certificate Holder is included as an Additional Insured. <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Zephyrhills and Zephyrhills Municipal Airport SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE <br /> 39450 SouthAve EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> Zephyrhills,FL 33542 CCORDANCE WITH THE POLICY PROVISIONS. <br /> urHowzEo a�ar�serrrnnvE <br /> � ��—. <br /> O 2009 ACORD CORPORATION.All rigMs reserved. <br /> ACORD 20(2009112j The ACORD name and logo are registered marks of ACORD <br />