ALL CLAIMS SHOULD BE REPORTED TO OUR CLAIMS DEPARTMENT 

U.S. Specialty Insurance Company 

Attn: Claims Department 

5601 Granite Parkway • Suite 1100 • Plano, TX 75024 

(800) 467-8731 ·Fax: (469) 633-7520 

E-mail: claims@ussic.com 
e. Bonds 

Pay premiums on bonds required to release 

attachments and to appeal from judgments w e elect 

to appeal, but we will not pay for bonds covering any 

aggregate amount more than the applicable limit of 

liability; 

f. Financial Responsibility Laws 

Comply with the provisions of any aircraft financial 

responsibility statute if we certify your policy as 

proof of your future financial responsibility under 

that statute. We will not, however, pay more than 

the limits of liability shown in Item 6 of the Coverage 

Identification Page. You must reimburse us for any 

amount we have to pay in complying with the statute 

that we would not otherwise have had to pay. 

PART FOUR 

MEDICAL EXPENSES 

Review Item 6E of your Coverage Identification Page to confirm the Medical Expense limits issued to you. 

1 . What We Will Pay 

We will pay the reasonable and necessary medical 

expense incurred within one year for injuries to you and 

any passenger caused by an occurrence while the 

aircraft was flown by you or anyone we protect Medical 

expense includes the cost of surgical, dental, hospital, 

professional nursing, ambulance or funeral services. The 

most we will pay for each person's medical expense is 

shown under Item 6E opposite "each person". The most 

we will pay for all medical expense is shown under Item 

6E opposite "each occurrence". 

2. Who We Will Pay 

We will pay each injured person directly, the person 

responsible for payment, or the person or organization that 

provided the service. 

3. What We Will Not Pay 

We will not pay any medical expense to the extent 

payment is required under any worker's compensation or 

disability benefits law or similar law. 

4. Effect of Payment 

We are not admitting that you have any legal liability by 

making medical expense payments. 

5. Proof of Claim 

The injured person or someone acting for the person must 

give us written proof of the medical expense and must 

help us obtain th e medical records and reports we need. 

If we ask, the injured person must submit to examination 

by any doctor we select. 

6. Legal Action for Medical Expense 

A legal action against us for medical expense cannot be 

brought unless you and anyone we protect have done 

everything that you and anyone we protect are required to 

do and at least 30 days must have passed since the proof 

of claim has been given to us. 

PART FIVE 

SPECIAL PROVISIONS AND CONDITIONS 

These Special Provisions and Conditions do not apply unless (Item 1 0) of the coverage Identification Page states use is limited to 

Pleasure and Business. 

1. Newly Acquired Aircraft 

If you notify us during the policy period and within 30 days 

after you acquire ownership of another aircraft, and pay 

the additional premium, we will cover it and your use of it 

if we insure all the aircraft you own. 

2. Temporary Use of Substitute Aircraft 

If you are unable to fly your aircraft because of its 

breakdown, repair, servicing, loss or destruction we will 

cover you and your use of the substitute aircraft. 

AlP 1105 (08/10) 9 

3. Use of Another Aircraft 

If you are an individual or. an individual and spouse, and 

use another aircraft not owned in whole or in part by you 

or furnished for your regular use we will cover you and 

your use of another aircraft. 

4. We will provide you with 

a. The same Liability to Others (PART THREE) and 

Medical Expenses (PART FOUR) coverage as we do 

on the aircraft with the greatest seating capacity on 

your Coverage Identification Page; 
d. Sllow Us the Records 

Show us all records you have that would prove the 

amount of loss. 

6. When We W ill Pay 

We will pay for loss of or damage to your aircraft 

within 30 days after you have given us a sworn Proof 

of Loss statement and you and we agree on the 

amount. 

7. Theft 

If your airc raft or any part of it is stolen and recovered 

before we have paid for it, we may return it to you along 

with payment for any physical damage to it. 

8. Disappearance 

We will consider your aircraft to be lost in flight if it 

disappears and its whereabouts is not reported within 60 

days. 

