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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 CONSTRUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certi0cate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WANED, subject to the terms and conditions Of the policy, certain policies may require an andomement. A statement on
this certificate does not confer rights to the certificate holder in Ileu of such endomement(s).
PRODUCER ICONTACT Jav Scarbo
AirSure Limited �D �,,E,,,. T 972-980-0800 wAi. xm: F 214-705{]262 I
5601 Granite Parkway Ste 860 E.M,Ax
Plano, TX 75024-6647 CAEss: iswdNNEvlrsuPE.cgm
,uemusu — CRUTAIR-01 I
Cruiser Aircraft, Inc.
214 Airport Dr. East
Sebastian FL 32958
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EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN R
AIRPORT B FBO LIABILITY COVERAGES CERTIFICATE NUMBER: 4363796:
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DESCRIPTION OF OPERATIONS / REMARKS (ACORD 101. Additional Remarks Schedule, may be attached If more space Is required)
—See Attached Remarks Schedule—
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Sebastian (including without limitation, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
members of the City Council Board, Officers, ACCORDANCE MUTHE POLICY PROVISIONS.
agents, and employyees
202 Airport Drive Eeat AumaR�OREegBswrATNE T
Sebastian FL 32958(TX) Jay Scarbo Y
® 2009, 2015 ACORD CORPORATION. All rights resmved.
ACORD 20(2016/03) The ACOR13 name and logo are registered marks&ACORD
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AGENCY CUSTOMER ID: CRUTAIR-01
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AC RR ADDITIONAL REMARKS SCHEDULE Page of
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the Limitedruiser Amaeft, Inc.
14 Airport Dr. East
_MY NUMBER Sebastan FL 32958
CARRIER M/JCCOOE
EFFECTIVE BALE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 20 FORM TITLE: ACORD 20 (03/16)
HOLDER: City of Sebastian (including without limitation, members of the City Council Board, officers, agents, and employees
ADDRESS: 202 Airport Drive East Sebastian FL 32958
In the event of material change or cancellation of said policy (a), the Company (s) shall
give thirty (30) days written notice to the certificate holder with the exception of a ten
(10) day notice for non-payment of premium.
Certificate Holder is included as an additional insured but only as respects operations of
the Rammed Insured.
The insurance extended by this policy shall not apply to, and the Certificate Holder shall
not be insured for bodily injury or property damage which arises from the design,
manufacture, modification, repair, sale, handling or servicing of the aircraft by the
Certificate Holder.
ACORD 101 (2000101) ®2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD ADDENDUM/DOO
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