HomeMy WebLinkAbout20132264.tiffRESOLUTION
RE: GRANT PERMIT FOR TEMPORARY ASSEMBLY TO LOVE -AIR R/C, INC./WARBIRDS
OVER THE ROCKIES - SEPTEMBER 13, 14 AND 15, 2013
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, Love -Air R/C, Inc., c/o Michael Harrington, 6112 Ashton Court, Fort Collins,
Colorado 80525, has presented to the Board of County Commissioners an application for a Permit
for Temporary Assembly on land within the unincorporated portion of the County of Weld, State of
Colorado, to be held from 9:00 a.m., until 4:00 p.m., on September 13, 14 and 15, 2013, for the
2013 Warbirds Over the Rockies on property described as follows:
12760 Highway 14, Ault, Colorado 80610; being
further described as Lot B of Recorded
Exemption #2769; being part of the W1/2 NE1/4 of
Section 18, Township 7 North, Range 66 West of the
6th P.M., Weld County, Colorado
WHEREAS, said applicant has paid Weld County the sum of ONE -HUNDRED DOLLARS
($100.00) for said Weld County Permit for Temporary Assembly, and
WHEREAS, having examined said application, the Board deems it appropriate to grant a
Weld County Permit for Temporary Assembly to Love -Air R/C, Inc., and
WHEREAS, said permit shall be issued subject to compliance with the terms and conditions
as set forth in the application materials and upon the express condition and agreement that the
temporary assemblage will be conducted in strict conformity to all laws of the State of Colorado and
the Weld County Code, and
WHEREAS, any violation to said terms and conditions shall be cause for revocation of said
permit and forfeiture of bond.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that said Weld County Permit for Temporary Assembly for the Warbirds Over the
Rockies to be held on September 13, 14 and 15, 2013, be, and hereby is, granted to Love -Air R/C,
Inc., to conduct a temporary assemblage at the hereinabove described location.
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2013-2264
LC0022
PERMIT FOR TEMPORARY ASSEMBLY - LOVE -AIR R/C, INC.
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 12th day of August, A.D., 2013.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST:
Weld County Clerk to the Board
BY:
Deputy
APPR
rney
Date of signaturAUG
e: 2 0 2013
EXCUSED
illiam F. Garcia. Chair
Douglas Radem her, Pro-Tem
P. Conway
arbara Kirkmeye
C—'
c)
2013-2264
LC0022
WELD COUNTY PERMIT FOR TEMPORARY ASSEMBLY
By action of the Board of County Commissioners of the County of Weld, State of Colorado,
taken this 12th day of August, 2013, IT IS HEREBY GRANTED a permit for a temporary
assemblage on land within the unincorporated portion of the County of Weld, State of Colorado, to
be held from 9:00 a.m., until 4:00 p.m., on September 13, 14 and 15, 2013, on property described
as:
12760 Highway 14, Ault, Colorado 80610; being further described as
Lot B of Recorded Exemption #2769; being part of the W1/2 NE1/4
of Section 18, Township 7 North, Range 66 West of the 6th P.M.,
Weld County, Colorado
This permit authorizes Love -Air R/C, Inc., to hold such an assemblage so long as it is in
accordance with Chapter 12 of the Weld County Code and all other applicable State and County
statutes and regulations. This permit is subject to compliance with the terms and conditions as set
forth in the application materials and to additional conditions set forth by the Board and attached
hereto.
PERMIT APPROVED this 12th day of August, 2013.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
Weld County Clerk to the Board
BY:
Deputy CI
to the Board
AUG 2 0 2013
Date of signature:
rbara Kirkmeyer
NOTE: THIS PERMIT MAY BE REVOKED AND THE BOND FORFEITED FOR FAILING TO
MEET THE CONDITIONS SET FORTH HEREIN.
2013-2264
LC0022
APPLICATION FOR TEMPORARY ASSEMBLY
INSTRUCTIONS TO APPLICANT: Complete each section and mark "N/A" where not applicable.
Additional sheets may be attached and maps, sketches or drawings may be substituted for the
verbal description of plans for the assembly site. All required information must be furnished before
the application will be processed.
NAME: 2013 Warbirds Over The Rockies AGE: N/A
RESIDENCE:
MAILING ADDRESS: 6112 Ashton Ct. Fort Collins CO 80525
NAME: Michael Harrington
RESIDENCE: 6112 Ashton Ct .Fort Collins CO 80525
AGE: 62
MAILING ADDRESS: email: wdal@lamar.colostate.edu, cell: 970-420-1309
NAME:
RESIDENCE:
AGE:
MAILING ADDRESS:
NAME:
RESIDENCE:
AGE:
MAILING ADDRESS:
(This must list all partners in a partnership, officers of an unincorporated association, society or
group, or, if there are no officers, by all members of such association, society or group. IF A
CORPORATION, ATTACH A CERTIFIED COPY OF THE ARTICLES OF INCORPORATION.)
1. Address and legal description of all property upon which the assembly is to be
held: LARC flying site - Drake Field 12760 Highway 14 Ault CO 80610, in the north half of section 18,
in the south-east 40 corner of Government map A31. Approximate size is twelve acres. 1000 feet by 550 feet
A. Name. residence and mailing address of the record owners of such property (Attach
a notarized statement by the record owners of such property consenting to the
assembly if application is not made by all of the record owners.)
NAME: Drake Family Partnership LLC
RESIDENCE: 10010 Highway 14 Ault CO 80610
MAILING ADDRESS: same as above
NAME:
RESIDENCE:
MAILING ADDRESS:
0:`000 X10000000`100000Q0.000000
2. Nature or purposes of the assembly:
10th Annual Warbirds Over The Rockies This is a fly -in for pilots of remote controlled military aircraft
with a noon full scale fly overs and model air show.
3. Dates and hours during which the assembly is to be held: September 13-15, 2013, 9 am to 4 pm
4. Maximum number of persons to be allowed at assembly at any one time: 2000
5. The maximum number of tickets to be sold. if any: NSA
6. Identify plans to limit number of persons to the maximum identified above:
Attendance is limited by the number of parking spaces available.
7. Identify plans for supplying potable (drinking) water, including the source, number, and
location of facilities, and type and means of disposing of waste deposited:
There will be food vendors on site with drinking water. See below for waste disposal details.
8. Identify the plans for holding, collecting, and disposing of solid waste materials:
During the event there will be a minimum of 16 trash barrels along the flightline, spectator and parking areas.
There will be a large roll off dumpster on site provided by Waste Management, there are also 2 smaller dumpsters on site
Trash barrels will be inspected hourly and emptied as needed
9. Identify the plans for providing separate toilet facilities for males and females, including the
source, number, and location, type and the means of disposing of wastes deposited:
There will be a total of sixteen porta-johns (15 standard, one ADA compliant) and four wash stations located between
the parking area and the spectator seating areas. The facilities, provided by Portable Rental Systems, will be serviced on
Saturday and Sunday mornings
0:V00'0000000 0'00000 000.000000
10. Identify the plans to provide for medical facilities, including the location and construction of
any structures, the names, addresses, and hours of availability of emergency medical
technicians and nurses and provisions for emergency ambulance service:
Emergency medical services will be provided by the Ault Fire and Rescue.
11. Identify the plans, if any, to illuminate the location of the assembly, including the source and
amount of power, and the location of lamps: N/A
12. Identify the plans for parking vehicles, including size and location of lots, points of highway
access and interior roads, including routes between highway access and parking lots:
Access to the event is off Highway 14. Traffic control will be provided by Traffic Masters of Windsor, CO
Once vehicles are on the property, club members will guide attendees to parking locations.
Please see site layout.
13. Identify the plans for communications with hospital, police, and fire services, including the
source, amount, and location of communication equipment:
Ault Fire and Rescue will be on site. The event director will have contact with additional
emergency services via cell phone.
14. Identify the plans for camping facilities, if any:
There is a designated area in the parking lot for dry camping only.
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15. Identify the plans for fire protection:
Fire extinguishers will be located along the flight line and in the pits. Ault Fire and Rescue will be on site.
Rental tents have fire extinguishers
All vegetation in the spectator areas will be trimmed or mowed.
Crops in immediate surrounding fields will have been harvest by the event dates.
16. Identify the plans for security, including the number of guards, their deployment, their names,
addresses, credentials and hours of availability and description of peer group control, if any:
General security measures, parking attendants and on site traffic control, as well as crowd
control will be provided by the more that 50 club members who will be working at the event. Event staff are
distinguished by specific vests and badges.. The flight line and pit areas are tightly controlled
by the Airboss, his staff and pit security to limit access to authorized individuals only. There is are safety fences
between the spectator area and flight operations and pits areas. The parking area is separate from the
spectator areas.
