HomeMy WebLinkAboutInsurance Certificate: Thomas, Albert
OLD REPUBLIC INSURANCE COMPANY
Certificate of Insurance
This is to certify to THE CITY OF ASHLAND OR
(Certificate Holder): 20 E MAIN ST.
ASHLAND, OR 97520
The following policy has Thomas, Albert
been issued to: 386 Guthrie St
ASHLAND, OR 97520
AIRCRAFT POLICY NO: PB 20522801 POLICY PERIOD: FROM: September 16, 2016 TO September 16, 2017
THIS COVERAGE IS EFFECTIVE 12:01 AM
INSURANCE COMPANY: OLD REPUBLIC INSURANCE COMPANY
LIABILITY COVERAGES: LIMITS OF LIABILITY
EACH PERSON EACH OCCURRENCE
Single Limit Including Passengers,
$1,000,000
with Passenger liability Limited to: $200,000
DESCRIPTION OF AIRCRAFT PHYSICAL DAMAGE COVERAGE:
FAA DEDUCTIBLES
NUMBER YEAR MAKE & MODEL INSURED VALUE NOT IN-MOTION IN-MOTION
N880AT 2012 VANS RV-8A $120,000 $0 so
THIS CERTIFICATE HOLDER IS:
Included as a Loss Payee on aircraft Physical Damage Coverage.
Included as an Additional Insured on aircraft Liability Coverage but only as respects operations of the Named Insured.
Provision has been made to give the Certificate Holder (30) days notice of Our cancellation of the referenced policy -
ten (10) days as a result of non-payment of premiums owed to Us. However, We assume no responsibility for the failure
to provide such notice.
This certificate is issued as a matter of information only and confers no rights upon the certificate holder.
This certificate does not amend, extend, or alter the coverage, terms, exclusions, conditions, or other provisions
afforded by the policies referenced herein nor does it constitute a contract between the issuing insurer(s),
_authorized representative or producer.
Agency Name: ARTHUR J GALLAGHER RISK MGMT SVS Date. 08/23/2016
Agency Phone: INC
636-532-0023
jOld Republic Aerospace Representative:;
1990 VAUGHN ROAD, SUITE 350, KENNESAW, GA 30144.(770) 590-4950 -Fax: (770) 590-0599
'0 LD REPUBLIC INSURANCE GROUP'