Site A-7/HDD, LLC (Exp 10/06/12)CHARTIS AEROSPACE INSURANCE SERVICES, INC.
CERTIFICATE OF INSURANCE
THIS IS TO CERTIFY TO: CITY OF KALISPELL, THE CITY, ITS OFFICERS,
EMPLOYEES AND AGENTS, DRAWER 1997
KALISPELL, MT 59904
THAT THE FOLLOWING POLICY/IES OF INSURANCE HAVE BEEN ISSUED TO:
HDD, LLC and DENNIS CARVER
1995 3RD AVENUE E.
KALISPELL, MT 59901, USA
POLICY NO. LA 004175941-13
POLICY PERIOD: From October 6, 2011 to October 6, 2012
INSURANCE COMPANY NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA
Coverage only applies as indicated by a specific limit and deductible. Limits of Liability
A. Aircraft Liability Single Limit for Bodily Injury and $ 1,000,000. each occurrence
Property Damage In cluding Passengers, but
Passenger Bodily Injury Limited within the Single
Limit to $ 100,000. each passenger
B. Medical Expense In cluding crew $ 5,000. each passenger
C. Physical Damage to Your Aircraft
Deductibles
ID Number Year Make and Model Agreed Value Not -in -Motion Not -in -Flight Flight
N2687F 1966 CESSNA 182 $ 75,000. $ 0. $ 0. $ 0.
N55BT 1992 STODDARD SPORTSMAN - TD $ N/A $ N/A $ N/A $ N/A
THIS CERTIFICATE HOLDER IS:
1. included as additional insured as respects liability coverage but coverage only applies after all other coverage available to the
additional insured has been exhausted-,
2. included as additional insured as respects liability coverage but coverage only applies with respect to the vicarious responsibility of
the additional insured for the operation of the aircraft by the Named Insured, including any interest in the aircraft as owner/lessor;
3. included as additional insured as respects liability coverage but coverage does not apply to any occurrence arising from the design,
manufacture, modification, repair, sale, or servicing of insured aircraft other than ground handling.
30 days notice of cancellation
Coverage is subject to Aviation Date Recognition Endorsement Form No. 71223.
The Aviation Managers have made provision to give the certificate holder prompt notice of cancellation of any policy
above. But, the Aviation Managers assume no responsibility for failure to provide such notice. This certificate does
not change in any way the actual coverages Erovided by the policy/ies sEecified above.
Certificate No. 11407190-13 _iE4
Date of Issue September 29, 2011 By
(Authorized Representative)
LAD30B (3/00)