9. Reinstatement of Coverage 

If your aircraft is damaged. the amount of coverage for 

the aircraft will be reduced by the amount of the 

damage. The coverage will be automatically increased, 

at no additional premium, by the cost of repairs 

completed until the agreed value has been restored or 

the policy expires. If, however, we pay as much as the 

agreed value, less the applicable deductible, we are 

entitled to the total Aircraft Physical Damage premium 

for the aircraft on which we made the payment. 

PART THREE 

LIABILITY TO OTHERS 

Review Item 6 of your Coverage Identification Page to confirm the particular liability coverages and limits issu ed to you. 

1. What We Cover 

We will pay damages you, and anyone we protect, are 

legally required to pay for bodily injury or property 

damage caused by an occurrence during the policy 

period. 

a. Coverage A covers bodily injury to persons other 

than passengers in your aircraft. The most w e will 

pay for bodily injury to any one person is shown 

under Item 6A opposite "each person". The most 

we will pay for bodily injury to all persons is shown 

in Item 6A opposite "each occurrence". We will not 

pay for bodily injury to passengers under 

Coverage A. 

b. Coverage B covers bodily injury to passengers in 

your aircraft. The most we wil l pay for bodily injury 

to any one passenger is shown under Item 6B 

oppos ite "each person". The most we will pay for 

bodily injury to all passengers is shown under Item 

68 opposite "each occurrence". We will not pay for 

bodily injury to persons other than passengers 

under Coverage B. 

c. Coverage C covers property damage. The most 

we will pay for property damage is shown under 

Item 6C opposite "each occurrence". 

d. Coverage D covers bodily injury and property 

damage in a combined limit of liability for each 

occurrence. Where the word "INcluding" is shown 

in Item 60, the most we will pay for bodily injury to 

all passengers and all others and property 

damage is shown under Item 60 opposite "each 

AlP 1105 (08/1 0) 7 

occurrence... Where the word "EXcluding" is shown 

in Item 60. the most we will pay for bodily injury to 

all persons and property damage is shown under 

Item 60 opposite "each occurrence", but w e will not 

pay for bodily injury to passengers. 

e. Coverage DL covers bodily injury to passengers 

and others and property damage in a combined 

limit of liability for each occurrence which includes a 

lower limit for each passenger. 

The most we will pay for bodily injury to each 

passenger is shown in Item 6DL opposite "each 

person". The most we will pay for all bodily injury 

and property damage is shown in Item 6DL 

opposite "each occurrence". 

2. Who Is Protected 

Except for those listed below under Who is Not 

Protected, your bodily injury and property damage 

liability coverage protects you and anyone you permit 

to fly your aircraft. 

You includes: 

a. Your partners if you are a partnership or joint 

venture; 

b. Your members and managers if you are a limited 

liability company (LLC): 

c. Your executive officers and directors while acting as 

such if you are a corporation. 

You and anyone you permit to fly your airc raft are 

protected separately, but the limits of liability shown in 
9. Other Coverage 

If there is other coverage protecting you or anyone we 

protect for an acc ident or occurrence covered by this 

policy, we will pay only the percentage portion that the 

applicable limit of coverage of this policy bears to the total 

of the applicable limit of coverage of all policies. 

If there is an accident or occurrence covered by your 

policy involving Temporary Use of Substitute Aircraft or 

Use of Another Aircraft, your policy will be excess over 

any other coverage protecting you. 

If there is other insurance covering the accident or 

occurrence issued through us, we will not pay more than 

the limits of liability of the policy having the greatest limits. 

10. Transfer of Interest in Your Policy 

Neither you nor anyone we protect can transfer an 

interest in this policy without our written consent. If you 

die during the policy period, your legal representative will 

have all of your rights and duties under the policy while 

settling your estate if we are notified within 60 days of 

your death. 

11. Our Right of Recovery 

If we make any payment, we will take over your right to 

recover the payment from anyone who is responsible for 

the accident or occurrence. You and anyone we protect 

must do everything necessary to transfer this right of 

recovery to us, including allowing suit to be brought in the 

name of the person or organization protected. You and 

anyone we protect must do nothing that will interfere with 

our efforts to recover. 

12. State Statutes 

Statements in this policy conflicting with statutes of the 

state shown in Item 2 of the Coverage Identification Page 

are hereby amended by us to conform to the statutes. 

