HomeMy WebLinkAboutInsurance Certificate: Harold E Lee
AIG AEROSPACE INSURANCE SERVICES, INC.
CERTIFICATE OF INSURANCE
THIS IS TO CERTIFY TO: CITY OF ASHLAND ITS OFCRS AGNTS AND
EMPLOYEES, CITY HALL RISK MANAGER
ASHLAND, OR 97520
THAT THE FOLLOWING POLICY/IES OF INSURANCE HAVE BEEN ISSUED TO.-
HAROLD E. LEE
258 ORANGE AVENUE
ASHLAND, OR 97520-1124, USA
POLICY NO. LA 004201640-18
POLICY PERIOD. From December _1, 2016 _ to December 1, 2017
INSURANCE COMPANY NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURGH, PA
Coverage only applies as indicated by a specific limit and deductible. Limits of Liability
A. Aircraft Liability Single Limit for Bodily Injury and $ 1,000,000. each occurrence
Property Damage In cluding Passengers, but
Passenger Bodily Injury Limited within the Single
Limit to $ 100,000. each passenger
B. Medical Expense In cluding crew $ 10,000. each passenger
C. Physical Damage to Your Aircraft
Deductibles
ID Number Year Make and Model Agreed Value Not-in-Motion Not-in-Flight Flight
N6443A 1956 CESSNA 182 $ 60,000. $ 0. $ 0. $ 0.
THIS CERTIFICATE HOLDER IS:
1. included as additional insured as respects liability coverage but coverage only applies after all other coverage available to the
additional insured has been exhausted;
2. included as additional insured as respects liability coverage but coverage only applies with respect to the storage of insured
aircraft:
3. included as additional insured as respects liability coverage but coverage does not apply to any occurrence arising from the design,
manufacture, modification, repair, sale, or servicing of insured aircraft other than ground handling.
Coverage is sub'ect to Aviation Date Recognition Endorsement Form No. 71223.
The Aviation Managers have made provision to give the certificate holder prompt notice of cancellation of any policy
above. But, the Aviation Managers assume no responsibility for failure to provide such notice. This certificate does
not change in an way the actual coverages provided b the olic /ies specified above.
Certificate No. 12110730-10 ~f"
Date of Issue December 1, 2016 By
(Authorized Representative)
LAD30B (3/00)