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Certificate of Insurance 1 DATE 2/0 ACOR[a CERTIFICATE OF AIRCRAFT INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Avemco Insurance Com any Avemco Insurance Company PHONE: 800 - 638 -8440 FAX: 800 - 863 -3338 8490 Progress Drive, Suite 100 (A/C, No, Ext): (A/C, No): Frederick, MD 21701 E -MAIL ADDRESS: avemcoftave.com PRODUCER CUSTOMER ID No. INSURED INSURER(S) AFFORDING COVERAGE % NAIC No. Terence R. Witt INSURER A: AVEMCO INSURANCE COMPANY 100% 10367 2900 N Riverside Dr INSURER B : Indialantic, FL 32903 INSURER C : INSURER D : INSURER E : INSURER F : THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY INFORMATION CERTIFICATE NUMBER: REVISION NUMBER: POLICY TYPE LINE OF BUSINESS SUBCODE INDUSTRIAL PLEASURE & COMMERCIAL AIRPLANE HELICOPTER MIXED FLEET EXCESS QUOTA _ AID X BUS X SHARE NON -OWNED LIABILITY HULL & LIABILITY HULL ONLY X ONLY AIRCRAFT INFORMATION ACORD 333, Aircraft Schedule attached YEAR MAKE MODEL SERIAL NUMBER REGISTRATION NUMBER 2005 CIRRUS SR -22 656TW TERRITORY: AIRCRAFT COVERAGES INSURER LETTER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE ADDITIONAL INSURED (Y / N) SUBROGATION WAIVED (Y IN) A 150123861400 12/08/2015 12/08/2016 Y Y COVERAGE OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO AIRCRAFT HULL All Risk Ground & Flight Ground Not In Motion $ $ Ded. — Not in motion Ground Not In Flight AGREED VALUE $ Ded. — In motion AIRCRAFT LIABILITY X Including Passengers $ 1,000,000 EA OCC $ 100,000 EA PER Excluding Passengers $ EA PASS $ AGGR MEDICAL PAYMENTS INCLUDING CREW $ EXCLUDING CREW EA PER $ EA PASS COVERAGE CODE DESCRIPTION OPTIONS LIMIT APPLIES TO LIMIT APPLIES TO $ $ $ $ $ $ $ $ $ $ DESCRIPTION OF OPERATIONS / REMARKS (Attach ACORD 101, Additional Remarks Schedule, if m r9,- - ; . � It r • f' , SEE ATTACHED ENDORSEMENT 125301 D = / G—) WA NJ �'. R CERTIFICATE HOLDER CANCELLATION Monroe County SHOULD ANY OF THE ABOVE DESCRIBED POLI IES BE CANCELLED BEFORE THE 500 Whitehead St EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Key West, FL 33040 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE MARCI L VERONIE © 2009 ACORD CORPORATION. All Rights reserved. ACORD 21 (2009/12) The ACORD name and logo are registered marks of ACORD With Respect to Aircraft Reg. No. 656TW AIRPORT USE - AIRPORT HANGAR ENDORSEMENT You have a written airport use or airport hangar agreement for your insured aircraft with the party shown below. We agree to include them as an "insured person" under that definition in your Policy. We also agree to waive our recovery rights against them for loss to your insured aircraft (you do, too). We agree to these changes provided their liability for bodily injury, property damage, or loss arises out of their agreement to let you use their airport or their hangar. THESE CHANGES DO NOT APPLY WHEN THEIR LIABILITY ARISES OUT OF THEIR MANUFACTURE, REPAIR, SERVICE, SALE, OR USE OF YOUR INSURED AIRCRAFT. We will notify this insured person when your Policy is cancelled. Notice will be sent at least 30 days before the cancellation date. Only 10 days' notice (or that notice required by your state, if more) will be given if we cancel for nonpayment of premium. If this insured person has other liability insurance, that insurance shall apply first. The addition of this insured person to your Policy does not increase the Limits of Liability provided Monroe County 500 Whitehead St Key West, FL 33040 The information below is required only when this Endorsement is issued after preparation of your policy This Endorsement is effective Mo.DayYr. 12/08/2015 at 12:00:01 A.M. local time at your address shown in item 1 of the Data Page and is part of Policy Number 150123861400 issued by Avemco Insurance Company. 125301 (11/01/2010)