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<br />AIRCRAFT INSURANCE POLICY <br /> <br />RELIANCE INSURANCE COMPANY OF ILLINOIS <br />1125 Kiwanis Drive, Freeport. IL 61032 <br /> <br />POLICY NUMBER: NAC1963793 <br /> <br />ISSUED BY <br />W. BROWN & ASSOCIATES INSURANCE SERVICES <br />DECLARATIONS <br /> <br />ITEM 1. NAMED INSURED: Western Kansas Groundwater Management District No. 1 <br />ADDRESS: P.O. Box 604 <br />Scott City,KS 67871 <br /> <br />ITEM 2. POLICY PERIOD: FROM April 12, 1994 TO April 12, 1995 <br />12:01 A.M. STANDARD TIME AT THE ADDRESS IN ITEM 1. <br /> <br />ITEM 3. The insurance afforded is only with respect to such of the following coverages 8S are indicated by specific premium charge or <br />charges. The limit of the Company's liability against each such coverage shall be as stated herein, subject to all of the terms of this <br />Policy having reference thereto. This Policy is completed by Aircraft Hull and Liability Form A V 00 POlO 00 1193. <br /> <br />ITEM 4. LIABILITY COVERAGES <br /> <br />LIMIT OF LIABILITY <br />EACH PERSON EACH OCCURRENCE <br /> <br />LIABILITY <br />PREMIUM <br /> <br />A. Bodily Injury Excluding Passengers <br />B. Property Damage <br />C. Passenger Liability <br />D. Single Limit Bodily Injury & Property Damage <br />eluding Passenger Liability <br />Passenger Liability Limited to: <br />E. Medical Expense <br /> <br />XXXX <br />XXXX <br /> <br />AS E~DORSED <br /> <br />AS ENDORSED <br /> <br />TOTAL LIABILITY PREMIUM: <br /> <br />$11,750.00 <br /> <br />ITEM 5. Description of Aircraft and Physical Damage Coverage Hereunder <br /> <br />YEAR <br /> <br />MAKE <br /> <br />MODEL <br /> <br />F .A.A. <br />CERT. NO. <br /> <br />SEATS <br />CREWfPASS <br /> <br />INSURED <br />VALUE <br /> <br />PHYSICAL <br />DAMAGE <br />PREMIUM <br /> <br />Please\refer to the multiple aircraft endorsement. <br /> <br />DEDUCTIBLES <br />NOT IN MOTION <br /> <br />DEDUCTIBLES <br />IN MOTION <br /> <br />PHYSICAL DAMAGE <br /> <br />TOTAL PREMIUM: <br /> <br />$5,950.00 <br />$17,700.00 <br /> <br />TOTAL PHYSICAL DAMAGE PREMIUM: <br /> <br />ITEM 6. PILOTS: When in flight the aircraft will be piloted only by the following pilots, provided each has a valid pilot's certificate including a <br />current and valid medical certificate appropriate for the flight and aircraft insured: <br /> <br />As Endorsed <br /> <br />ITEM 7. The aircraft will be used for: As Endorsed <br /> <br />ITEM 8. LOSS PAYABLE Endorsement in favor of: Not Applicable <br />ANY APPLICABLE TAXES AND FEES TO BE COLLECTED AND PAID BY PRODUCER,' <br /> <br />ITEM 9. The Namad Insured is and shall remain the sole and unconditional owner of the aircraft and the aircraft is not subject to any <br />encumbrance other than as indicated in ftem 8. <br /> <br />PRODUCER: Nason & Associatos <br />6901 W. 63rd Street <br />Suite 207 <br />. Overland Park, KS 66202 <br /> <br />Additional Comments: <br />Endorsement No.1, Endorsement No.2. Endorsement No. <br />3 <br /> <br />COUNTERSIGNED: <br />BY: <br /> <br />c, ,Jt, ~ <br />(, ~ , <br />Authorp:ed Representalve <br /> <br />OATE ISSUED: <br />APPROVED BY: <br /> <br />~JY~..yi~. <br /> <br />AVIation Managers <br /> <br />AV 00 POlO 001193 <br />