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DATE(MM1DdYYYYJ <br /> .4C[7R�� CERTIFICATE OF AVIATION LIABILITY INSURANCE o1,1�fB <br /> �� <br /> THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BEIW�I THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESQVTATNE OR PRODUCER,AND THE CERTIFICATE HOL.�R. <br /> IMPORTANT:If the certlflcate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subJectto <br /> the terms and condttlons of the policy,certaln pol�les may requlre an endorsement A s�tement on this certtflcate does not confer rigMs to the <br /> certificate holder in lieu ofsuch endorseme s. <br /> CONTACT <br /> PRODUCER NAME. <br /> Falcon Insurance Agency,II1C. PHONE F� <br /> P.O.Box 291388 WC,No.F�d: P/C.No: <br /> Kerrville,TX 78029 E-MAILPDDRESS: <br /> RODUCER CUSTOMERIDt�h. <br /> INSURED INSURER(S)AFFORDING COVERAGE % NAIC No. <br /> Skydive City, Inc. <br /> INSURERA.U.S.SPECIALIY INSURANCE COMPANY 10096 <br /> 4241 Sky Dive Lane INSURER B <br /> Zephyrhills,FL 33542 INSURER C <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 NAAAED,4BOVE FOR THE POLICY PERIOD <br /> INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERAA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT UNTH 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 NUMBER: REVISION NUMBER: <br /> INSURER LETTER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE ADDITIONAL INSURED7(Y/N) SUBROGATION WAIVED9(Y/N) <br /> UA00167344-06 02/18l2016 02/1 Sl2017 Y N <br /> COVERAGE OPTIONS LIMIT APPLIESTO LIMIT APPLIESTO <br /> $ 100,000 BI e,a PER $ PD <br /> PREMISIS LIABILITY <br /> $ 1,000,000 ea,OCC $ Z,OOO,OOO AGGR <br /> PREMISES MEDICAL PAYMENT $ EA PER $ E4 OCC <br /> $ BIEAPER $ AGGR <br /> PRODUCTS LIABILITY EXTENDm <br /> $ EA OCC <br /> COMPLEiED $ BIEAPER � AGGR <br /> OPERATIONS EMENDED <br /> LIABILITY $ EA OCC <br /> INCLUDING TAXI <br /> HANGERKEEPERS <br /> LEGAL LIABILITY IN FLIGHT $ EA NRCRAFT $ EA OCC <br /> $ <br /> $ EA OCC $ AGGR <br /> $ EAOCC $ AGGR <br /> INCLUDED EXCLUDED <br /> COVERAGE <br /> CODE DESCRIPTION OPTIONS LIMIT APPLIESTO LIMIT APPLIESTO <br /> $ $ <br /> DESCRIPTION OF OPERATIONS I REMARKS(Attach ACORD 101,Additlonal 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 /> Pasco County SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE <br /> 8731 Citizens Dr. EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> New Port Richey,FL 34654 CCORDANCE WITH THE POLICY PROVISIONS. <br /> UTHORIZE�REPRESENTATIVE , <br /> .�� �����'. <br /> O 2009 ACORD CORPORATION.All rights reserved. <br /> ACORD 20(20�112) The ACORD name and logo are registered marks of ACORD <br />