Airsure/Goose Bay Equipmentt-,ERTIFICATE OF INSURANCE
CERTIFICATE ATE: 11/01/2005 CERTIFICATE : of
CERTIFICATE ER:
POLICYHOLDER:
Kalispell City Airport
Goose Bay Equipment, Inc.
Drawer 1997
1995 3rd Avenue East
Kalispell, MT 59901
Kalispell, MT 59901
This is to certify that the following policy(s), subject to the terms, conditions, limitations and endorsements contained therein, and darning their effective period, have been
issued by the company(s) indicated below. In the event of material change or cancellation of said policy(s), the company will endeavor to notify the certificate holder, but
failure to do so shall impose no liability or obligation of any kind upon the undersigned or the company(s) involved.
Policy Type: AIRPORT
Insurance Company: Old Republic Insurance Company
Policy Number: AP 009334 01
Policy Period: October 7, 2005 to October 7, 2006
Premises Liability $1,500,000 Combined Single Limit
Premises Medical Payments $1,000 Each Person / $5,000 Each Occurrence
This certificate or verification of insurance in not an insurance policy and does not amend, extend cbr alter the coverage afforded
by the policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document, with respect
to which this certificate or verification of insurance may be issued or may pertain, the insurance afforded by the policies
described herein is subject to all terms, exclusions and conditions of such policies.
ADDITIONAL AGREEMENTS:
Products Exclusion We won't cover Kalispell City Airport for claims arising out of their liability as 4 manufacturer,
seller, handler, distributor or service facility of any product or service sold, handled distributed or
provided.
NOTICE OF CAN L T1 : IN THE EVENT OF MATERIAL CHANGE OR CANCELLATION OF SAID POLICY(S), TIHE COMPANY(S) SHALL ENDEAVOR
TO GIVE 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER WITH THE EXCEPTION OF A 10 DAY NOTICE FOR N<DN-PAYMENT OF PREMIUM.
AIRMURE
ME mom M01W
L I M I T E D
25548 Genesee Trail Road
Golden, Colorado 80401 Authorized Signature
(303) 526-5300 telephone (303) 526-5303 fax
Western States Ins - Kalispell
P O Box 8090
Kalispell, MT 59904-1090
Phone: 406-7584200 FAX: 406-755-1189
Kalispell, City Of
Amy Robertson
Drawer 1997
Kalispell, MT 59903
I have attached a revised certificate for Goose Bay. The limit is $1.5
M instead of $2M. This replaces all other certificates issued. Thanks