13. Legal Action Against Us 

No legal action shall be brought against us until the policy 

provis ions have been complied with fully. No one shall 

have any right to: 

a. Join us as a party to any legal action against you or 

anyone we protect; or 

b. Bring us into any legal action to determ ine your 

liability or the liability of anyone we protect. 

14. Concealment or Misrepresentation 

We do not provide coverage for you or anyone who has 

concealed or misrepresented any material fact or 

circumstance relating to this policy either before or after an 

accident or occurrence. 

15. Inspection and Audit 

We shall have the right, but shall have no obligation, to 

inspect the aircraft and records during and up to one year 

after the policy period. 

PART TWO 

AIRCRAFT PHYSICAL DAMAGE 

Review Item 5 of your Coverage Identification Page to confirm the Aircraft Physical Damage coverage issued to you. Please 

note also the agreed value of your aircraft and the amount for which you are responsible (deductible). This coverage is for your 

benefit and not for the benefit of anyone else in possession of your aircraft. 

1. What We Cover 

a. Coverage F covers direct physical loss of or damage 

to your airc raft caused by an accident while the 

aircraft is not in motion. 

b. Coverage G covers direct physical loss of or 

damage to your aircraft caused by an accident 

while the aircraft is in motion. 

2. What You Must Pay or Bear (Deductible) 

a. Not In Motion Deductible 

The amount shown in Item 5F of your Coverage 

Identification Page must be paid or borne by you 

when loss or damages are under Coverage F. 

b. In Motion Deductible 

The amount shown in Item SG of your Coverage 

Identification Page must be paid or borne by you 

when loss or damages are under Coverage G. 

c. No Deductible 

We will not subtract either deductible amount if the 

When we pay for loss of or damage to your aircraft, loss or damage is caused by: 

you must first pay or bear one of the following amounts 

unless no deducti ble applies (1 ) Fire , lightning, explosion, theft or vandali sm; 

AlP 1105 (08/1 0) 5 
PART ONE 

GENERAL PROVISIONS AND CONDITIONS 

1. Words and Phrases 

The following words and phrases have special meaning 

throughout the policy: 

a. You and your means the person(s) or organization(s) 

named in Item 1 of the Coverage Identification Page 

under the heading "Named Insured." 

b. Anyone means any person or organization other than 

you; 

c. We, our and us mean the insurance company named 

on the Coverage Identification Page; 

d. Air carrier means a person who undertakes directly 

by lease, or other arrangement, to engage in air 

transportation; 

e. Aircraft means the aircraft shown in Item 5 of your 

Coverage Identification Page or qualifying under PART 

FIVE of your policy. It includes the airframe; landing 

gear; propulsion system (including engine(s), 

accessories and propeller{s) or rotor(s)); flight and 

engine instruments; communication/navigation system; 

electrical system; flight control system; fuel system; 

hydrau lic system; and pressurization system. 

Parts usually mounted or attached to the aircraft are 

included while temporarily removed as long as they 

are not replaced by other parts; 

f. Agreed value means the amount of money shown in 

Item 5 of the Coverage Identification Page. It is the 

amount that you and we have agreed your aircraft is 

worth and the maximum amount of Aircraft Physical 

Damage coverage we provide; 

g. In motion means when the aircraft is moving under 

its own power or th e resulting momentum; 

h. In flight means when the aircraft movement begins 

for takeoff until completion of the landing run; 

i. Passenger means any person who is in the aircraft or 

getting in or out of it; 

j. Bodily injury means physical injury to a person, 

including sickness, disease or death; 

k. Property damage means damage to or destruction of 

property including any resulting loss of use of the 

property. It does not include damage to or destruction 

of the aircraft or any other property you or anyone 

we protect under your pol1cy owns; has charge of or 

transports; 

I. Accident means a sudden event during the policy 

period, neither expected nor intended by you. that 

AlP 1105 (08/10) 3 

involves your aircraft and causes physical damage to 

or loss of the aircraft during the policy period; 

m. Occurrence means a sudden event or repeated 

exposure to the same general conditions, involving the 

aircraft during the policy period, neither expected nor 

intended by you, that causes bodily injury or 

property damage to others during the policy period. 

