Office of the Secretary 

of Transportation

AGENCY DISPLAY OF ESTIMATED BURDEN 

The public reporting burden for this collection of information is estimated to average 30 minutes per response. If you wish 

to comment on the accuracy of the estimate or make suggestions for reducing this burden, please direct your comments 

to: U.S. Department of Transportation, Office of Aviation Analysis, X-56, 400 7th St., SW., Washington, D.C. 20590. 

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information 

unless it displays a valid OMB control number.

NOTE: For information on where to file completed copies of this form, see FILING INSTRUCTIONS below. 

OMB No. 2106-0030 Expires 9-30-2007 

U.S. AIR CARRIERS - CERTIFICATE OF INSURANCE 

POLICIES OF INSURANCE FOR AIRCRAFT ACCIDENT BODILY INJURY 

AND PROPERTY DAMAGE LIABILITY 

FILING INSTRUCTIONS: File a signed original of this form with the Federal Aviation Administration, AFS-260, 800 Independence Ave., S.W., 

Washington, D.C. 20591. (See EXCEPTIONS 1 and 2 below.) 

 EXCEPTION 1: If Block 2B on the reverse is filled in because the insured is a commuter air carrier, file a signed original of this form with the 

Department of Transportation, Air Carrier Fitness Division, X-56, 400 7th St., SW, Washington, DC 20590. 

 EXCEPTION 2: For any insured that is located in the State of Alaska (regardless as to whether Block 2A, 2B, or 2C is filled in), file a signed 

original of this form with the Federal Aviation Administration, Alaskan Region Hq., AAL-230, 222 W. 7th Ave., #14, Anchorage, Alaska 99513. 

(Please type information, except signatures.)

THIS CERTIFIES THAT: _______________________________________ has issued a policy or policies of Aircraft Liability Insurance to 

 (Name of Insurer) 

 _______________________________________________________________________________FAA Certificate Number_______________

 (Name, address of Insured U.S. Air Carrier) 

effective from _________________ until ten (10) days after written notice from the insurer or carrier of the intent to terminate coverage is received by 

the Department of Transportation.

NOTE: Part 205 of the Department’s Regulations does not allow for a predetermined termination date, and a certificate showing such a date is 

unacceptable.

1. The Insurer (Check One): 

 X is licensed to issue aircraft insurance policies in the United States; 

  is licensed or approved by the government of _______________________ to issue aircraft insurance policies; or 

  is an approved surplus line insurer in the State(s) of _________________________

2. The insurer assumes, under the policy or policies listed below, aircraft accident liability insured to minimums at least equal to 

 the following during operation, maintenance, or use of aircraft in “air transportation” as that term is defined in 49 U.S.C. 40102. 

(Complete applicable section(s) A, B, or C below): 

A. U.S. AIR TAXI OPERATORS (EXCLUDING U.S. COMMUTER AIR CARRIERS) WITH PART 298 AUTHORITY ONLY: 

The aircraft covered by this policy are SMALL AIRCRAFT (i.e., with 60 or fewer passenger seats or with a maximum payload capacity of 

18,000 pounds or less). (Complete separate or combined coverage as appropriate): 

 Separate Coverages:

 

Minimum Limit 

Policy Number Type of Liability Each Person Each Occurrence 

Bodily Injury Liability 

(Excluding Passengers) $75,000 $300,000

Passenger Bodily Injury $75,000

$75,000 x 75% of total number 

of passenger seats installed in 

aircraft

Property Damage $100,000 

 Combined Coverage: The amount of coverage set forth below is a single limit of liability for each occurrence at least equal to the 

required minimums stated above for bodily injury (excluding passengers), property damage, and passenger bodily injury. 

Policy Number Amount of Coverage 

 This policy covers CARGO operations only and excludes passenger liability insurance. 

OST Form 6410 

XL Specialty Insurance Company 

City Wings, Inc., Cosmopolitan Broadcasting Corp. & Aguadilla Airline Service, Inc. 

80 Riverside Drive, New York, NY 10024 9CWA241M 

 February 6, 2012 
B. U.S. COMMUTER AIR CARRIERS OR CERTIFICATED AIR CARRIERS OPERATING SMALL AIRCRAFT 

The aircraft covered by this policy are SMALL AIRCRAFT (i.e., with 60 or fewer passenger seats or with a maximum payload 

capacity of 18,000 pounds or less). (Complete separate or combined coverage as appropriate): 

 Separate Coverages:

Minimum Limit 

Policy Number Type of Liability Each Person Each Occurrence 

Combined Bodily Injury (Excluding Passengers other than cargo 

attendants) and Property Damage Liability $300,000 $2,000,000

Passenger Bodily Injury $300,000 

$300,000 x 75% of total 

number of passenger 

seats installed in aircraft 

X Combined Coverage: The amount of coverage set forth below is a single limit of liability for each occurrence at least equal to the 

required minimums stated above for bodily injury (excluding passengers), property damage, and passenger bodily injury. 

Policy Number UA00004682AV12A Amount of Coverage $300,000 each passenger 

$5,000,000 each occurrence 

 This policy covers CARGO operations only and excludes passenger liability insurance. 

C. U.S. CERTIFICATED AIR CARRIERS OPERATING LARGE AIRCRAFT 

The aircraft covered by this policy are LARGE AIRCRAFT (i.e., with more than 60 passenger seats or with a maximum payload capacity of 

more than 18,000 pounds). (Complete separate or combined coverage as appropriate): 

 Separate Coverages: 

 Minimum Limit 

Policy Number Type of Liability Each Person Each Occurrence 

Combined Bodily Injury (Excluding Passengers other than cargo 

attendants) and Property Damage Liability $300,000 $2,000,000

Passenger Bodily Injury $300,000

$300,000 x 75% of total 

number of passenger 

seats installed in aircraft 

 Combined Coverage: The amount of coverage set forth below is a single limit of liability for each occurrence at least equal to the 

required minimums stated above for bodily injury (excluding passengers), property damage, and passenger bodily injury. 

Policy Number Amount of Coverage 

 This policy covers CARGO operations only and excludes passenger liability insurance. 

3. The policy or policies listed in this certificate insure(s) (Check One): Make and Model FAA or Foreign Flag 

 Registration No. 

 Operations conducted with all aircraft operated by the insured Cessna 208 Caravan N394SF 

 Operations conducted with the following types of aircraft: Cessna 208 Caravan N404SF 

X Operations with the following aircraft: (Use additional page if necessary) 

4. Each policy listed in this certificate meets or exceeds the requirements in 14 CFR Part 205. 

XL Specialty Insurance Company Aircraft & Marine Insurance Agency Inc. 

(Name of Insurer) (Name of Broker) 

190 South LaSalle St., Suite 3900 101 W. Burnsville Parkway - Suite 215 

(Address) (Address) 

Chicago, IL 60603 Burnsville, MN 55337 

(City, State, Zip Code) (City, State, Zip Code) 

Brian Ackland 

(Contact person who can verify the effectiveness of the coverage) (Officer or authorized representative) 

312-444-6579 / 212-945 0829 

(Area Code, Phone Number) / (Area Code, Fax Number) (Area Code, Phone Number) / (Area Code, Fax Number) 

(Signature, if applicable) (Signature) 

July 23, 2012 

(Date) (Date)