17. Identify the plans for sound control and sound amplification, if any, including number,
location, and power of amplifiers and speakers:
The club provides the PA system (600 watt) for the event. There will an announcer who describes the action
for spectators and who will also advise pilots of flight line activities. There are a total of 6 speakers
which provide adequate coverage without excessive volume.
18. If applicable, identify plans for meeting County health standards for food concessions and
concessionaires who will be allowed to operate on the grounds, including the names and
addresses of all concessionaires and their license permit numbers:
Food and drinks will be available from Famous Dave's BBQ, 16539 N Washington St Thornton, CO 80020
Thornton tax license #20099, CO sales tax license #27-78562, retail food license #35-10181-000
19. Identify the plans, if any, for an electrical system:
Electricity for all needs will be provided by on site generator(s).
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20. Identify the plans to ensure that trees, underbrush, large rocks, and other natural features
shall be left intact and undisturbed, and natural vegetative cover retained, protected and
maintained so as to facilitate drainage, prevent erosion, and preserve the scenic attributes;
and the plans to abate dust on the site:
Please note the maintenance section of the club lease which stipulates terms. The access road and gravel
parking lot will be watered daily.
21. Attach a statement by a bonding company licensed to do business in the State of Colorado
indicating its intent to furnish a bond required in Section 12-1-30.6.13 of the Weld County
Code to ensure performance by the applicant of each of the terms and conditions of the
temporary assemblage permit.
22. Attach a statement by an insurance company licensed to do business in the State of
Colorado stating its intent to provide liability insurance, as required by Section 12-1-30.B.14
of the Weld County Code, to protect against injury to persons or property occurring as a
result of such an assembly.
23. Submit $100.00 fee for each event where three -hundred fifty (350) or more people assemble
or can reasonably by anticipated to assemble at any one (1) location, unless the location is
properly zoned for such assembly, in which case one permit shall be required for the total
number of events scheduled for that location for the reminder of the calendar year, not to
exceed ten (10) events per year. As used herein, the term event means an assembly or
anticipated assembly which is scheduled to last for three (3) consecutive days or less.
BY THIS APPLICATION, APPLICANT(S) AGREES TO INDEMNIFY AND HOLD HARMLESS
WELD COUNTY OR ANY OF ITS AGENTS, OFFICERS, SERVANTS, AND EMPLOYEES FROM
ANY LIABILITY OR CAUSES OF ACTION WHICH MIGHT ARISE BY REASON OF GRANTING OF
A TEMPORARY ASSEMBLAGE PERMIT, AND FROM ANY COSTS INCURRED IN DEFENDING
AGAINST SUCH ACTIONS OR IN CLEANING UP ANY WASTE MATERIAL PRODUCED OR LEFT
BY THE ASSEMBLY.
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The applicant, and each of them, swears, (affirms) that, to the best of his knowledge, the
statements contained in the application are true and correct.
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Applicant's printed name
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Applicant's position
SUBSCRIBED AND SWORN to before me this / 3 day of
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Witness my hand and official seal.
My commission expires:
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M:CTB\CTBFORMS\FOASM BLY.DOCdoc
BYLAWS
LOVE AIR RC CLUB
AMA Sanctioned Club #2356
Revised, January 2004
ARTICLE I - Name, Location and Duration
The club shall be known as Love -Air RC Club, Inc. herein referred to as the "Club". The
Club is sanctioned by the Academy of Model Aeronautics (AMA), a 501c3 organization
that works to foster and maintain the hobby/sport of aeromodeling.
The Club is incorporated as a non profit in the state of Colorado (19881003322 DNC).
The duration of the Club shall be perpetual.
ARTICLE II - Purposes
The objectives of the club shall be:
1. To unite in one organization those people interested in model aviation.
2. To develop a quality program of activities for the members.
3. To function in such other ways as will further the interests of the organization.
4. To cooperate with other agencies or organizations, both public and private, with
similar or related objectives.
ARTICLE III - Membership
1. Membership in the club shall be open to anyone who is interested in model
aviation and who is a member in good standing of the Academy of Model
Aeronautics. Prospective members must submit a membership application. All
members shall provide evidence of current AMA membership and shall pay upon
dues as provided in these Bylaws.
The types of membership shall be:
2. GENERAL: A general member is entitled to all rights and privileges without
limitation.
3. FAMILY: A family member is a dependent member of the immediate family of a
general member who shall enjoy all the rights and privileges of a general member
upon application and payment of dues equal to one-half the annual amount for
general membership.
4. JUNIOR: A junior member is a member who is under the age of eighteen (18) and
is entitled to all the rights and privileges of a general member upon application
and payment of dues.
5. HONORARY: An honorary member is a designation bestowed upon a person by
the membership who has distinguished themselves in service to the club or to the
hobby of model aeronautics. The club may consider such designation upon the
recommendation of a general member. Honorary members shall have no voting
privileges and may use the club facilities, but only as a guest of a general member
and providing the honorary member is a current member in good standing of the
AMA.
6. The club secretary shall provide each new member with a copy of the club's
Bylaws and any rules or regulations which may have been adopted. The secretary
shall also distribute revisions of these Bylaws and rules or regulations to the
membership.
7. Each member shall be responsible for the proper enforcement of all club and
AMA rules and regulations.
8. A membership may be terminated, for cause, by a majority vote of the club
membership as detailed below
ARTICLE IV - Dues
1. The amount of dues shall be as determined by the Board of Directors and
approved by a majority of the club membership.
2. The dues shall be due on July 1 of each year, and are payable during the
preceding thirty day period. Any new member, being received into the club at a
time other than on July 1, shall pay the required amount as established, by the
Board of Directors and approved by the club membership.
3. Any member more than thirty days delinquent in payment of their dues shall be
removed from membership. A member removed for non-payment of dues may
make reapplication for membership only with full payment of the current year's
dues.
4. During the month of June, the Secretary shall provide each member with an
appropriate statement of dues together with such appropriate forms to be
completed and returned by the member, as a condition of membership. Said
forms will report the member's AMA number and status, and any other pertinent
information required for continued membership. Such statement and forms may
be included in the club newsletter.
5. All dues collected shall be entered upon the books of the club for general use.
6. Dues are non-refundable, except under extraordinary circumstances. Any refund
shall be prorated and shall be determined by the Board of Directors on a case -by -
case basis.
ARTICLE V - Officers and Elections
1. The elected officers of the club shall be: President, Vice -President, Secretary,
Treasurer and Safety Officer.
2. The Club shall also elect two (2) members Directors to serve as members of the
Board of Directors. The immediate past President shall also serve as a Director.
In the event that the sitting President is reelected to an additional term, three (3)
Directors shall be elected.
3. The election of club officers shall be conducted annually, at the last regular
meeting (usually November) of each calendar year.
4. The term of office runs from January 1 to December 31 of each calendar year.
5. In the event of a resignation by an elected officer prior to expiration of the term,
the Board of Directors shall appoint a replacement to serve the remainder of that
term.
6. No position shall be held by a probationary member.
ARTICLE VI - Duties of the Officers
1. President: The President shall be the Chief Executive Officer of the club and
shall have general supervision of its affairs. The President shall preside at all
meetings of the club and shall carry out the policies established by the Board of
Directors. The President may appoint committees and shall be an ex officio
member of all committees.
2. Vice -President: The Vice -President shall assist the President and act on behalf of
the President in case of his/her absence. The Vice -President shall also act as
Public Relations officer for the club.
3. Secretary: The Secretary shall keep a record of the proceedings of the meetings;
conduct club correspondence; and shall perform the duties incidental to the office
of the Secretary and such other duties as the President may prescribe. In
cooperation with the membership chairman, the Secretary shall maintain a record
of the club membership, member applications and status. In conjunction with the
Newsletter Editor, the Secretary shall provide a mailing and telephone list of all
members in good standing to the membership during the month of September
each year.
4. Treasurer: The Treasurer shall be the principal financial officer of the Club and
should render an accurate account of the fmancial condition of the club at the
regular meetings of the membership. The Treasurer shall collect all dues,
assessments, and amounts owing to the club and deposit same to a bank account
in the Club's name. The Treasurer shall discharge all financial obligations of the
club as approved by the Board of Directors or the club membership. In addition,
the Treasurer shall cause an audit to be conducted in December of each year with
the report to be distributed to the membership by the following February meeting
of the Club.
5. Safety Officer: The Safety Officer shall ensure existing safety regulations are
enforced. This includes working with the Board of Directors in the processing the
grievance forms and following the existing grievance procedure as documented
in these by-laws. The Safety Officer shall conduct a general safety meeting at
least once each year.
