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HomeMy WebLinkAboutInsurance Certificate: Tailwheel Associates DATE rt•.~r~DL; ~.r 'r; CERTIFICATE of AIRCRAFT INSURANCE 07,1u»016 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). i DDNTACT PRA UCER NAME Costello Insurance Associates, Inc. PW)NE FA,< Post Office Box 28280 (ABC. No, EA) (wC. r:o) Tempe, AZ, 85285 E-MAIL REDRESS r PRODUCER CUSTOPr'ERIDNo t=UF'ED INSURER(S) AFFORDING COVERAGE % NAIL 1do Tailwheel Associates, LLC INSURERA U.S. SPECIALTY INSURANCE COMPANY loom j 1390 Frank Hill Rd. INSURER B ! Ashland, OR, 97520 INSURER C IrJSURER D i 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 j 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. POLICY INFORMATION CERTIFICATE NUMBER: REVISION NUMBER: POLICY TYPE LINE OF EUSINESS SUE-CODE NDUSTRIAL PLEASURE& COMMERCIAL AIRPLANE HELICOPTER D:11XECFLEET EXCESS J1)TA. AD BUS ❑ ❑ , SHAPE L_J I PJk741-OV4TlED ❑ LIABILITY' HULL & LIiBILITY ❑ HULL ONLY ONLY AIRCRAFT INFORMATION ACORD 333, Aircraft Schedule attached YES-F.' aa}iE hAODEL SERIAL NUMBER REi,ISTRATIC?N NI ItABER_ j 1958 I CESSf,,IA 182A N2192G TERRITORY: I AIRCRAFT COVERAGES Ir,:SURERLETTER POLICY NUMEER EFFECTIVE DATE EXPIRATIi_r f,ATE ADDITIONALItTSURED;(YIN) _UcnvcA,TIUNa.,~~EC'/{`i/N} GA00168372-06 0723M16 0723/2(317 Y N i CvVERA-E OPTIO^.S LIrv11T APPLIES TO LIM 1T APPLIES TO i ALL RISK GROLIND A.ND FLIGHT $ 70,000 $ Ded. - Not in motion v AIRCRAFT HULL © ALL RISK GROUND ONL'( AGREED VALUE ~ Ded. - In motion LIABILITY $ 1,000,000 EAOCC. $ E4 PER AIRCRAFT LIABILITY $ 100,000 EA PASS A13 R INCLUDING CREV&I $ 5,000 I ia1ELICAL PAYMEt.1TS - Ea PER 20,000 EA C" ❑ EXCLUDING CREVv I COVERAGE i CODE DESCRIPTION i~PTIONS LIPAIT APPLIES TO LIMIT APPLIES TO DESCRIPTION OF OPERATIONS J REMARKS (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is included as an Additional Insured. j CERTIFICATE HOLDER CANCELLATION City of Ashland Oregon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 51 Winburn Way EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE Ashland, OR 97520 WITH THE POLICY PROVISIONS. IAUTHORIZED REPRESENTATIVE I i ! I © 2009 ACORD CORPORATION. All rights reserved. ACORD 21 (2009112) The ACORD name and logo are registered marks of ACORD ?i j DATE(r.1PNDDi'r'r' 2 0 16 ACC)MY CERTIFICATE OF AIRCRAFT INSURANCE °7 /Ia, 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). CONTACT PRnD!_ICER NAME Costello Insurance Associates, Inc. PHOr,jE FAX Post Office Box 28280 (A/C, No, Ertl (A C NO) i Tempe, AZ, 85285 E-MAIL AL;DRESS ~ I PRODUCER 0_LST01"ERIDNo. IPI UF,'ED I!`,JS1'PER'(S)AFFORDING 00VERAGE % NAIL No TaMbeel Associates, LLC INSURER' A U.S. SPECIALTY INSURANCE COMPANY ioo°ro i 1390 Frank Hill Rd. j Ashland, OR, 97520 . INSURER C I --1 N:;URER D ~ INSURER E i 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, I EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY INFORMATION CERTIFICATE NUMBER: REVISION NUMBER: POLICY TYPE LINE CF BUSINESS SUBCODE It IDUSTRIAL PLEASURE & COMMERCIAL AIRPLANE HEL ICORTER MINED FLEET EXCESS «UOTA ❑ I Alf, B ;S ❑ L I t1CI1 0=.^~r dED ❑ LIABILITY HULLS LABILITY ❑ HULL ONLY ONLY I ~ AIRCRAFT INFORMATION ACORD 333, Aircraft Schedule attached MODEL SERIAL NUMBER REGISTRAT10tI NUMSEP E~:r MATE 1940 PIPER I J5A N30270 ET RRITORY: AIRCRAFT COVERAGES INSURER LETTER POLICY NUMBER EFFEG T IVE DATE Ex-ExI DATE ADDITIONAL INSURED~ (Y I H) SUER ~G.u.TIOr1 'VVA, IvED 7, (YN; GA00168372-06 I 0723/2016 07232017 Y N -C'JER CE OPTIONS LIMIT APPLIES TO LIMIT APPLIES -G ❑ ALL RISK GROUNCD AND FLIGHT Ded. - Not in motion $ 40,000 ~ AGREED VALUE JRCRAFT HULL .-,',LL R.iSI<G RCiUNG ONLY $ Ded. - In motion 1,000.OC EA Oa_ EA PER © LIAILIT'Y 4J" 10 a.IF'~RA:FT Li,-,;=!'CITY EA.FASS `~f R I 100,000 .5 I ❑ INCLUGINC K `W 5,000 EA PER $ 10,000 EA I I P.1Ei~i~AL FAYF."Ef•1T:3 ❑ EXCLUDING CREV C--1VERAG E rn~,E DESCF'IFTIOid OPTIONS LIMIT APPLIES TO LIMIT APPLIES -G I DESCRIPTION OF OPERATIONS 1 REMARKS (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is included as an Additional Insured. CERTIFICATE HOLDER (CANCELLATION City of Ashland Oregon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 51 Winburn Way (EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE i ©2009 ACORD CORPORATION. All rights reserved. ACORD 21 (2009112) The ACORD name and logo are registered marks of ACORD Costello Insurance Associates, Inc. HVI -~TION INSURANCE July 25, 2016 City of Ashland Oregon 51 Winburn Way Ashland, OR 97520 INSURANCE SHOWING ADDITIONAL INSURED (LIABILITY) INTEREST Owner: Tailwheel Associates, LLC Property: 1958 Cessna 182A 1940 Piper J5A Company: U.S.Specialty Insurance Co. Policy No.: GA 00168372-06 Effective Date: July 23, 2016 Term: 1 Year The enclosure shown below protects your interest in the above property in accordance with the policy provisions. Please advise if any corrections are necessary. Enclosed: insurance certificate with additional insured wording Best Regards, /d 1 1 I }Y Anne Sopp-Kouris V P. O. BOX 28280 / 428 E. SOUTHERN AVENUE / TEMPE, AZ. 85285-8280 TEL: 480-968-7746 / 800-528-6483 / FAX: 480-967-3828 / insure@aviationi.com