HomeMy WebLinkAboutInsurance Certificate: Stephen C. Smith
Costello Insurance Associates, Inc.
RVIORTION
INSURONCE
August 6, 2018
City of Ashland
51 Windburn Way
Ashland, OR 97520
INSURANCE SHOWING
ADDITIONAL INSURED (LIABILITY) INTEREST
Owner: Stephen C Smith
Property: Aviation N825RV
Company: Old Republic
Policy No.: PB204934-03
Effective Date: August 15, 2018
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,
Riley Clark
Y
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
* OLD REPUBLIC INSURANCE COMPANY
*
Certificate of Insurance
This is to certify to CITY OF ASHLAND
(Certificate Holder): 51 WINDBURN WAY
ASHLAND, OR 97520
The following policy has STEPHEN C SMITH
been issued to: 1804 ANDERSON CREEK RD
TALENT, OR 97540
AIRCRAFT POLICY NO: PB 20493403 POLICY PERIOD: FROM: August 15, 2018 TO August 15, 2019
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
N825RV 2009 VANS RV-8 $95,000 $0 $0
THIS CERTIFICATE HOLDER IS:
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: COSTELLO INSURANCE Date: 07/23/2018
Agency Phone: ASSOCIATES INC.
800-528-6483
Old Republic Aerospace Representative:
1990 VAUGHN ROAD, SUITE 350, KENNESAW, GA 30144 •(770) 590-4950 Tax: (770) 590-0599
OLDREPUBLIC INSURANCECROUP