<br />RELIANCE INSURANCE COMPANY OF ILLINOIS
<br />
<br />IT IS HEREBY UNDERSTOOD AND AGREED THAT:
<br />
<br />Item 4 Coverages and Item 5 Description of Aircraft and Physical Damage Coverage as shown on
<br />the Policy Declaration are completed to read as follows:
<br />
<br />ITEM 4. LIABILITY COVERAGES
<br />
<br />EACH
<br />OCCURRENCE
<br />$1,000,000,00
<br />$1,000,000.00
<br />$1.000,000,00
<br />$1,000,000,00
<br />$1,000,000.00
<br />
<br />Single Limit Bodily Injury & Property
<br />
<br />WITH PASSENGER
<br />LIABILITY LIMITED TO
<br />
<br />EACH
<br />PERSON
<br />$100,000.00
<br />$100,000.00
<br />$100,000.00
<br />$100,000.00
<br />$100,000.00
<br />
<br />EACH
<br />OCCURRENCE
<br />$300,000.00
<br />$300,000.00
<br />$300,000.00
<br />$300,000.00
<br />$300,000.00
<br />
<br />LIABILITY
<br />PREMIUM
<br />$2,350.00
<br />$2,350.00
<br />$2,350.00
<br />$2,350.00
<br />$2,350.00
<br />
<br />EACH
<br />PERSON
<br />$0.00
<br />$0.00
<br />$0.00
<br />$0.00
<br />$0.00
<br />
<br />Medical Expense
<br />
<br />EACH
<br />OCCURRENCE
<br />$0,00
<br />$0,00
<br />$0.00
<br />$0.00
<br />$0.00
<br />
<br />TOTAL
<br />LIABILITY
<br />PREMIUM
<br />$ 2,350.00
<br />$2,350.00
<br />$2,350.00
<br />$2,350.00
<br />$2,350.00
<br />
<br />$11.750.00
<br />
<br />LIABILITY
<br />PREMIUM
<br />
<br />$11,750.00
<br />
<br />ITEM 5. DESCRIPTION OF AIRCRAFT AND PHYSICAL DAMAGE COVERAGE HEREUNDER
<br />
<br />YEAR MAKE MODEL
<br />1976 Piper PA31-350
<br />1958 Piper PA24-250
<br />1959 Piper PA24-250
<br />1963 Piper PA24-250
<br />1961 Piper PA24-250
<br />
<br />INSUREO
<br />VALUE
<br />$155,000,00
<br />N/A
<br />N/A
<br />N/A
<br />N/A
<br />
<br />DEDUCTIBLES
<br />
<br />NOT
<br />IN MOTION
<br />$5,000.00
<br />N/A
<br />N/A
<br />N/A
<br />N/A
<br />
<br />IN MOTION
<br />$5,000.00 ,
<br />N/A
<br />N/A
<br />N/A
<br />N/A
<br />
<br />F .A.A.
<br />CERT. NO.
<br />
<br />N62869
<br />N5359P
<br />N5842P
<br />N7805P
<br />N7104P
<br />
<br />SEATS
<br />CREW/PASS
<br />
<br />1/3
<br />1/3
<br />1/3
<br />1/3
<br />1/3
<br />
<br />PHYSICAL
<br />DAMAGE
<br />COVERAGE
<br />F. All Risk Basis
<br />Not Covered Hereunder
<br />Not Covered Hereunder
<br />Not Covered Hereunder
<br />Not Covered Hereunder
<br />
<br />PHYSICAL
<br />DAMAGE
<br />PREMIUM
<br />$5,950.00
<br />$0,00
<br />$0.00
<br />$0,00
<br />$0.00
<br />
<br />$5,950.00
<br />
<br />ENDORSEMENT TOTAL:
<br />
<br />$17,700.00
<br />
<br />This endorsement is part of your Policy and takes effect on the effective date of your policy, unless another effective date is shown below.
<br />
<br />Date Issued:
<br />
<br />Policy Number:
<br />Issued To:
<br />
<br />Effective Date:
<br />
<br />Endorsement No.:
<br />
<br />Countersigned:
<br />Countersigned Date:
<br />
<br />April 26, 1994
<br />NAC1963793
<br />
<br />Complete only when endorsement is Not prepared with the policy
<br />or is not to be effective with the Policy.
<br />
<br />Western Kansas Groundwater Management District No.1
<br />
<br />April 12, 1994
<br />
<br />W. Brown & Associates Insurance Services
<br />
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