6. Directors: The Directors shall represent the general membership on the Board of
Directors and shall participate in the general conduct of the business affairs of the
Club.
ARTICLE VII - Board of Directors
1. The Board of Directors consists of the Club officers and elected Directors.
2. The Board may meet from time to time as determined by the club President.
3. The Board shall conduct the business affairs of the club. The Board may
approve the expenditure of monies in the club treasury, pursuant to the
conducting of club business affairs for a dollar amount up to and including five
hundred dollars ($500). Expenditures exceeding five hundred dollars ($500)
must be approved by a majority vote of the members present at a regular club
meeting.
ARTICLE VIII - Newsletter
1. The club shall publish a monthly newsletter which shall be distributed to each
club member in good standing at least five (5) days prior to the regular monthly
meeting.
2. The newsletter will be edited and published under the direction Newsletter
Editor. The Editor shall be appointed by the Board of Directors.
3. The purpose of the newsletter is to provide newsworthy information to club
concerning its members, model aviation, and events and activities of the club.
ARTICLE IX — Meetings
1. There shall be regular monthly meetings of the club's membership at a time and
place as determined by the Board of Directors. Regular meetings may be omitted
as determined by the Board of Directors providing not more than three
consecutive months pass without holding a regular meeting.
2. Special meetings maybe called at any time as determined necessary by the
Board of Directors.
3. Each member shall be entitled to one vote on each issue at all meetings of the
club. All issues shall be decided by a majority vote of the members as described
under "Quorum" below or as otherwise specifice in these Bylaws.
ARTICLE X - Resignation, Disciplinary Action, Reinstatement
1. Any member may resign his/her membership by giving notice to the Club.
2. Any member failing to maintain AMA membership shall be terminated from the
Club and may be reinstated upon restoration of eligibility.
3. Club members shall exhibit good behavior and serve as positive role models at all
times. Any other unacceptable behavior by an individual member or members, as
defined by the club, becomes the responsibility of the members as stated in the
bylaws.
4. Any member may be expelled from membership from the club by a two-thirds
majority vote of the members if, in the members determination, violation of any
of these bylaws, or the rules of AMA, or any act that is detrimental to the Club, or
the AMA.
5. Any member who is expelled from the membership may be reinstated by a two-
thirds majority vote of those club members voting. Mail -in ballots will be made
available to all members. Mail -in ballots shall be opened at the meeting and
counted as if those persons were present at the meeting.
6. The Board of Directors shall have the discretionary authority to provide for and
impose disciplinary action, including probation, for such acts or omissions that do
not justify expulsion from membership except as noted below.
ARTICLE XI - Grievance Procedure (Flight and Ground Safety Rules)
1. Purpose: The grievance procedure provides a mechanism to enforce existing
safety rules by providing a progressive disciplinary system when needed.
Although most complaints can be resolved informally, if a complaint is serious or
cannot be resolved informally, the matter should be referred to the Board of
Directors for its consideration by means of a Grievance Form to be filled out and
turned into the Safety Officer. At least one witness is required to sign the
Grievance Form.
2. The Board of Directors shall use its judgment in carrying out action on the
following:
(a) A grievance form (see Appendix A) will be filled out and turned into the Safety
Officer. At least one witness is required.
(b) FIRST VIOLATION
a. Viewpoints of both complainants and accused will be considered.
b. Complainant's name will be disclosed.
c. A verbal reprimand will be given to the accused by the Board of Directors,
and this will be recorded in the Board's files.
(c) SECOND VIOLATION
a. Complainant's name will be disclosed.
b. The accused has the right to a written rebuttal, to be reviewed by the
Board.
c. If the Board so decides, the flying privileges of the accused will be
suspended for thirty (30) days. Written notice of this shall be issued and a
copy published in the Club newsletter.
(d) THIRD VIOLATION
a. Board will notify the accused in writing and the Club members via the
Club newsletter that the Club will vote on the expulsion of the accused at
the next meeting.
b. A member may be expelled from the Club only upon a two-thirds (2/3)
majority vote those club members voting. Mail -in ballots will be made
available to all members. Mail -in ballots shall be opened at the meeting
and counted as if those persons were present at the meeting.
c. Voting will be by secret ballot at a regular monthly meeting.
d. Said expulsion will last for a one-year minimum. (Longer if deemed
necessary by the Board).
e. The expelled member may reapply for membership after the expiration of
the expulsion time period.
(e) The three violations actions will not be enforced unless they are accumulated
within a two-year period of time.
(0 Any member receiving a Grievance, who directs any retaliation action against the
person filing said Grievance, will be subject to immediate expulsion from the
Club at the discretion of the Board of Directors. This is to include threats,
intimidation, physical harm, intentional equipment damage, or any other action
deemed to be retaliatory by the Board.
(g) Any member receiving a safety Grievance as stated in this Article, who is
involved in non -flying violations, or who has key information of a non -flying
violation and withholds it from the Board of Directors, may at the Board's
discretion be placed on probation for one (1) year regardless of his or her tenure
in the Club.
ARTICLE XII — Dissolution of the Club
The Club may be dissolved with the approval of a two-thirds majority vote of the
membership. Upon the dissolution of the Club and after paying all liabilities of the Club,
the remaining members shall dispose of all the assets of the Club to the Academy of
Model Aeronautics, Inc., or to such other organization or organizations organized and
operated exclusively for furtherance of model aviation.
Article XIII - Quorum
A simple majority of those in attendance shall decide all questions except in the case of
revision of these Bylaws as provided herein.
ARTICLE XIV - Parliamentary Authority
The emphasis in all meetings shall be on orderly process to achieve an objective decision
by those present and voting. Should there be a parliamentary challenge, however, it shall
be answered by reference to Roberts Rules of Order.
ARTICLE XV - Repository of Documents
The Secretary and Treasurer shall maintain all records of the club in an orderly fashion
and shall pass all records to his/her successor.
ARTICLE XVI - Logo
The club logo show on page 1 shall be the property of the Love -Air RC Club Inc and
shall be used only for official purposes as approved by the Board of Directors or the club
membership.
ARTICLE XVII - Amendments
These Bylaws may be amended at any regular meeting of the club provided that the
proposed amendment has been published in advance of initial presentation the
membership at a prior regular meeting. The amendment is passed by a two-thirds (2/3)
majority of those club members voting. Mail -in ballots will be made available to all
members. Mail -in ballots shall be opened at the meeting and counted as if those persons
were present at the meeting.
Date:
Appendix A
Love Air RC Club Grievance Form
Time:
Nature of Violation:
Signature:
Witness:
Additional Witnesses (not required):
1 of 8
LOVE MR R/C INCORPORATED
AND
DRAKE FAMILY PARTNERSHIP LLLP
LEASE AGREEMENT
2ofS
Drake Family Partnership LLLP - Love Air R/C Inc. - Lease
Lessor [Landlord] Drake Family Partnership LLLP
Attn: Linda Blehm
10010 Highway 14
Ault, CO 80610
Lessee [Tenant] Love Air R/C Incorporated
Mark Smith, 2007 President
3563 Gold Hill Dr.
Loveland, CO 80538
[P.O. Box 1781, Loveland, CO 80539-1781]
Location of subject property: 12760 Highway 14 Ault CO 80610, in the north half
of section 18 in the south-east 40 corner, Government map A31. Approximate size
is twelve acres, 1000 feet by 550 feet.
This agreement shall replace any and all previous agreements between the two
parties.
The term of the lease shall be 180 months [15 fifteen years], beginning May 15,
2007, ending May 31, 2022. The Lessee shall have the first right of refusal option
to renew this contract for an additional 5 [five] years. Lessee shall have the first
right of refusal option to purchase the leased area. The lease will be payable in
semi-annual installments as outlined in Exhibit A. The first semi-annual
installment to be paid on or before May 31, 2007.
3 of 8
Maintenance:
The lessee shall keep property in good maintenance at all times. This shall include
mowing of the weeds and grasses. Lessee shall communicate with landlord on
which herbicides, etc. to use so as not to endanger landlords ground and crops.
Lessee shall always take steps to keep erosion and blowing of topsoil to a
minimum. This includes the planting of grasses in open areas of the field and
maintaining them.
Landlord is aware that:
1. Lessee will construct and maintain a model airstrip [blacktop with
surrounding grass].
2. Lessee will construct a shade shelter and possibly a storage building on the
site.
3. A parking area will be designated with appropriate gravel or pit run fill not
larger than 3/8 inch rock.
4. Designated area will not be used for anything other than club use.
5. Structures may be moved on to the club site, such as large spools, tables,
fences, etc.
6. The club will install any necessary culverts to the site to aid the landlord in
the irrigation of his crops.
