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�ATE(MMIDD/YYYY) <br /> AC R� CERTIFICATE OF AVIATION LIABILITY INSURANCE �y�yZ�,� <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND 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. <br /> IMPORTANT: If the cert'rficate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed.If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions ofthe policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement s. <br /> CONTACT <br /> PROIXICER NAME: <br /> Falcon Insurance Agency, II1C. PHONE FAx <br /> P.O.Box 291388 c No�,a c No: <br /> Kerrville, TX 78029 E-MAILADDRESS: <br /> RO DU C E R CUSlDMER ID Na <br /> INSURED INSURER(S)AFFORDINGCOVERAGE % NAIC No. <br /> Skydl�e City, InC. <br /> iNsuRERn.U.S.SPECIALIY INSURANCE COMPANY 100% <br /> 4241 Sky Dive Lane INSURERB <br /> Zephyrhills, FL 33542 INSURERC <br /> INSURER D <br /> INSURER E <br /> INSURER F <br /> THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED.NOTWITHSTANDING ANY REQUIREfU�NT,TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT WffH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDffIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS. <br /> AIRPORT&FBO LIABILITY COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> INSURERLETTER POLICY NUMBER EFFECTNE DAlE EXPIRAl10N DA1E ADDITIONAL INSURED7(Y/N) SUBROGAl10N WANED?(Y/N) <br /> UA0016734407 02/18/2017 02/18/2018 Y N <br /> COVERAGE OPTIONS LIMIT APPLESTO LIMIT APPLESTO <br /> $ 100,000 BIEnPER $ PD <br /> PREMIStS LIABILITY <br /> $ 1,000,000 ep,ocC $ 2,000,000 AGGR <br /> PREMISES MEDICAL PAYMENT $ EA PER $ EA OCC <br /> $ BIEAPER $ AGGR <br /> PRODUCTS LIABILfTY EXTENDED <br /> $ EA OCC <br /> COMPLElED $ BIEAPER $ AGGR <br /> OPERATIONS EXiENDED <br /> L1481LfTY $ EA OCC <br /> INCLUDING TNO <br /> H4NGEf�EPERS <br /> LEGAL LIABLI7Y IN RIGHT $ EAAIRCRAFT $ EA OCC <br /> $ <br /> $ EA OCC $ AGGR <br /> $ EA OCC $ AGGR <br /> INCLUDED EXCLUDED <br /> COVERAGE <br /> CODE DESCRPTION OPTIONS LIMIT APPLESTO LIMIT APPLESTO <br /> $ � <br /> DESCRIPTION OF OPERATIONS/REMARKS Attach ACORD 101,Additional Remarks Schedule, if more s ace is re uired <br /> ZFPHYRHILLS MUNI,ZEPHYRHILLS, FL <br /> Certificate Holder is included as an Additional Insured. <br /> CERTIFICATE HOLDER CANCELLATION <br /> Clt ofZe h rhillsandZe h rhillsMunici alAir ort SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORETHE <br /> Y P Y P Y P p EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I <br /> 39450 SOUtII AV@. ACCORDANCE 1MTH THE POLICY PROVISIONS. � <br /> Zephyrhills, FL 33542 AUTHOPoZEDREPRFSENTATNE ' <br /> �� Vei--�•: <br /> 02009 ACORD CORPORATION.All rights reserved. � <br /> ACORD 20(2009/12) The ACORD name and logo are regisUered marks of ACORD � <br />