Insurance Certificates* OLD REPUBLIC INSURANCE COMPANY
PHOERT� AVIATION
CERTIFICATE OF INSURANCE
This is to cemiry to �" C�I� l�f
(Certificate Holder): MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
FLORIDA KEY MARATHON AIRPORT
ATTN: STAGY
9400 OVERSEAS HIGHWAY, SUITE 200
MARATHON, FL 3306p
The followingli v i
Po �y(tes) sMs FLIGHT SERVICE LLC
have been issued to: 4916 CANEY CT�' [�
PORT RICHEY, FL 34688.6=
AIRCRAFT POLICY NO: AV 10244301 -
THIS COVERAGE IS EFFECTIVE 12:01 AM 09/09/2010 LILY PERIOD. FROM: 12/29/2009
INSURANCE COMPANY: TO: 12/29/2010 OLD REPUBLIC INSURANCE COMPANY 4z G
LIABILITY COVERAGES:
LIMITS OF LIABILITY
® Single Limit Including Passengers, EACH PERSON ® with Passenger Liability Limited to; $�X OCCURRENCE
$1 OOEACH ACH
—-- $100,000. $XXXX
DESCRIPTION OF AIRCRAFT FM PHYSICAL DAMAGE COVERAGE: ALL RISKS GROUND AND IN-FLIGGHT
NUMBER YEAR MAKEd�MOQEL INSURED
N53310 200g VALUE NOT IDEDUCTIBLES
CESSNA 182 IN -MOTION
$227 500 $p IN -MOTION
$ $ $200.
$ $
$ $ $
❑ As respects; any Aircraft Owned and Operated by the Named Insured and covered under the above referenced policy
"'Lawea as a Loss Payee for Aircraft Physical Damage Coverag.
❑ Breach of Warranty Coverage on Aircraft Physical Damage as theeir interest maY appear not to exceed 9096 of the Insured Value.
® Included as an Additional Insured on Aircraft Liability Coverage but only with resPect to hangaring and tie -down of insured airs
❑ Provided a Waiver of Subrogation on Aircraft Physical raft
OTHER COVERAGES/CONDITIONSMEMARKS; Damage Coverage, but only
Provision has been nwde to give the Certificate Hd
roaporuitrility for the failure to Provide such notice.
M2!9_e afforded by the Posicy(les) numbered in this
Agency Phone: 772-918-4331
ref thirty (30) days Notice of CanceMtion of arty pofjcy above. however,
This Certificate of Insurance neither afflnnaHvely nor ne a the ComPary assumes no
certificate, fl nvebr amends. extends, nor @,ors the
Date: September 10, 2010
A MEMBER OF THE OLD REPUBLIC INSURANCE COMPANY
* OLD REPUBLIC INSURANCE COMPANY
* * * * * »>Larr
Evidence of Insurance
This is to certify to MONROE COUNTY
(Certificate Holder): BOARD OF COUNTY COMMISSIONERS
FLORIDA KEY MARATHON AIRPORT
MARATHON, FL 33050
The following policy(ies) SMS FLIGHT SERVICES,LLC
have been issued to: STEVEN M STROBBE
4916 CANEY COURT
PORT RICHEY, FL 34668
AIRCRAFT POLICY NO: AV 10244303
THIS COVERAGE IS EFFECTIVE 12:01 AM
INSURANCE COMPANY:
LIABILITY COVERAGES:
X Single Limit Including Passengers,
X with Passenger Liability Limited to:
DESCRIPTION OF AIRCRAFT
FAA
NUMBER YEAR MAKE & MODEL
N53310 2003 CESSNA 182
This Certificate Holder is:
POLICY PERIOD: FROM: 12/29/2011 TO: 12/29/2012
OLD REPUBLIC INSURANCE COMPANY
LIMITS OF LIABILITY
EACH PERSON EACH OCCURRENCE
$1,000,000
$100,000
PHYSICAL DAMAGE COVERAGE: ALL RISKS GROUND AND IN-FLIGHT
INSURED DEDUCTIBLES
VALUE NOT IN -MOTION IN -MOTION
$180,000 $0 $200
Included as an Additional Insured on aircraft Liability Coverage but only with respect to hangaring and/or
tie -down of the aircraft covered under this policy.
n' C
C4 11
Provision has been made to give the Certificate Holder (30) days notice of Our cancellation of the referenced policy -
ten (10) days as a result of non-payment of premiums owed to Us. However, We assume no responsibility for the failure
to provide such notice.
This certificate is issued as a matter of information only and confers no rights upon the certificate holder.
This certificate does not amend, extend, or alter the coverage, terms, exclusions, conditions, or other provisions
afforded by the policies referenced herein nor does it constitute a contract between the issuing insurer(s),
authorized representative or producer.
Phoenix Aviation Representative:
Agency Name:
NATIONAIR INSURANCE AGENCIES INC.
Agency Phone:
636-532-0023
Date: 12/19/2011
1990 VAUGHN ROAD, SUITE 350, KENNESAW, GA 30144 • (770) 590-4950 • Fax: (770) 590-0599
A MEMBER OF THE OLD REPUBLIC INSURANCE GROUP