7. Any of the above stated items may change upon written agreement of both
parties.
Lease buyout:
In the event that the property is sold and the new owner is not amenable to
assuming the lease terms or negotiating a new lease that is agreeable to Love Air
R/C, the Lessor will make a payment to the Lessee to "buy out" the remaining
period the lease. The amount shall be 10% of the remaining value of the lease or
$5000.00, whichever is less. If the new owner chooses to exercise the lease buyout
option and has no intention of farming the property then the need for returning the
site to its original condition will be revisited.
4 of 8
Lessee agrees that any major changes will not be made without prior consultation
and consent of the landlord.
The lessee and lessor may mutually terminate the lease in the event that model
flying at the site is not permitted for some legal reason. At that time the lessee
would return the property to the original condition prior to the initial lease.
If the lessee needs to terminate the lease for any other reason the lessee will give
the lessor written notification one year in advance of our intent to vacate. No
additional lease payments will be due after the terminal year. Upon termination
the lessee will restore the property as described in the paragraph entitled "Site
cleanup" below.
Cleanup or damage account:
Love Air R/C will maintain an escrow account of $4000.00 plus interest. This
account would be in both the landlords and the lessees names and can be reviewed
at any time by the landlord, and cannot be used for any purpose other than to return
the site to its original condition. Lessee will provide a copy of the most recent
statement semi-annually. The statement will be included with the semi-annual
payment.
Insurance:
The Club will maintain a charter with the Academy of Model Aeronautics which
provides insurance to the site owner. All documentation will be provided to the site
owner.
Club membership:
Love Air R/C will present lessor with free membership in the club during the term
of the lease. This will be extended to the immediate family.
5 of 8
Site cleanup, removal of blacktop and gravel:
At the end of the lease agreement, if a renewal lease is not given, Love
Air R/C shall remove all blacktop and gravel in such manner that topsoil is
disturbed as little as possible. Love Air RIC will use the cleanup account to
accomplish this restoration. In the event the cleanup account does not have enough
funds, Love Air R/C will be responsible for any additional cost. The site owner
agrees that not all of the gravel can be removed and some of the gravel can be
worked into the top soil.
Access to site:
Love Air R/C will have the access road graded as needed. The site owner agrees
that he will assist Love Air R/C with any problems that may limit or stop the use of
the current access road. Love Air R/C agrees that this road will not be blocked at
any time. Love Air R/C will be permitted to install a gate at the entrance to the
parking area. The site owner will be provided with keys or combination to any
locks used.
Signs:
Love Air RIC may construct a sign at the entrance road of the access road
at the intersection with Highway 14. This sign will be no larger than 5 [five] feet
square, and placed so as not to obstruct the right of way.
Policing of site:
Love Air R/C will be responsible for asking unwanted guests to leave the site.
Love Air R/C will be required to stop any non -club activities at the site. Site
owner will not be required to watch the site.
6 of 8
Lessor [landlord] --Drake Family Partnership LLLP
by F
Lessee (tenant] — Love Air R/C Inc.
by
Witness /1
Date: S ` Z ic - t.' 7
Date:
Date: j -2 6
Date: O5726 o= -7 -
Witness 44 Date: .1"--,Z6 .0 7
7 of 8
Exhibit A
Annual lease rate and semi-annual payment schedule
Year Annual Rate Year over year increase
2007 $4000.00 (+$300)
2008 $4400.00 (+$400)
2009 $4800.00 (+$400)
2010 $4900.00 (+$100)
2011 $5000.00 (+$100)
2012 $5100.00 (+$100)
2013 $5200.00 (+$100)
2014 $5300.00 (+$100)
2015 $5400.00 (+$100)
2016 $5500.00 (+$100)
2017 $5600.00 (+$100)
2018 $5700.00 (+$100)
2019 $5800.00 (+$100)
2020 $5900.00 (+$100)
2021 $6000.00 (+$100)
Due date Semi-annual payment
5/31/2007 52000.00
11/30/2007 $2000.00
5/31/2008 $2200.00
11/30/2008 $2200.00
5/31/2009
11/30/2009
5/31/2010
11/30/2010
5/31/2011
11/30/2011
$2400.00
$2400.00
$2450.00
$2450.00
$2500.00
$2500.00
8 of 8
5/31/2012
11/30/2012
5/31/2013
11/30/2013
5/31/2014
11/30/2014
5/31/2015
11/30/2015
5/31/2016
11/30/2016
5/31/2017
11/30/2017
5/31/2018
11/30/2018
5/31/2019
11/30/2019
5/31/2020
11/30/2020
5/31/2021
11/30/2021
$2550.00
$2550.00
$2600.00
$2600.00
$2650.00
$2650.00
$2700.00
$2700.00
$2750.00
$2750.00
$2800.00
$2800.00
$2850.00
$2850.00
$2900.00
$2900.00
$2950.00
$2950.00
$3000.00
$3000.00
Linda Blehm
10010 Hwy. 14
Ault, CO 80610
(970) 686-2809
Love -Air R/C, Inc.
P.O. Box 1781
Loveland, CO 80539-1781
May 5, 2008
Attn.: Mark Smith, President
I am enclosing the road maintenance agreement that Dennis signed. It is
ready for your approval and signature. If you want anything changed, let
me know. Otherwise, please sign and return it in the envelope I've
enclosed. Dennis said that you can call him if you want the road graded
more often, or if you see it needs to be done and he hasn't noticed yet. I
didn't get that put in the agreement because he told me after he signed it.
He has already used the scraper for three passes on March 31. So I will be
sending a bill shortly. I wanted to wait until we got this done before billing
you for it.
Sincerely,
YrLSD
Linda Blehm
AIRFEILD ROAD MAINTENANCE AGREEMENT
Dennis Drake and Love -Air R/C, Inc. agree to the following terms for the
maintenance of the access road to the Love -Air field located in section 18,
township 7, range 66. Love -Air leases this property from Drake Family
Partnership, LLLP.
Frequency: Dennis will scrape or grade the road when he feels it is
necessary and when the conditions are good. The best time is when the road
is still damp after a rain shower.
Payment: Love -Air will pay Dennis $15 per round trip when he uses his
box scraper. Additional passes will cost $7.50 each. Once or twice a year,
Dennis will use his tractor and grader. This charge will be $40 per hour, and
will include the time it takes to hook the grader up to the tractor, drive from
Dennis' house to the field, grade the road, and drive back to his house.
Dennis will mail an invoice to Love -Air for the necessary payment.
Term: This agreement will be in effect until cancelled in writing by either
party, or replaced by another agreement.
5
Dennis Drake
�._. ! /Nog
Love -Air Representative and title
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SPECIAL
EVENT
AHEAD
500'
500'
ACADEMY OF MODEL AERONAUTICS
Coordinating Body for Model Aviation in the United States and the U.S. Aeromodeling
Representative in the United States for the Federation Aeronautique Internationale
se
AAM
ACADEMY OF
MODEL AERONAUTICS
'C'aetspof Wadden ?eget-es
CHARTERED CLUB CERTIFICATE
LOVE —AIR R/C INC #2366
COLORADO
is registered as a Chartered Club of The Academy of Model Aeronautics, Inc. entitled to all
privileges and special benefits accorded to AMA Chartered Clubs. Each club chartered by the
Academy is protected by insurance coverage with liability limits of $2,500,000 while engaged
in modeling and related club activities, for bodily injury and/or property damage arising out of
any one accidentwhich may be incurred as aresult of club participation in such activities; the
owner of any property used for club activities maybe included as an additional insuredby
issuance of a certificate of insurance IF requested by a chartered club and a fee paid for adding
coverageforthe site owner. Asummary oftheprotection provided under insurance policies
issued to theAcademy is printed on the reverse side.
Executive Director
Issued by The Academy of Model Aeronautics at Headquarters Expires on March 31, 2014
Rev. 01/21/13: camembrshptcubcert.cdr -
2013 SUMMARY OF LIABILITY
INSURANCE PROTECTION
for Chartered Clubs and Sanctioned Events
provided under insurance policies issued to
The Academy of Model Aeronautics, Inc.
This Summary of insurance coverages is merely descriptive and should be used for familiarization and general
reference purposes only. For specific policy information including coverage exclusions, limitations or conditions,
copies of master policy(s) may be requested from the AMA and are available for $5.00 per copy for handling and
postage or can be downloaded at www.modelaircraft.org.1
The General Liability Insurance policy coverage for chartered clubs, chapters, designated site owners and sanctioned
event sponsors is effective March 31, 2013, subject to the tens and conditions of the policy issued by Westchester
Surplus Lines Insurance Company. These insurance policies provide legal liability coverage for AMA chartered
clubs and chapters if they are sued or claimed to have been negligent in causing bodily injury or property damage.
