Certificate of InsuranceNAME AND ADDRESS OF AGENCY
Via:
COMPANIES AFFORDING COVERAGES `
Time Insurance Agency
P.O. Box 1199
COMPANY
A
LETTER American States Insurance Company ;
Kalispell, Mt. 59901
COMPANY
LETTER L.0
NAME AND ADDRESS OF INSURED
COMPANY
LETTER 3
kkka
Kalispell Airport Association
c/o Dr. A. V. Swanberg
COMPANY � C
LETTER _
610 7th Street East
Kalispell, Mt. 59901
COMPANY 5
LETTER
x�-
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time.
Limits Of Liability
in Thousands (000)
COMPANY
LETTER
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION DATE
EACH
AGGREGATE
OCCURRENCE
GENERAL LIABILITY
BODILY INJURY
$
$
A
��yyqq
i��,�^COMPREHENSIVE FORM
OL-231-365
2-11-79'
❑
PREMISES —OPERATIONS
PROPERTY DAMAGE
S
$ :
❑ EXPLOSION AND COLLAPSE
HAZARD
❑
UNDERGROUND HAZARD
❑ PRODUCTS/COMPLETED
OPERATIONS HAZARD
BODILY INJURY AND
❑ CONTRACTUAL INSURANCE
PROPERTY DAMAGE
$ 500,00
$.
❑ BROAD FORM PROPERTY
COMBINED
DAMAGE
F
❑ INDEPENDENT CONTRACTORS
?e
PERSONAL INJURY
�.
$
❑ PERSONAL INJURY
I
AUTON10BILE LIABILITY
BODILY INJURY
$
(EACH PERSON)-'
❑ COMPREHENSIVE FORM
$
=' z
BODILY L INJURY
(EACH ACCIDENT)
❑ OWNED
❑
PROPERTY DAMAGE
$
HIRED
❑
BODILY INJURY AND
x
NON -OWNED
PROPERTY DAMAGE
$
EXCESS LIABILITY
BODILY INJURY AND
❑ UMBRELLA FORM
PROPERTY DAMAGE
$
+
❑ OTHER THAN UMBRELLA
COMBINED
FORM
WORKERS' COMPENSATION
STATUTORY
and
-
ENI,PLOYEAS' LIABILITY
"
r
$
(EAcHACCIDENT)
OTHER
P -
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES
Cancellation: Should any of the above de cribed policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail � 0 days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
DATE ISSUED:
City of Kalispell
Attention: Forrest Daley
P.O. Box 1035
Kalispell, Mt. 59901
� G �
AUTHORIZED REPRESENTATIVE
a4 I 1
ADDITIONAL INSURED
(PREMISES LEASED TO THE NAMED INSURED)
'
This endorsement, effective FEuRUARY 11, 1473 , forms a part of policy No. O'' 231 3 6 5 G7
(12:01 A.M., standard time)
Issued to: KALISPELL AIRPORT ASSOC.
By: At-U RICAW STATES It?SLTRA14CE CO, z'A1-T'Y
It is agreed that the "Persons Insured" provision is amended to include as an Insured the person or organization designated
below, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises desig-
nated below leased to the Named Insured, and subject to the following additional exclusions:
The Insurance does not apply:
I. To any occurrence which takes place after the Named Insured ceases to be a tenant in said premises;
2. To structural alterations, new construction or demolition operations performed by or on behalf of the person or organi-
zation designated below.
SCHEDULE
DESIGUATION OF PREMISES
(Part Leased To Named Insured)
KALISPELL CITY AIRPORT
KALISPELL, FIONTANA
NAME OF PERSON OR
ORGANIZATION
(Additional Insured)
CITY OF KALISPELL
BOX 1035
KALISPELL, MONT'ANA
59901
PREMIUMS
Bodily Property
Injury Damage
Liability Liability
P;IL NIL
NOTHING HEREIN CONTAINED SHALL BE HELD TO VARY, WAIVE, ALTER OR EXTEND ANY OF THE TERMS, CONDITIONS,
AGREEMENTS OR WARRANTIES OF THE POLICY, OTHER THAN AS ABOVE STATED.
AVIATION OFFICE OF AMERICA, INC.
Endorsement No. _---------_--3 --.Y1ARCFt 6, 1973
---------._ -._---
Authwized Rowntati" Date
nnnQ In a.7n