All bodily injury or property damage resulting from 

the same general conditions will be considered to be 

caused by one occurrence; 

n. Student pilot means any pilot meeting the 

requirem ents of Item 9 of your Coverage Identification 

Page who is receiving instruction, either dual or solo, 

under the direct supervision of an FAA Certificated 

Flight Instructor; 

o. Renter pilot means any pilot meeting the 

requirements of Item 9 of your Coverage Identification 

Page who is renting one of your aircraft from you; 

p. Federal Aviation Administration (FAA) means the 

authority of the United States of America having 

jurisdiction over civil aviation or its counterpart in 

another country; 

q. Pleasure and Business means personal and 

business related purposes where no charge is made 

for such use; 

r. Instruction and/or Rental means use of the aircraft 

for instruction of, or rental to, others for their Pleasure 

and Business use. You may also use the aircraft for 

your Pleasure and Business use; 

s. Charter/Air Taxi means use of the aircraft for 

transporting passengers and/or freight for hire. You 

may also use the aircraft for your Pleasure and 

Business use; 

t. Commercial means use of the aircraft for Instruction 

and/or Rental use, Charter/Air Taxi use and your 

Pleasure and Business use; 

u. Flying Club means use of the aircraft by your 

members for their Pleasure and Business use. A 

member is any person having an ownership interest in 

or owning stock in, the organization shown in ltem 1 of 

the Coverage Identification Page. You may charge 

membership fees and dues and you may also charge 

the members fees for use of the aircraft; 

2. Our Obligations and Your Duties 

We agree to provide coverage in your policy if you pay 

the premium and comply fully with the poli cy requirements, 

but if you do not, then we are not obligated to you or 

anyone. We have the right to deduct any premium or other 
This Policy 

is an 

Aircraft Insurance Policy 

provided by 

U.S. SPECIAL TV INSURANCE COMPANY 

ADMINISTRATIVE OFFICES: 13403 NORTHWEST FREEWAY, HOUSTON, TEXAS 77040 

This policy is written in language that is easier to understand than language previously used. The provisions of your 

policy are set forth in detail in the Coverage Identification Page, Parts One through Five and the Endorsements we 

issued, which together comprise your policy. 

This policy may provide you with coverage for Aircraft Physical Damage, Liability to Others and Medical Expense. Be 

sure to review your Coverage Identification Page to confirm the coverages and limits issued to you. Then read each 

Part of the policy, and each Endorsement we issued. This will enable you to better understand your policy. 

This policy is a legal contract between you and the Company, therefore, IT IS IMPORTANT THAT YOU READ YOUR 

POLICY CAREFULLY. 

The next page provides a brief outline of where you will find the important features of your policy. 

AIP 1105 (08/10) 
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 

This endorsement is issued by U.S. Specialty Insurance Company 

Policy num ber: AC3005376-00 

Endorsement number: 

Issued to (first Named Insured): 

Effective: 

CVT Marketing a dba of Tim Fleming 

09/25/2015 

For: premium of $ 

(if no entry appears above, information req uired to complete this endorsement will be shown in the Declarations 

as applica ble to this endorsement.) 

EXCLUSION OF CERTIFIED ACTS OF TERRORISM 

AND EXCLUSION OF OTHER ACTS OF TERRORISM 

COMMITTED OUTSIDE THE UNITED STATES 

A. Under PART ONE - GENERAL PROVISIONS AND 

CONDITIONS - Item 1. - Words and Phrases is 

amended to include: 

1. Certified act of terrorism means an act that is 

certified by the Secretary of the Treasury, in 

consultation with the Secretary of Homeland 

Security and the Attorney General of the United 

States to be an act of terrorism pursuant to the 

federal Terrorism Risk Insurance Act. The criteria 

contained in the Terrorism Risk Insurance Act for 

a certified act of terrorism include the following: 

a. The act resulted in insured losses in excess 

of $5,000,000 in the aggregate, attributable to 

all types of insurance subject to the Terrorism 

Risk Insurance Act; 

b. The act resulted in damage: 

( 1) Within the United States (including its 

territories and possessions and Puerto 

Rico; or 

(2) Outside of the United States in the case 

of: 

(a) An air carrier (as defined in Section 

40102 of Title 49, United States 

Code) or United States flag vessel (or 

a vessel based principally in the 

United States, on which United States 

income tax is paid and whose 

insurance coverage is subject to 

regulation in the United States). 

regardless of where the loss occurs; 

or 

(b) The premises of an United States 

mission; and 

c. The act is violent act or an act that is 

dangerous to human life, property, or 

infrastructure and is comm itted by an 

individual or individuals as part of an effort to 

coerce the civilian population of the United 

States or to influence the policy or affect the 

conduct of the United States Government by 

coercion. 