Coverage for liability arising from club modeling operations is also extended to designated site owners who are
issued an official Certificate of Insurance as evidence of coverage. Policy benefits include assignment of legal
counsel and payment of legal cost related to the investigation, defense or settlement of a covered claim and payment
of bodily injury, property damage or limited personal injury (libel, slander, defamation, invasion of privacy)
settlements or judgements up to the limits of the policy. Clubs, chapters and sanctioned event sponsors are provided
this liability insurance as excess of any other Spplicable coverage for accidents; however, coverage for a designated
site owner is primary.
The maximum per occurrence limit of coverage available by ibis policy is $2,500,000 involving bodily injury,
personal injury and/or property damage with an overall limit of $5,000,000 in the aggregate. These limits are for
claims occurring during the policy period. Model cars, boats and rockets are included. Property damage liability
coverage is subject to a $250 per claim deductible payable by the Club or Sanctioned Event Sponsors. The deductible
does not apply to bodily injury or personal injury. There is no coverage for damage caused to models. Liability
coverage not provided under the policy for AMA members in suits or claims assorted by members of their own
household. Likewise, no coverage is provided for claims arising from the use of private or commercial aircraft,
automobiles or other motor vehicles, or water craft which transport people as operators or passengers in conjunction
with club, chapter or sanctioned event activities.
Site Owner Coverage includes:
*Premises liability for injury to spectators at a flying event.
*Liability for injury or damage off -site (i.e. a model that strays from the site and injures someone on adjoining
property).
*Legal costs for defense of a lawsuit naming the site owner.
*Contractual Liability coverage for contracts between the club and site owner holding the site owner harmless
for claims or suits involving injury.9r damage caused by the club's activities.
*AMA insurance is primary.
*Separation of insured protects site owner from member or club acts voiding coverage.
SPECIFICALLY NOTE:
1. This summary is general in nature. For exact and specific details of liability protection and its exclusions,
limitations, or conditions, please refer to the master insurance policy. Copies will be provided by AMA Headquarters
for $5.00 per copy or can be downloaded at wwwrnodelaircraft.org.
2- Claim reporting --any incident or claim must be reported immediately to AMA Headquarters, (765) 287-1256, or
email claims@modelaircraftorg. To report any incident involving serious injury after hours or on weekends, please
call (765) 749-9210.
I Choose "AMA Documents" from the menu then select "Safety and Member Benefits" from the contents section. The liability
policies are Documents 500-L and 500 -LA.
chap-pubsnsuritncert.gxp 1/13
Insurance Information
Love Air. RC is chartered by the Academy of Model Aeronautics (AMA), please see chartered club
certificate #2356. As a chartered club, the club,its officers and the landowner"each have *2,500,000 in
liability coverage (see certificate). Each participating pilot is required to be a member Of AMA and is
also insured with $2;500,000in liability coverage. The event is also insured. ($2,500,000) by having been
sanctioned as anofficial event by the AMA. The aggregate coverage is..$5000,(l00 (see attached
certificate and letter).
Academy of Model Aeronautics
5161 East Memorial Drive
Muncie, Indiana 47302
(765) 287-1256 — Business
(765) 289-4248 — Fax
(800) 435-9262 — Membership Services
http://www.modelaircraft.org
2013 INSURANCE SUMMARY - THE FACTS ABOUT AMA'S INSURANCE BENEFITS
For Individual Members
Please report all incidents to AMA as soon as possible!
Commercial General Liability Coverage (Effective March 31)
• AMA Liability Protection applies to bodily injury or property damage caused by an AMA member. Any AMA
member who causes an accident resulting in an injury must report that accident immediately to AMA HQ.
• Applies to accidents arising from the modeling activities of model aircraft, rockets, cars and boats, in
accordance with the AMA NATIONAL Safety Code(s).
• The per occurrence limit of coverage available by this policy is $2,500,000 involving bodily injury and/or
property damage. These limits are for claims occurring during the policy period. Coverage is provided only for
accidents arising from the model activities.
• A separate policy covers participation in FAI events outside of the United States and Canada. This policy has
a $1,000,000 limit.
• There is no coverage for injury to a member to his own family (Household and Relative(s) living in the
member's household) for claims or suits.
• The policy does NOT cover business pursuits; that is any activity that generates income for a member beyond
reimbursement of expenses, except this business pursuit exclusion does not apply to individual members
providing modeling instructions for pay to AMA members.
• AMA insurance is "excess" to any other applicable coverage, such as homeowner's.
• Has a $250.00 deductible (property damage only), which is the responsibility of the AMA member causing the
accident.
Accident/Medical Coverage (Effective January 1)
The Accident/Medical coverage applies to injuries while engaged in model activity regardless of who causes the
accident. It reimburses an AMA member in accordance with policy terms and conditions for only medical
expenses (also the beneficiary for loss of life) incurred within 52 weeks of the accident. The Accident/Medical
coverage works as follows:
• Provides up to $25,000 for medical expenses and $10,000 for dismemberment or death.
• Insures AMA member directly — does not require claim action by another person.
• Pays for eligible expenses upon submission of bills or other documents certifying cost of treatment and that
injury was caused by model activity.
• Reimburses medical expenses only after submission to any other health plan, including Medicare.
• Has a $750.00 deductible.
Fire, Vandalism, and Theft Coverage (Effective March 31)
• Provides up to $1,000 for loss of aircraft models and accessories, including RC equipment. All theft loss
claims must be accompanied by a police report. NOTE: Theft has to occur from a locked vehicle or
residential dwelling. There must be physical evidence of violent forcible entry.
• Has a $100.00 deductible.
• Is "excess" to any other applicable coverage, such as homeowner's.
To report an incident, request claim forms, or inquiry about filing procedures please call (765) 287-1256 or e-mail
claims(c modelaircraft.orq. Regular business hours are Monday —Friday, 8 am -5 pm EST.
To report an incident that involved serious injuries to individuals outside our regular business hours, please call
(765) 749-9210.
This information is merely a brief summary. Complete details of coverage, reporting periods, and exceptions are contained in
master policies available at www.modelaircraft.org/documents.aspx, documents #500-L, 500 -LA, 500-M and 500-N.
Q:\Special Services\Documents\REPORTS\Annual Insurance Sunnnmy\2013 Insurance Summary combined.doc 1/29/2008
Academy of Model Aeronautics
5161 East Memorial Drive
Muncie, Indiana 47302
(765) 287-1256 — Business
(765) 289-4248 — Fax
(800) 435-9262 — Membership Services
http://www.modelaircraftorg
AMA
ACADEMY OF
Mona AERONAUTICS
gitkp,Vds«n ?jeer
2013 Park Pilot Membership Insurance Summary Benefits
The Facts About AMA's Park Pilot Insurance For Individual Members
Commercial General Liability Coverage (Effective March 31)
The AMA Park Pilot Liability Protection applies to bodily injury or property damage caused by an AMA
Park Pilot member. It applies to accidents arising from the operation of model aircraft (as defined
for the Park Pilot Program), in accordance with the AMA Park Flyer Safe Operating
Recommendations.
• The "per occurrence" limit of coverage available by this policy is $500,000 for claims
involving bodily injury and/or property damage. These limits are for claims occurring
during the policy period. Coverage is provided only for accidents arising from the model
activities.
• There is no coverage for injury to a member to his own family (Household and
Relative(s) living in the member's household) for claims or suits.
• The policy does NOT cover business pursuits; that is any activity that generates income
for a member beyond reimbursement of expenses, except this business pursuit
exclusion does not apply to individual members providing modeling instructions for pay
to AMA members.
• AMA insurance is "excess" to any other applicable coverage, such as homeowner's.
• Has a $250.00 deductible (property damage only), which is the responsibility of the AMA
member causing the accident.
• Is "excess" to any other applicable coverage such as homeowner's.
To report an incident, request claim forms, or inquiry about filing procedures please call (765) 287-1256 or
e-mail claimsCcamodelaircraft.oro. Regular business hours are Monday —Friday, 8 am -5 pm EST.
To report an incident that involved serious injuries to individuals outside our regular business hours, please
call (765) 749-9210.
