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HomeMy WebLinkAboutInsurance Certificate: Tailwheel Assoc. LLC DATE(MM/DD/YYYY) A`o CERTIFICATE OF AIRCRAFT INSURANCE 07/23/2019 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 have ADDITIONAL INSURED provisions or 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 CONTACT Costello Insurance Associates, Inc. PHONE FAX (NC,No,Ext): (NC,No): Post Office Box 28280 E-MAIL ADDRESS Tempe, AZ 85285 PRODUCER CUSTOMER ID#. INSURER(S)AFFORDING COVERAGE % NAIC# INSURED INSURER A:U.S.SPECIALTY INSURANCE COMPANY 100% Tailwheel Associates, LLC INSURER B: INSURER C: 1390 Frank Hill Rd. INSURERD: Ashland, OR 97520 INSURERE: 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. POLICY INFORMATION CERTIFICATE NUMBER: REVISION NUMBER: POLICY TYPE UNE OF BUSINESS SUBCODE INDUSTRIAL AID K PLEASURE&BUS LI COMMERCIAL K AIRPLANE HELICOPTER MIXED FLEET - EXCESS I I QUOTA SHARE NON-OWNED LIABILITY ONLY K HULL&LIABILITY HULL ONLY AIRCRAFT INFORMATION ACORD 333,Aircraft Schedule attached YEAR MAKE MODEL SERIALNUMBER REGISTRATION NUMBER 1940 Piper J5A N30270 TERRITORY: AIRCRAFT COVERAGES INSURER LETTER POUCY NUMBER EFFECTIVE DATE EXPIRATION DATE ADDITIONAL INSURED?(Y/N)' SUBROGATION WAIVED?(Y/N) GA00168372-09 7/23/2019 7/23/2020 Y N COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO AIRCRAFT HULL K ALL RISK GROUND AND FLIGHT $ 0 Ded.-Not in motion $ 40,000 AGREED VALUE $ 0 Ded.-In motion • AIRCRAFT UABIUTY K LIABILITY $ 1,000,000 EA OCC $ EA PER - $ 100,000 EA PASS $ AGGR MEDICAL PAYMENTS K INCLUDINGCREW EXCLUDING CREW $ 5,000 EA PER $ 10,000 EA OCC COVERAGE CODE DESCRIPTION OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO I $ $ - $ $ $ ,$ - $ $ $ $ DESCRIPTION OF OPERATIONS/REMARKS (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is included as an Additional Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Ashland Oregon EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 51nburn Way ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ashland, OR 97520 ©2009,2015 ACORD CORPORATION.All rights reserved. ACORD 21(2016/03) The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) .a►`Ro® CERTIFICATE OF AIRCRAFT INSURANCE 07/23/2019 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 have ADDITIONAL INSURED provisions or 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 CCNTACT NAME: Costello Insurance Associates, Inc. PHONE FAX NC,No, Post Office Box 28280 (E-MAIL EMk (NC,No): ADDRESS Tempe, AZ 85285 PRODUCER CUSTOVER INSURER(S)AFFORDING COVERAGE % NAIC# INSURED INSURER A:U.S.SPECIALTY INSURANCE COMPANY 100% Tailwheel Associates, LLC INSURER B: INSURER C: 1390 Frank Hill Rd. INSURERD: 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. POLICY INFORMATION CERTIFICATE NUMBER: REVISION NUMBER: POLICY TYPE UNE OF BUSINESS SUBCODE INDUSTRIAL AID H PLEASURES BUS u COMMERCIAL x AIRPLANE HELICOPTER MIXED FLEET — EXCESS u QUOTA SHARE NON-OWNED LIABILITY ONLY X HULL&LIABILITY HULL ONLY AIRCRAFT INFORMATION ACORD 333,Aircraft Schedule attached YEAR MAKE MODEL SERIAL NUMBER REGISTRATION NUMBER 1958 Cessna 182A N2192G TERRITORY: AIRCRAFT COVERAGES INSURER LETTER POUCY NUMBER EFFECTIVE DATE DCPIRATIONDATE ADDITIONAL INSURED?(Y/N) SUBROGATION WAIVED?(Y/N) GA00168372-09 7/23/2019 7/23/2020 Y N COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO AIRCRAFT HULL K ALL RISK GROUND AND FLIGHT $ 0 Ded.-Not in motion $ 60,000 AGREED VALUE $ 0 Ded.-In motion AIRCRAFT LIABILITYK UABIUTY $ 1,000,000 EA OCC $ EA PER — $ 100,000 EA PASS $ AGGR MEDICAL PAYMENTS X INCLUDING CREW _EXCLUDING CREW $ 5,000 EA PER $ 20,000 EA OCC COVERAGE CODE DESCRIPTION OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO $ $ — $ $ . $ $ $ $ DESCRIPTION OF OPERATIONS/REMARKS (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is included as an Additional Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Ashland Oregon EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 51nburn WayACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ashland; OR 97520 ©2009,2015 ACORD CORPORATION.All rights reserved. ACORD 21(2016/03) The ACORD name and logo are registered marks of ACORD Costello Insurance . Associates , Inc. INSURANCE July 29,2019 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: US.Specialty Policy No.: GA00168372-09 Effective Date: July 23,2019 • 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 Regar.:, • • . e 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