Loading...
HomeMy Public PortalAboutH602C - Contact Info - COI - FY23City of McCall AIRPORT www,mccall.id.us Central Idaho Charter LLC c/o Todd Hitchcock 161 Joslin Way Twin Falls ID 83301 12/16/2022 216 E. Park Street McCall FD 83638 (208) 634-8909 (208) 634-8909 Fax 208..634-3038 RE: Annual Lease Billing and Information Requests Dear Central Idaho Charter LLC Enclosed is your annual lease billing for the period October 1, 2022 through September 30, 2023. With your lease payment, please return: • Proof of liability insurance, with hangar number clearly identified; and, • A completed Lessee Contact and Aircraft Information Form attached. Please provide a current email address to facilitate airport/tenant communications. Please send all documents to: City of McCall McCall Municipal Airport 216 E. Park St. McCall, ID 83638 Please write your customer number 87.8 on your check If you have any questions or concerns regarding this letter, or your lease, please contact me by phone at 208-634-1488, or via email at ehart@mccall.id.us Sincerely, Emily Hart Airport Manager McCall Municipal Airport 1'CLelle, al- Took! 1-f1'1- an cock S20o - 79z' -aryl rni'cLe ti tt - ,4-(1, @ r.a<< 1 cow Toad : ,208- 7 9 y --,Q z/t/v 1-\,± Q >� c\c-o ck • a vi* -K � oh E C \u-i , acts CERTIFICATE OF LIABILITY INSURANCE DATE (MM1DDfYYYY) 12/27/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Western Community Ins Co PO Box 4848 Pocatello, ID 83205-4848 CARON KEEFAN NAME: CARON U PHONE FAX (A/C. No. Exi): 208-375-3411 Not: 208-232-3608 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Western Community Ins Co 39519 INSURED E e II.il11f1111111111111111111111111111111111'llll11111 MILLER STEVE PO BOX 4270 MCCALL ID 83638 INSURER B: INSURER C: INSURERD: INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: AF0870 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM DIYYYY) POLICY EXP(D IMM(DDIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LABILITY Y N 8N145602 1/21/23 EACH OCCURRENCE $ 1,000,000 $ 100,000 DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) $ 5, 000 CLAIMS -MADE X OCCUR 1/21/24 PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 $ INCLUDED PRODUCTS- COMP/OP AGG GENII_ AGGREGATE X POLICY LIMIT APPLIES PRO JECT PER: LOC $ AUTOMOBILE LIABILITY — SCHEDULED AUTOS NON --OWNED AUTOS COMBINED SINGLE EMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAR , " EXCESS LIAB _ OCCUR CLAIMS -MADE I I b t19 y�t� } $a 11 r�3 EACH OCCURRENCE $ AGGREGATE $ $ DEC RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS helm Y f N N1 A . WC STATU- TORY LIMITS 0TH - ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LINNET S DESCRIPTION OF OPERATIONS i LOCATIONS 1 VEHICLES (Attach ACORD 161, Additional Remarks Schedule if more space Is required) CERTIFICATE HOLDER CANCELLATION 1111111iIlilll llllllllllllll ll1 I11 I111II 111111111111 CITY OF MCCALL MCCALL MUNICIPAL AIRPORT 216 E PARK ST MCCALL ID 83638 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (,), ACORD 25 (2010!05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: D� AC ADDITIONAL REMARKS SCHEDULE Page of AGENCY Western Community Ins Co NAMED INSURED MILLER STEVE PO BOX 4270 MCCALL ID 83638 POLICYNUMBER 8N1456O2 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: CITY OF MCCALL MCCALL MUNICIPAL AIRPORT is listed as an additional insured per endorsements CG 20 11(01/96) ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 2011 01 96 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Part Leased to You): 2. Name of Person or Organization (Additional Insured): 3. Additional Premium: (If no entry appears above, the information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule. CG 20 11 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 ❑ Alliant Insurance Services, Inc. -- 8377 PO Box 8377 Pasadena, CA 91109-8377 Phone: (509) 325-3024 Fax: (509) 325-1803 Robert T. Hitchcock 203 Joslin Way Twin Falls, ID 83301 Invoice # 1904149 Page l oft ACCOUNT NUMBER DATE RO B ETHI-01 3/8/2022 BALANCE DUE ON AGENCY CODE 4/16/2022 200 AMOUNT PAID AMOUNT DUE ( ®d S 2,534.00 return to14partion with__,_ v ,_,our payment rd L" - 044:".c. 2 Pay your invoice online. Alliant Connect accepts electronic funds transfer (EFT) from a checking or savings account. Contact your Alliant service team to learn more. Insured Payment Information Only Policy Term: Commercial Package 4/16/2022 to 4/16/2023 insurance Carrier: Travelers Indemnity Company Policy Number: KTK630250986371ND22 Item # Trans. Bff-Date Due Date .Trans Description 7727867 4/16/2022 4/16/2022 RENB Renewal Business Premium Total Invoice Balance: We have implemented lockbox deposit services with our bank. Please use this new address to avoid delays in Effective immediately, please mail all future checks along with remittance invoice detail to the followir Standard Mail Remittance Address — US Mail including Priority Mail and Priority Mail Express Alliant Insurance Services, Inc. — 8377 PO Box 8377 Pasadena, CA 91109-8377 0verni hr�t./Courier Remittance Address — Via Private Carriers such as Fed Ex or UPS Alliant Insurance Services, Inc. — Lockbox #8377 5th Floor 2321 Rosecrans Ave El Segundo, CA 90245 processing your payments.. Vt• Amount- $2,534.00 $2,534.00 IMP 0 RTANT NOTICE: The Nonadmitted & Reinsurance reform act (NRRA) went into effect July 21, 2011, Accordingly, surplus lines tax rates and regulations are subject to change which could result in an increase or decrease of the total surplus lines taxes and/or fees owed on this placement. if a change Is required, we will promptly notify you. Any additional taxes and/or fees due must be promptly remitted to Alliant insurance Services, Inc. IMPORTANT NOTICE: The Foreign Account Tax Compliance Act (FATCA) requires the notification of certain financial accounts to the United Stales Internal Revenue Service. Alliant does not provide tax advice. Please contact your tax consultant for your obligations regarding FATCA. Alliant embraces a policy of transparency with respect to Its compensation from insurance transactions. Details on our compensation policy, including the types of income Alliant may earn on a placement, are available at www.alliant.com. For a copy of our policy or for inquiries regarding compensation issues pertaining 10 your account contact: Alliant Insurance Services, Inc., Attn: General Counsel, 701 8 St., 6th Floor, San Diego, CA 92101