This information is merely a brief summary. Complete details of coverage and exceptions are
contained in the master policy available at www.modelaircraft.oro/documents.aspx, document #500-L,
Q:\Special Services\Documents\REPORTS\Annual Insurance Summary\2013 Insurance Summary combined.doc 1/29/2008
m0ceLr f#vie-rian
ST LI,De rlT £L LFS
Academy of Model Aeronautics
5161 East Memorial Drive, Muncie, IN 47302
Phone (765) 287-1256, FAX (765) 289-4248
www.modelaircraft.org
193G 52011
4�1AMA
ACADEMY. OF MODEL AERONAUTICS
Academy of Model Aeronautics Liability Insurance Program for Site Owners
The AMA General Liability Insurance Program insuring AMA, members, and clubs for liability
resulting from aeromodeling activities includes broad and unique coverage for flying site
owners. AMA recognizes the importance of providing site owners with insurance to protect them
for potential liability for injury or damage resulting from club activities on a flying site and has
negotiated a custom policy with a major insurer to provide such coverage.
This policy has special coverage provisions for site owners as follows:
1. Westchester Surplus Lines Insurance Company has an A.M. Best rating of A+ XI and is a
member of the ACE USA Group, a large insurance organization with an A.M. Best rating
of A+ XV.
2. Authorization for AMA to issue certificates of insurance naming site owners as additional
insured. This is the equivalent of issuing an endorsement to the policy and assures the site
owner of coverage equal to coverage for AMA, its members, and clubs.
3. Site owner's coverage is primary. This means that the AMA policy pays on the site
owner's behalf without involvement of the site owner's own insurance.
4. Acts voiding coverage by any other insured may not apply to site owners. Should an
AMA member or club either do something, or fail to do something that voids coverage
for that member or club, the site owner still could have coverage under this policy.
5. Contractual liability coverage. This coverage clause reinforces the club's contractual
obligations (if any) to indemnify and hold harmless the site owner for injury or damage in
connection with the club's use of the site.
6. The $2,500,000 aggregate limit of liability applies per location (flying site). This limit of
liability usually exceeds the site owner's requirements and the per location aggregate
means the site owner does not share the limit with other site owners. It has the effect of a
separate policy for each site owner.
7. The insurer must give AMA 90 days notice of cancellation or non -renewal. This allows
ample time for AMA to replace the coverage and to notify certificate holders of the
change in coverage. AMA pays the entire annual premium at the beginning of the policy
year so the policy cannot be cancelled for nonpayment.
While this policy provides very broad coverage, as with any policy, there are limitations and
exclusions. The actual policy should be reviewed and site owners may want to consult their
insurance agent, insurance advisor, or risk manager.
Coverage questions must be directed to AMA Headquarters in Muncie, Indiana; (765) 287-1256,
ext. 251.
-te
Commercial General Liability Policy Declarations
With Self Insured Retention
I Policy No: G22011534008
Renewal of: G22011534007
Item 1.
NAMED INSURED & MAILING ADDRESS
Academy of Model Aeronautics, Inc.
(See Named Insured Endorsement - GLE0034 (01/99)J
5161 East Memorial Drive
Muncie, IN 47302
Item 2.
Item 3.
POLICY PERIOD
When Coverage Begins: 03/31/2013 12:01 A.M. Local Time At Named Insured's Address
When Coverage Ends: 03/31/2014 12:01 A.M. Local Time At Named Insured's Address
INSURING COMPANY
Producer's Name & Address:
Westchester Surplus Lines Insurance Co
CRUMP INSURANCE SERVICES INC
650 W VAN BUREN
SUITE 1500
CHICAGO IL 60607
Producer No. 58654W
Item 4.
LIMITS OF INSURANCE
A. EACH OCCURRENCE LIMIT
DAMAGE TO PREMISES RENTED TO YOU
MEDICAL EXPENSE LIMIT
B. PERSONAL & ADVERTISING INJURY LIMIT $
C. GENERAL AGGREGATE LIMIT (OTHER THAN
PRODUCTS/COMPLETED OPERATIONS) $ 1,000,000
$
1,000,000
300,000
Any One Premises
Excluded
Any One Person
Any One Person
1,000,000 Or Organization
D.
PRODUCTS/COMPLETED OPERATIONS
AGGREGATE LIMIT $
1,000,000
Item 5.
SELF INSURED RETENTION
A. EACH OCCURRENCE LIMIT
B. ANNUAL AGGREGATE
C. MAINTENANCE (After Exhaustion of Annual
Aggregate
$ See MS3609 (08/11)
$ See MS3609 (08/11)
Not Applicable
Item 6. I ATTACHED FORMS
Endorsements as Listed on Schedule of Endorsements No. CPFS2
WaG 040 (01-10)
2
Page 1 of 2
Named Insured Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
SEW
Policy Number
622011634008
Policy Period
03/31/2013
TO 03/31/2014
Effective Date of Endorsement
03/31/2013
Insured By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NAMED INSURED - AMENDED
Item One of the Declarations, Named Insured, is completed to read as follows:
Academy of Model Aeronautics, Inc.
Members, Clubs and Chapters of the Academy of Model Aeronautics, Inc,
Students in the intro Pilot Training Program
Special Interest Groups as recognized by the Academy of Model Aeronautics, Inc. and approved
by the Executive Council of the Academy of Model Aeronautics, Inc.
Authorized Representative
GLE0034(01-99)
16
Page 1 of 1
POLICY NUMBER: G220 1 1 534008 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following;
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization:
1) All certificate holders, provided that the Academy of Model Aeronautics, Inc. or The Harry A. Koch Co.
issued the certificate.
2) All "event sponsors" and "show organizers".
"Event Sponsor" means a person or organization hosting a modeling event, or financially contributing
to the event with donations, property or money.
"Show Organizer" means a personls) or organization responsible for planning, arranging, managing
and conducting a model show or event. -
(If no entry appears above, information required to complete this endorsement will be shown in the Decla-
rations 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 as an insured but only with respect to liability arising out of your operations or premises
owned by or rented to you.
CG 20 26 11 85
9
Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1
POLICY NUMBER: G22011534008 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -
STATE OR POLITICAL SUBDIVISIONS - PERMITS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
State or Political Subdivision:
All certificate holders, provided that the Academy of Model Aeronautics, Inc. or
The Harry A. Koch Co. issued the certificate.
Of no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an Insured any state or political subdivision shown in
the Schedule, subject to the following provisions:
1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or
political subdivision has issued a permit.
2. This insurance does not apply to:
a. °Bodily injury," °property damage; "personal injury" or °advertising injury° arising out of operations per-
formed for the state or municipality; or
b. "Bodily injury° or °property damage° included within the "products -completed operations hazard.°
CG 20 12 11 85
Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1
POLICY NUMBER: G22011534008 COMMERCIAL GENERAL LIABILITY
CG 20 21 10 93
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - VOLUNTEER WORKERS
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
WHO IS AN INSURED (Section II) is amended to
include as an insured any person(s) who are volunteer
worker(s) for you, but only while acting at the direction
of, and within the scope of their duties for you. How-
ever, no volunteer worker(s) are Insureds for:
1. "Bodily injury" or "personal injury":
a. To you, to your partners or members (if you
are a partnership or joint venture), to your
other volunteer worker(s) or to your "em-
ployees" arising out of and in the course of
their duties for you;
b. To the spouse, child, parent, brother or
sister of your volunteer worker(s) or your
"employees° as a consequence of para-
graph 1.a. above;
c. For which there Is any obligation to share
damages with or repay someone else who
must pay damages because of the injury
described in paragraphs 1.a. or b. above; or
CG 20 21 10 93
d. Arising out of his or her providing or failing
to provide professional health care services.
2. "Property damage" to property:
a. Owned, occupied, or used by,
b. Rented to, in the care, custody or control of,
or over which physical control is being exer-
cised for any purpose by
you, any of your other volunteer worker(s), your
"employees" or, if you are a partnership or joint
venture, any partner or member.
Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1
POLICY NUMBER; G22011534008 COMMERCIAL GENERAL LIABILITY
CG 24 04 10 93
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
All certificate holders, provided that the Academy of Model Aeronautics, Inc. or The Harry A. Koch Co.
issued the certificate.
(If no entry appears above, information required to complete this endorsement will be shown in the Decla-
rations as applicable to this endorsement.)
The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMER-
CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule
above because of payments we make for injury or damage arising out of your ongoing operations or "your
work" done under a contract with that person or organization and included in the "products -completed
operations hazard". This waiver applies only to the person or organization shown in the Schedule above.
CG 24 04 10 93
11
Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMENDMENT -AGGREGATE LIMITS OF INSURANCE
(PER LOCATION)
This endorsement modifies insurance provided under the following: -
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
The General Aggregate Limit under LIMITS OF INSURANCE (Section III) applies separately to each of your "loca-
tions" owned by or rented to you.
"Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only
by a street, roadway, waterway or right-of-way of a railroad.
CG 25 04 11 85 13
Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1
Named Insured
Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
SEW
Poky Number
G22011534008 .