2. Other act of terrorism means a violent act or an 

act that is dangerous to human life, property or 

infrastructure that is committed by an individual or 

individuals and that appears to be part of an effort 

to coerce a civilian population or to influence the 

policy or affect the conduct of any government by 

coercion, and the act is not a certified act of 

terrorism. 

Multiple incidents of an other act of terrorism 

which occur within a seventy-two hour period and 

appear to be carried out in concert or to have a 

related purpose or common leadership shall be 

consid ered to be one incident. 

B. If Aircraft Physical Damage coverage is included in 

your policy, as evidenced by applicable premium 

shown on the Coverage Identification Page, the 

following exclusion is added to PART TWO -

AIRCRAFT PHYSICAL DAMAGE: 

1. This insurance does not apply to: 

NOTHING HEREIN CONTAINED SHALL BE HELD TO VARY, ALTER OR EXTEND ANY OF THE TERMS, 

CONDITIONS OR AGREEMENTS OF THE POLICY OTHER THAN AS STATED ABOVE. 

AlP 1881 (01/15) Page 1 of 2 
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 

STATE OF FLORIDA CANCELLATION AND NONRENEWAL AMENDATORY 

This endorsement changes PART ONE - GENERAL 

PROVISIONS AND CONDITIONS - Paragraph 8, 

"Cancelling Your Policy", to read: 

8. Cancelling Your Policy or Renewing Your Policy 

You may cancel your policy at any time by telling us 

in writing in. advance of the date you want your 

coverage to end. We will compute the premiums 

earned by us using the customary short rate table. 

We can cancel this policy as follows: 

a. The policy can be cancelled at any time for 

nonpayment of premium by mailing or 

delivering a notice of cancellation to the first 

"Named Insured" at least 1 0 days before the 

effective date of the cancellation; or 

b. If this policy has been in effect less than 90 

days it may be cancelled at any time by mailing 

or delivering a notice of cancellation to the first 

"Named Insured" at least 20 days before the 

effective date of the cancellation; or 

c. If this policy has been in effect 90 days or more 

it may be cancelled at any time by mailing or 

delivering a notice of cancellation to the first 

"Named Insured" at least 45 days before the 

effective date of the cancellation and only for 

one of the following reasons: 

(1) The policy was issued because of 

material misrepresentation; 

(2) A substantial change in the risk which 

increases the risk of loss during the 

policy period; 

(3) Your substantial breach of contractual 

duties, conditions or warranties; or 

(4} Our cancellation of all policies for a 

given class of insureds. 

We will compute the premium earned by us based on 

the percentage of the original policy period that we 

provided coverage. 

If we cancel your policy we will return any premium 

you have paid that we have not earned but making a 

refund is not a condition of cance llation. 

No notice of nonrenewal or renewal with less 

favorable terms shall be effective unless mailed or 

delivered by us to you at least 45 days prior to the 

date of the proposed action. 

Any notice will be mailed or delivered to the first "Named 

Insured's" last mailing address known to us. If notice is 

mailed, proof of mailing will be sufficient proof of notice. 

NOTHING HEREIN CONTAINED SHALL BE HELD TO VARY, ALTER OR EXTEND ANY OF THE TERMS, CONDITIONS OR AGREEMENTS OF THE POLICY OTHER THAN AS STATED ABOVE. 

AlP 12 10 (08/10) Page 1 of 1 
PROTECTING THE PRIVACY OF INFORMATION 

U.S. Specialty Insurance Company ("USSIC") is committed to protecting your privacy by keeping the nonpublic personal 

information we collect from you confidential and secure. This policy applies to our relationships with individual consumers 

who inquire about and/or obtain products or services from USSIC for personal, family and household purposes. Please 

read this Privacy Policy that details USSIC's information use policies and practices. 

