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AiRPOR7 LIABItITY PQLICY � <br /> DECLARAT(ONS—PART ONE <br /> Company: . <br /> U.S. SPECIALTY INSURAPICE CaMPANY Your Policy Number, uA0016734a-02 <br /> . Administrative offices: 13403 Northwest Freeway, prior Policy Number. UA00167344-Q1 <br /> • Hduston,TX 77040 <br /> �� NAMED INSURED AND ADDRESS YOUR AGENTS NAME AND ADDRESS � �ndividual <br /> � � SKYDIVE GITY, 1NC. FAL.CON lNS. AGENCY, INC. p��nership <br /> '; 4241 SKY DIVE LANE P.O. BOX 29138$ � <br /> ZEPHYRHII.LS, FL 33542 KERRVILL�,TX 78028 or Joint <br /> Venture <br /> 0 Other <br /> ,.2;:.; POLICY PERIOD: 12:Q1 a.m.standard time at our above address F�20M: 02/78/201� TO: Q2/18/2013 <br /> ,�%:.�:;:� BUSINESS t�F NAMED 1NSUREp: SKYI�IVING SCHOOL <br /> .,�,. PART OCCUPI�D BY NAM�D INSURED'S <br /> °,�;::; lOCA7iO1V OF AIRPOR7INSURED BYTHIS POLICY NqM�D 1NSURED INTEREST <br /> • .;:'s; <br /> ::: 2�PHYRHIILS MUNI,ZEPHYRHILLS, FL PORY(QN T�NAN7 <br /> ,���'s� LIMITS OF INSURANCE, COVERP►GES AND PREMIUMS: 7his insurance is only with respect to the follawin <br /> '`° coverage(s}tor whicFi a p�emium charge is shown in the premium co�umn.Absence of a premfum charge means tha <br /> "��"� no insurance is rovided b the II for that covera e• <br /> $`�'�`'� lIMITS OF (NSURANCE , C4VERAGES PREMIUM <br /> �p'P <br /> ''�'ti''r:• $ 100 Q00 Eacfi Person <br /> ''�� 300,000 Each Ocaurrence a�PORT <br /> �,.�.��;;u � BQDlLY INJURY AND PROPERTY DAMAGE LIABILI7Y 1 500.00 <br /> ��. <br /> '°:�::,,: S 600 a0fl <br /> ��.=•:t�.���: <br /> '"�;�:•:; PRODUCTS COMPLETED OPERA710NS HAZARD <br /> ` ��-� $ Each�ccurrence <br /> :.�i;. <br /> re gpDILY INJURY AND PROPERIY DAMAGE LlABILflY <br /> i�.�w�� $ Ste <br /> ,... r� $ My One Airccaft <br /> �`�"`' Each Occurrence HANGARKEEPER'S LIABILITY <br /> V., $ <br /> ':a��,.::;+ $ Deducctible <br /> �'k"�`•;°' $ Each Per'son M�DICAL PAYMEN7S <br /> ��' Each Occurrence <br /> ;�'�. $ <br /> ::�;;�,4� Forms and�ndorsements attached: Qremium fnr Endarsement <br /> ' ��� 20001 20029 20053 20a31 2U701 20210 20702 Surcha e $26.00 540 <br /> �r�°yYf.�y <br /> 'Y^ <br /> :t;�'•a TOTAL POLICY PF�EMlUM 2,026.00 <br /> .st��=: <br /> .�r�r:.:�� <br /> ,�,,: <br /> f":;:.:; <br /> ' 4'::'-��� PRODUCTS-COMPL�TED OPERATIONS PR�MIUM RATE <br /> ; '"������ Cave e licable Onl 1JV'�th Res To The Followin Class�ication BASI5 er$1,000 <br /> .iJ^;'.�1 <br /> � i,+ �!, <br /> ! . <br /> � <br /> ` . <br /> � • <br /> � <br /> { <br /> j :�1 <br /> > <br /> 1 <br /> i <br /> inimum Premium$ <br /> Ccuntersig�ed: <br /> , Z0002 (08l1�) Authorized Representative <br /> SKYA0187 A10001 15.00 ClIT-VND A�gOYF 003 <br /> Z0/Z0 3JCd AlI� 3/1IQl��iS ZLZZE8LEZ8 Wd0Z�0t ZZOZ/i£/ZZ <br />