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HomeMy WebLinkAboutInsurance Certificate: Paul D Martin DATE (MM/DD/YYYY) Ate' CERTIFICATE OF AIRCRAFT INSURANCE 10/10/2014 `64 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . CONTACT PRODUCER NAME: AVemco Insurance Company Avemco Insurance Company PHONE: 800-638-8440 FAX: 800-863-3338 8490 Progress Drive, Suite 100 (A/C, No, Ext): (A/C, No): Frederick, MD 21701 E-MAILADDRESS: avemco ave.com PRODUCER CUSTOMER ID No. INSURED INSURER(S) AFFORDING COVERAGE % NAIC No. Paul D. Martin INSURER A: AVEMCO INSURANCE COMPANY 100% 10367 1940 Soda Mountain Rd INSURER B : Ashland, OR 97520 INSURER C : INSURER D : INSURER E : INSURER F : THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY INFORMATION CERTIFICATE NUMBER: REVISION NUMBER: POLICY TYPE LINE OF BUSINESS SUBCODE INDUSTRIAL X PLEASURE 8, COMMERCIAL X AIRPLANE HELICOPTER MIXED FLEET H EXCESS QUOTA AID BUS SHARE NON-OWNED LIABILITY HULL & LIABILITY HULL ONLY ONLY X AIRCRAFT INFORMATION ACORD 333, Aircraft Schedule attached YEAR MAKE MODEL SERIAL NUMBER REGISTRATION NUMBER 1958 PIPER PA-22-160 9413D TERRITORY: AIRCRAFT COVERAGES INSURER LETTER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE ADDITIONAL INSURED (Y / N) SUBROGATION WAIVED (Y /N) A 100119088111 11/16/2014 11/16/2015 Y Y COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO AIRCRAFT HULL II Risk Ground & Flight round Not In Motion $ $ Ded. - Not in motion round Not In Flight AGREED VALUE $ Ded. - In motion AIRCRAFT LIABILITY X ncluding Passengers $ 1,000,000 EA OCC $ 100,000 EA PER Excluding Passengers $ EA PASS $ AGGR MEDICAL PAYMENTS INCLUDING CREW $ EXCLUDING CREW EA PER $ EA PASS COVERAGE CODE DESCRIPTION OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO $ $ $ $ $ $ $ $ $ $ $ $ DESCRIPTION OF OPERATIONS / REMARKS Attach ACORD 101, Additional Remarks Schedule, if mores ace is required) SEE ATTACHED ENDORSEMENT 125301 CERTIFICATE HOLDER CANCELLATION Ashland Muni-Sumner Parker Fld SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City Of Ashland Oregon EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E. Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE MARCI L VERONIE © 2009 ACORD CORPORATION. All Rights reserved. ACORD 21 (2009/12) The ACORD name and logo are registered marks of ACORD