Strict Security Measures 

USSIC takes the security of information very seriously and has established security standards and procedures to prevent 

unauthorized access to customer information. These standards exist for both our physical facilities and our online 

services. We maintain physical, electronic and procedural safeguards that comply with federal standards to guard 

consumer information. In addition, USSIC has policies and procedures to limit employee access to information to only 

those employees with business reason for accessing such information. USSIC educates its employees about the 

importance of confidentiality and customer privacy. We take appropriate disciplinary measures to enforce employee 

responsibilities regarding customer information. 

Why USSIC collects information 

USSIC collects information about you to: 

• Accurately identify you; 

• Protect and administer your records, policies, and funds; 

• Help us design or improve our products and services; 

• Save you time when you apply for new products and services; 

• Offer you quality products and services; and 

• Comply with certain laws and regulations. 

Information We Collect 

USSIC may collect the following nonpublic personal information from you and outside sources: 

• Data you provide on your application and other forms you provide USSIC, such as name, address, date of birth, 

occupation, FAA Certificate Number and other information compiled by the FAA concerning you, your plane and your 

aviation record; 

• Your transactions with USSIC, such as your account balance, payment history and claims history; 

• Driving Record from the Department of Motor Vehicles. 

USSIC has established procedures so that the information we collect 1s accurate, current and complete. USSIC is 

committed to working with you to promptly correct any inaccurate information. 

Information We Share 

Depending on the type of relationship you have with USSIC, we may share or disclose the information we collect from 

you, such as your claims history and payment history, with USSIC affiliates, as well as with unaffiliated third parties. 

This information is shared to the extent necessary to service you and your policy as completely as possible. USSIC 

reserves the right to share all information we col lect as this policy provides. 

Under the law, USSIC is permitted to share identification information with USSIC affiliates, as well as information related 

to the transactions and experiences we have with our customers. By sharing this information, USSIC is able to streamline 

claims processes to ensure you receive the service you need. 

We also disclose the information we collect from you to complete transactions initiated by you when you request or 

authorize the disclosure, or if the disclosure is required by law. At times, it is necessary to disclose information to enforce 

or apply the terms and conditions of any agreement we have with you and to protect the rights, property, or safety of 

USSIC, our customers, or others. This includes exchanging information with other companies and organizations, 

including governmental law enforcement authorities, to detect or prevent fraud, criminal activity, material 

misrepresentations or material non-disclosures in connection with insurance transactions. 

We may also disclose the information we collect from you to unaffiliated third parties, as permitted by law. This includes 

unaffiliated third parties who provide marketing services for USSIC. 

AlP 1680 (08/1 0) 

Page 1 of 2 
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 

This endorsement is issued by U.S. Specialty Insurance Company 

Policy number: AC3005376-00 

Endorsement number: 

Issued to (first Named Insured): CVT Marketing a dba of Tim Fleming 

Effective: 09/25/201 5 

For: premium of$ 

(if no entry appears above, information required to complete this endorsement will be shown in the Declarations 

as applicable to this endorsement.) 

HELICOPTER/ROTORCRAFT 

In addition to the Words and Phrases in Paragraph 1 of 

PART ONE GENERAL PROVISIONS AND 

CONDITIONS, the following apply to your coverage for 

your helicopter or rotorcraft: 

1. In Motion means when a rotor of the aircraft is engaged and turning. 

2. In Flight means when the aircraft is moving on the 

ground or in the air as a result of engine power or autorotation. 

NOTHING HEREIN CONTAINED SHALL BE HELD TO VARY, ALTER OR EXTEND ANY OF THE TERMS, CONDITIONS OR AGREEMENTS OF THE POLICY OTHER THAN AS STATED ABOVE. 

AlP 1441 (08/10} Page 1 of 1 
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 

This endorsement is issued by U.S. Specialty Insurance Company 

Policy number: 

Endorsement number: 

Issued to (first Named Insured): 

Effective: 

For: 

AC3005376-00 

CVT Marketing a db a of Tim Fleming 

09/25/2015 

premium of$ 

(if no entry appears above, information required to complete this endorsement will be shown in the Declarations 

as applica ble to this endorse ment.) 

