Site A-4/Belhat VenturesTHIS CERTIFICATE ISSUED TO:
City of Kalispell
Attn: Fred Leistiko
PO Box 1997
Kalispell, MT 59903
® (if checked) Certificate Holder listed as Additional Insured
AIRCRAFT LIABILITY AND PHYSICAL DAMAGE COVERAGE
INSURED'S NAME AND ADDRESS:
Belhat dentures
590 Labrie Dr.
Whitefish, MT 59937
Insurance Company Providing Coverage:
Policy Number:
Effective Expires
NO.
AIRCRAFT COVERED
AMOUNT OF HULL
INSURANCE
TYPE OF COVERAGE
(Ground&Flight, Excl Flight, or NIM only)
DEDUCTIBLE S
NIM
IN MOTION
L
3.
4.
LIMITS OF LIABILITY
Each Person Each Occurrence
A. Bodily Injury — Excluding Passengers
XXXXXXXXXX
B. Property Damage
XXXXXXXXXX
C. Passenger Liability
XXXXXXXXXX
D. Single Limit Bodil Injury eluding Passengers & Propert
Damage
AIRPORT LIABILITY
Insurance Company Providing Coverage: One Beacon Insurance Group
Policy Number: 710-03-3A-73-0000 Effective
09/30/2013 Expires 09/30/2014
LIMITS OF LIABILITY
Per Aircraft Per Occurrence
A. Premises Liability
XXXXXXXXXX
$1,000,000*
B. Personal & Advertising Injury
XXXXXXXXXX
C. Products/Com feted Operations
XXXXXXXXXX
D. Medical Expense__
XXXXXXXXXX
E. Hanagerkee ers LiabilityDeductible
REMARKS/ADDITIONAL PROVISIONS
*$2,000,000 aggregate limit
Certificate holder is included as an additional insured under liability coverages, but only as respects the operations of the named insured.
Premises covered: Kalispell City Airport Hangar A4, Kalispell, MT 59901
This certificate does not affirmatively or negatively amend, extend, or alter the coverage afforded by the insurance policy.
Absence of any entry indicates not applicable to this certificate. All coverages effective/expire 12:01 AM Standard Time at the insured's address
This is to certify that the Policy/Policies of Insurance as described herein have been insured by the company/companies listed and are in force as of the
date of this certificate. In the event o f cancellation of the policy/policies, the company/companies will endeavor to give the party to whom this certificate
is issued 30 days advance written notice of such cancellation but will not be liable in any way for failure to give such notice. In the event of cancellation
for non-payment of premium, the company/companies will endeavor to give the party to whom this certificate is issued 10 days advance written notice of
such cancellation but 'ill not be liable in any way for failure to give such notice.
October 3, 2013
io ature of A41thorized Representative Date
Mountain Air Insurance Services, Inc.
P 0 Box 1918 ® Hamilton, MT 59840 ■ Phone 406-363-1411 n Fax 406-363-1412