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<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 /> <br />v <(';' <br />.,., /I~ <br />_....'. ,;,. ~.;.G,~'?<J <br />AViation Managers <br />