POLICY CHANGES 

This endorsement will not be used to decrease coverages, increase rates or deductibles or alter any terms or conditions 

of coverage unless at the sole request of the insured. 

The following item(s): 

Insured's Name Insured's Mailing Address 

Policy Number Company 

Effective/Expiration Date Insured's legal Status/Business of Insured 

Payment Plan Premium Determination 

Additional Interested Pa rties X Coverage Forms and Endorse ment s 

Limits/Exposures Deductibles 

Covered Property/Located Description Classification/Class Codes 

Rates Underlying/Excess Insurance 

Under Part One General Provisions and Conditions, Paragraph 4 The use of the Aircraft, item cis deleted. 

Under Part Three Liability to Others, Paragraph 4 i. (3} Electrical and/or Electromagnetic Interference is deleted. 

NOTHING HEREIN CONTAINED SHALL BE HELD TO VARY, ALTER OR EXTEND ANY OF THE TERMS, 

CONDITIONS OR AGREEMENTS OF THE POLICY OTHER THAN AS STATED ABOVE. 

AlP 1029 (08/10) Page 1 of 1 
AIRCRAFT INSURANCE POLICY 

COVERAGE IDENTIFICATION PAGE 

U. S. SPECIALTY INSURANCE COMPANY YOUR POLICY NUMBER 

Prior Policy No . I A G.?ITAL STOCK ::o:-:PAN:' 

I .~.!:HINlSTRI\TlVE OFfiCES : l3!Q3 NORTH\·IEST ?RE~I>.Y 

I HCUSTON, TE!J!S 77040-6:!94 

AlP 1115 

AlP 1881 

(08/10) 

(01 /15) 

AERIAL PHOTOGRAPHY 

EXCLUSION OF CERTIFIED ACTS OF TERRORISM 

AC3005376-00 

,'9:' ·· nA THE · ?ILOT FLYING mg f.IRCRAFT: .•.. the ~i~;c&ti: must t~ operated in iig ~,t ciniy by i! person stci·1n ce ~~ . who , M must haye ~ e-n rent _<md proper, ( 1.) medical cer,tifica1:e arid (2) pilot ce~t~fic_ate 11ith. nece~sary ratinqs . ,: ; · . · .. ·.NUM_. ·.B. ur<'R _ . a$ reqtnrec by the ~;>}., for eacn fhght .: There 1$ no coverage under the .pohcy. 1£ the p1lot ace:s not rr.eet · ::'):·i ~~~~~t~n~e:s r~e~Qlut~r~err~,e nt ~· ~----~~·-··~·· ·· ·· __ ·_··· ________ ..• ·· ·· ··,.•. _ ___ ·· ~~~-- -- · __ · ----------~~ 

.~ ... 

UAV001 

. ·~· . . 

Open Pilot Warranty 

UAV operators as approved by the Named Insured. No pilot certificate or medical certificate required 

Named Pilots 

No Named Pilots 

Named Pilots with Requirements 

·.·1·.:··:11 •. ·.· ·····.'.•_. _, ••.• _N· ._U.FMl\i~E-·R.·'' '_· ... ·. ·· THE USE .. Of .THE .• i\IRCMD:.i .... Tll~ a~,rs;~ !t H+ll.be u~e(! ;t oi .. y,ouli: pleasilte and,. J~i~;e.ss o:elat d purpu~~s .. 'tlhere ·_no< .\1 charge is made f()i: .Such.use_ arid also \oJ~ll be used for the follotlin~ vurposes: < ' 

UAV001 

Your Operation for Aerial Photography and/or Mapping 

ADDITIONAL =NTEREST : Pa··,•mer.t for _i',ircr aft P~• si al Loss cr Damage under Cove rage For G ;;ill ile nade to ·,·':J'J and Iii: -K~J1E ANC. ADDRESS 0? ~N LD~ R I LOSS ?AYEE L/I LOAN BF.LM:CE ,, ,. ;_ ., -------,--------~~ ~~~~ -=~ -----------------+~~--~~~~ ~ 

':-:< . 

•• 

i 

~' " ,: Uaj L _________ - -----

AlP 1106 (08/10) Document Number: 693716 Page 2 of 3 
This page is intentionally left blank