HomeMy WebLinkAboutInsurance Certificate: JLC Avioncs LLC
® DATE (MM/DD/YYYY)
CERTIFICATE OF AVIATION LIABILITY INSURANCE
07/06/2016
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 endorsement(s).
PRODUCER NCONTACT
AME: Ryan J. Birr
Northwest Insurance Group, Inc. SON No Ext : 503-640-6060 A/c, No ; 503-640-6202
3301 NE Cornell Road ADDRESS: ryan@nwinsurance.net -MODUCER
Suite R CUSTOMER ID
Hillsboro OR 97124 INSURER(S) AFFORDING COVERAGE % NAIC #
INSURED INSURER A : StarNet Insurance Company 100
INSURER B :
JLC Avionics, LLC INSURER C
433 Dead Indian Memorial Road INSURER D
Ashland OR 97520 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 HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
AIRPORT & FBO LIABILITY COVERAGES CERTIFICATE NUMBER: 1 REVISION NUMBER:
INSURER LETTER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE ADDITIONAL INSURED? (Y I N) SUBROGATION WAIVED? (Y I N)
A BA-16-07-00131 07/0112016 07/01/2017 Y N
COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO
I I ~ $ BI EA PER $ PD
PREMISES LIABILITY
$ 1,000,000 EA OCC
PREMISES MEDICAL PAYMENTS $ EA PER $ EA OCC
SALE OF FUEL & OIL $ BI EA PER $ AGGR
PRODUCTS LIABILITY
EXTENDED $ EA OCC
COMPLETED EXTENDED I $ BI EA PER $ AGGR
OPERATIONS
LIABILITY $ EA OCC
HANGARKEEPERS INCLUDING TAXI
$ EA AIRCRAFT $ EAOCC
LEGAL LIABILITY IN FLIGHT
FIRE LEGAL LIABILITY I $ ANYONE FIRE
PERSONAL INJURY LIABILITY i ! $ EA OCC $ AGGR
ADVERTISING LIABILITY ? f $ EA OCC $ AGGR
CONTRACTUAL LIABILITY I INCLUDED EXCLUDED
COVERAGE
CODE DESCRIPTION OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO
$ $
$ $
$ $
j $ $
$ $
$ $
i
DESCRIPTION OF OPERATIONS / REMARKS (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH.THE-POLICY PROVISIONS.
City of Ashland
AUTHORIZED REPRESENTATIVE ter.
20 East Main Street ' =$;k
Ashland OR 97520 RYAN J. BIRR
w.,
0 2009 ACO~D CORPORATI N. All rights reserved.
ACORD 20 (2009/12) The ACORD name and logo are registered marks of ALaRD