Policy Period
03/31/2013 TO 03/31/2014
Effective Date of Endorsement
03/31/2013
Issued By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
INSURING AGREEMENT 2., EXCLUSIONS
- AMENDED
Insuring Agreement 2, EXCLUSIONS of Coverage A, is amended to include the following additional
exclusions:
P. "Bodily injury" to any spouse, child or relative of the insured, whether related by blood or marriage,
who Is a member of the insured's household.
Q. "Bodily injury" or "property damage" arising from any commercial enterprise or business pursuit of
any individual Academy of Model Aeronautics, Inc. member. However, this exclusion does not apply
to individual members providing modeling instructions for pay to Academy of Model Aeronautics, Inc.
members.
R "Bodily injury" or "property damage" arising from the use of equipment that has been ruled obsolete
by the FCC.
S "Property damage" to any model airplane by another model airplane.
T. "Property damage" to models arising from any frequency interference of any radio controlled model
aircraft. However, this exclusion does not apply to organized events wherein all participants are AMA
members and where there is a control transmitter impound area as defined by AMA, but only when
interference is shown by clear and convincing evidence of impound operator error.
U. 1. "Bodily injury", "property damage", "personal injury", or "advertising injury" or any other
liability or damage arising out of or involving asbestos, asbestos fibers, or any product
containing asbestos or asbestos fibers.
2. Coverage for any fees, costs or expenses of any nature whatsoever in the investigation or
defense of any claim or "suit" arising out of or involving asbestos, asbestos fibers or any
product containing asbestos or asbestos fibers.
V. 1. "Bodily injury", property damage", "personal injury", "advertising injury" or any other liability or
damage arising out of or involving lead, paint containing lead or any other product containing
lead; or
A Any fees, costs or expenses of any nature whatsoever in the investigation or defense of any
"claim" or "suit" arising out of or involving lead, paint containing lead or any other product
containing lead.
W.
"Bodily injury" or "property damage" arising from the operation of any "combat robot."
For the purpose of this exclusion, a "combat robot means any robot or remote controlled
surface device used for or Intended for combat or other destructive competition.
MANA 0159 07 04
Named Insured
Academy of Model Aeronautics, Inc.
Endorsement Number
PolicySymbol
SEW
Policy Number
G22011534008
PoheyPeriod
03/31/2013 TO 03/31/2014
Effective Date of Endorsement
03/31/2013
Issued By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONDITION 4, OTHER INSURANCE, AMENDED
A. Condition 4. b. (1) is amended to include the following:
(e)
(f)
That is homeowners insurance for individual insureds. However, this insurance
is primary and non-contributory as respects volunteer worker(s) for the Academy
of Model Aeronautics, Inc., but only while acting at the direction of, and within the
scope of their duties for the Academy of Model Aeronautics, Inc.; or
That is insurance for other modeling associations which the insured is an
Individual member.
B. Paragraph 4.c. is deleted in its entirety and replaced by the following:
c. If all of the other insurance permits contribution by equal shares, we will follow
this method unless the insured has agreed to provide insurance that is primary
and non-contributory as evidenced by a certificate issued by the Academy of
Model Aeronautics, Inc. or The Harry A. Koch Company, or where required by
contract or agreement. In addition, it is agreed that this insurance is primary and
non-contributory as respects volunteer worker(s) for the Academy of Model
Aeronautics, Inc., but only while acting at the direction of, and within the scope of
their duties for the Academy of Model Aeronautics, Inc.
However, under the contributory approach each Insurer contributes equal
amounts until it has paid its applicable limit of insurance or none of the loss
remains, whichever comes first.
If any of the other insurance does not permit contribution by equal shares, we will
contribute by limits. Under this method, each insurer's share is based on the ratio
of its applicable limit of insurance to the total applicable limits of insurance of all
insurers.
MANA 0160 07 04
Named Insured
Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
SEW
Policy Number
G22011534008
Potty Period
03/31/2013 TO 03/31/2014
Efleolive Date of Endorsement
03/31/2013
Issued By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
EXCLUSION G., AIRCRAFT, AUTO OR WATERCRAFT
AMENDED
Exclusion g. is amended to include the following:
g. (6) "Bodily injury and "property damage" arising out of "model aircraft", "model watercraft' or "model
automobiles",
For the purposes of this endorsement, "model aircraft' means any aircraft that is not capable of carrying a
human passenger and weighs 55 pounds or less with fuel, unless a special waiver has been granted by
the Academy of Model Aeronautics, Inc. allowing the "model aircraft" to weigh up to 125 pounds including
fuel.
This definition includes model rockets if the weight of such rocket is 3.5 pounds or less.
This definition includes "model hot air balloons" and "model blimps" which are non -human carrying, lighter
than air aerostats capable of sustained flight in the atmosphere intended to be used only for recreational
or competition activity with a mass (weight) of no more than 55 pounds and lift is provided by lighter than
air gases or hot air. The model shall not exceed any limitations as established in the Academy of Model
Aeronautics National Model Aircraft Safety Code.
This definition does not include a "model aircraft" during periods of autonomous flight unless the "model
aircraft" has been granted a special waiver by the Academy of Model Aeronautics, Inc. allowing such
flight and such flight Is within the guidelines established by the special waiver.
For purposes of this endorsement, "model watercraft' means a nonhuman carrying vehicle capable of
navigation in water intended to be used only for recreational or competition activity with total weight,
including fuel, of no more than 55 pounds. The model shall not exceed any applicable limitations for a
model as established in the Academy of Model Aeronautics National Model Aircraft Safety Code.
For the purposes of this endorsement "model automobile" means any automobile model that is 36" or less
length and weighs 25 pounds or less.
MANA01620704
POLICY NUMBER: G22011534008 - COMMERCIAL GENERAL LIABILITY
CG 24 07 01 96
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRODUCTS/COMPLETED OPERATIONS HAZARD
REDEFINED
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Description of Premises and Operations:
All premises and operations as required.
(If no entry appears above, information required to complete this endorsement will be shown in the Decla-
rations as applicable to this endorsement.)
With respect to "bodily injury° or "property dam-
age" arising out of "your products" manufactured,
sold, handled or distributed:
1. On, from or in connection with the use of any
premises described in the Schedule, or
2. In connection with the conduct of any operation
described in the Schedule, when conducted by
you or on your behalf,
CG 24 07 01 96
12
Paragraph a. of the definition of "Products -com-
pleted operations hazard" in the DEFINITIONS Sec-
tion is replaced by the following:
"Products -completed operations hazard":
a. Includes all "bodily injury° and "property
damage' that arises out of 'your products"
if the °bodily injury" or 'property damage"
occurs after you have relinquished posses-
sion of those products.
Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1
Named Insured Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
SEW
Policy Number
G22011534008
Policy Period
03/31/2013 TO 03/31/2014
Effective Date of Endorsement
03/31/2013
Insured By 'Name of Insurance Company'
Westchester Surplus Lines Insurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
UNINTENTIONAL ERRORS AND OMISSIONS
It is agreed that your rights under this policy will not be prejudiced if you fail to give notice of any
occurrence due solely to your reasonable belief that the "Bodily Injury", "Property Damage", "Personal
Injury" or "Advertising Injury" is not covered by this insurance.
It is further agreed that the unintentional omission of, or unintentional error of any information provided by
you shall not prejudice your rights under this insurance. However, this provision does not affect our right to
collect additional premium or to exercise our right of cancellation or nonrenewal.
Authorized Representative
MANA 0069 (09-00) Page 1 of 1
26
1€
Named Insured Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
SEW
Policy Number
G22011534008
Policy Period
03/31/2013 TO 03/31/2014
Effective Date of Endorsement
03/31/2013
Insured By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DEFINITION OF BODILY INJURY - AMENDED
It is agreed that Paragraph 3., "Bodily Injury", of Section V., Definitions, is deleted in its entirety and
replaced with the following:
3. "Bodily Injury" means bodily injury, sickness, disease, disability, shock, mental
anguish, mental injury, and humiliation, including resulting death.
Authorized Representative
GLE0050 (02-01) Page 1 of 1
21
Named Insured -
Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
SEW
Policy Number
G22011534008
Policy Period
03/31/2013 TO 03/31/2014
Effective Date of Endorsement
03/31/2013
Issued By (Name al Insurance Company)
Westchester Surplus Lines Insurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PERSONAL INJURY EXCLUSION
Insuring agreement 2., Exclusions is amended to include the following additional exclusion:
c. "Personal Injury" arising from any claims or "sults" between or on behalf of an insured
against another insured.
However, this exclusion does not apply to Academy of Model Aeronautics, Inc. or the
following Additional Insured: Site Owners, Sponsors or Organizers.
MANA 0161 07 04
POLICY NUMBER: G22011534008 COMMERCIAL GENERAL LIABILITY
CG 21 35 10 93
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
EXCLUSION - COVERAGE C - MEDICAL PAYMENTS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Description and Location of Premises or Classification:
All Locations
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement)
With respect to any premises or classification shown in the Schedule, Coverage C. MEDICAL PAYMENTS (Sec-
tion I) does not apply and none of the references to It in the Coverage Part apply.
The following is added to SUPPLEMENTARY PAYMENTS (Section I):
8. Expenses incurred by the insured for first aid administered to others at the time of an accident for "bodily injury"
to which this insurance applies.
CG 21 3510 93
Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1
Named Insured Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
SEW
Insured By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
Policy Number
G22011534008
Policy Period
03/31/2013 TO 03/31/2014
Effective Date of Endorsement
03/31/2013
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DISCRIMINATION EXCLUSION
This policy does not apply to any liability or damage caused by the acts or omissions of any insured or
insured's employee or any person acting on behalf of the insured arising out of:
1. Discrimination of any kind; and
2. Any actual or alleged defamation, emotional distress, humiliation or harassment which arises out of
discrimination of any kind.
Authorized Representative
GLX0001 101-9a} Page 1 of 1
34
Named Insured Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
SEW
Insured By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
Policy Number
G22011534008
Policy Period
03/31/2013
TO 03/31/2014
Effective Date of Endorsement
03/31/2013
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED THIRD PARTY CLAIMS ADMINISTRATOR
OR LEGAL COUNSEL ENDORSEMENT
The duties of the Third Party Claims Administrator or Legal Counsel are outlined in the Self -Insured
Retention Endorsement attached to this policy, The Third Party Claims Administrator or Legal Counsel is
designated below:
Third Party Administrator: Vericlaim
Legal Counsel:
Rendings, Fry, Kiely & Dennis
Authorized Representative
ULE0002 (01-981 Page 1 of 1
28
Named Insured
Academy of Model Aeronautics, Inc.
Endorsement Number
Potty Symbol
SEW
Policy Number
G22011534008
Policy Period
03/31/2013 TO 03/31/2014
Effective Date of Endorsement
03/31/2013
Issued By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
LIMITS OF INSURANCE - AMENDED
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PARK PILOT MEMBERS SCHEDULE
General Aggregate Limit
Products -Completed Operations Aggregate Limit
Personal & Advertising Injury Limit
Each Occurrence Limit
Damages To Premises Rented to You Limit
Medical Expense Limit
LIMITS OF INSURANCE
$See Policy Declarations
$500.000
$500.000
$500,000
$See Policy Declarations
Any One Premises
$See Policy Declarations
Any One Person
(If no entry appears above, information required to complete this endorsement will be shown in
the Declarations as applicable to this endorsement.)
The Limits of Insurance shown in the Declarations are replaced by the limits designated in the
Schedule or in the Declarations as subject to this endorsement with respect to which an entry is
made, but only as respects, "Park Pilot Members".
"Park Pilot Member" means an Academy of Model Aeronautics member who has applied for and
by payment of dues received by the Academy of Model Aeronautics Is accepted as a special
membership class designated "Park Pilot Member". A "Park Pilot Member" is an insured only for
aeromodeling activity in which a "model aircraft within the definition of "Park Pilot Model Aircraft"
results in a claim or lawsuit.
"Park Pilot Model Aircraft" means a "model aircraft" weighing not more than three (3) pounds at
takeoff, designed for a maximum speed of sixty (60) miles per hour, and either hand launched or
propelled by an electric motor, rubber band or similar non -combustion engine. The "Park Pilot
Model Aircraft" must be flown within the pilot's line of sight at all times and must be either
remotely controlled or on a line tethered to the pilot during flight.
MAMA 0135 12 07
Named Insured
Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
SEW
Policy Number
G22011534008
Policy Period
03/31/2013 To 03/31/2014
Effective Dale of Endorsement
03/31/2013
Issued By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COVERAGE TERRITORY - AMENDED - AFFILIATE MEMBERS
THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is agreed that as respects "Affiliate Members" Item 4. of SECTION V - DEFINITIONS,
is deleted and replaced by the following:
4. "Coverage territory" means:
a. The United States of America (including its territories and possessions).
and Puerto Rico;
b. International waters or airspace, provided the injury or damage does not
occur in the course of travel or transportation to or from any place not
included in a. above.
"Affiliate Member" means a non -United States resident who is a member of their
respective National Aero Club (if the country of origin has such a club available) and
has joined the Academy of Model Aeronautics, Inc. under this membership designation.
All other terms and conditions of the policy remain unchanged.
MS 6798 (01/12) Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc with its permission
IL00171198
COMMON POLICY CONDITIONS
All Coverage Parts included in this policy are subject to the following conditions.
A. Cancellation
1, The first Named Insured shown in the Decla-
rations may cancel this policy by mailing or
delivering to us advance written notice of
cancellation.
2. We may cancel this policy by mailing or de-
livering to the first Named Insured written
notice of cancellation at least:
a. 10 days before the effective date of can-
cellation if we cancel for nonpayment of
premium; or
b. 30 days before the effective date of can-
cellation if we cancel for any other rea-
son.
3. We will mail or deliver our notice to the first
Named Insured's last mailing address known
to us.
4. Notice of cancellation will state the effective
date of cancellation. The policy period will
end on that date.
5. If this policy is cancelled, we will send the
first Named Insured any premium refund
due. If we cancel, the refund will be pro
rata. If the first Named Insured cancels, the
refund may be less than pro rata. The can-
cellation will be effective even if we have not
made or offered a refund.
6. If notice is mailed, proof of mailing will be
sufficient proof of notice.
B. Changes
This policy contains all the agreements between
you and us concerning the insurance afforded.
The first Named Insured shown in the Declara-
tions is authorized to make changes in the
terms of this policy with our consent. This pol-
icy's terms can be amended or waived only by
endorsement issued by us and made a part of
this policy.
C. Examination Of Your Books And Records
We may examine and audit your books and re-
cords as they relate to this policy at any time
during the policy period and up to three years
afterward.
D. Inspections And Surveys
1. We have the right to:
a. Make inspections and surveys at any
time;
b. Give you reports on the conditions we
find; and
c. Recommend changes.
2. We are not obligated to make any inspec-
tions, surveys, reports or recommendations
and any such actions we do undertake relate
only to insurability and the premiums to be
charged. We do not make safety inspections.
We do not undertake to perform the duty of
any person or organization to provide for the
health or safety of workers or the public.
And we do not warrant that conditions:
a. Are safe or healthful; or
b. Comply with laws, regulations, codes or
standards.
3. Paragraphs 1. and 2. of this condition apply
not only to us, but also to any rating, advi-
sory, rate service or similar organization
which makes insurance inspections, surveys,
reports or recommendations.
4. Paragraph 2, of this condition does not apply
to any inspections, surveys, reports or rec-
ommendations we may make relative to
certification, under state or municipal stat-
utes, ordinances or regulations, of boilers,
pressure vessels or elevators.
E. Premiums
The first Named Insured shown in the Declar-
ations:
1. Is responsible for the payment of all prem-
iums; and
2. Will be the payee for any return premiums
we pay.
F. Transfer Of Your Rights And Duties Under This
Policy
Your rights and duties under this policy may not
be transferred without our written consent ex-
cept in the case of death of an individual named
insured.
If you die, your rights and duties will be trans-
ferred to your legal representative but only
while acting within the scope of duties as your
legal representative. Until your legal representa-
tive is appointed, anyone having proper tempo-
rary custody of your property will have your
rights and duties but only with respect to that
property.
IL 00 17 11 98
7
Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1
POLICY NUMBER: G22011534008 COMMERCIAL GENERAL LIABILITY
CG 00 01 07 98
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
Various provisions in this policy restrict coverage.
Read the entire policy carefully to determine rights,
duties and what is and Is not covered.
Throughout this policy the words "you" and °your" refer
to the Named Insured shown in the Declarations, and
any other person or organization qualifying as a
Named Insured under this policy. The words °we°, "us"
and "our" refer to the company providing this Insur-
ance.
The word °Insured" means any person or organization
qualifying as such under Section II — Who Is An In-
sured.
Other words and phrases that appear in quotation
marks have special meaning. Refer to Section V —
Definitions.
SECTION I - COVERAGES
COVERAGE A BODILY INJURY AND PROPERTY
DAMAGE LIABILITY
1. Insuring Agreement
a. We will pay those sums that the insured be-
comes legally obligated to pay as damages be-
cause of "bodily injury" or "property damage° to
which this insurance applies. We will have the
right and duty to defend the insured against any
"suit" seeking those damages. However, we will
have no duty to defend the insured against any
"suit" seeking damages for "bodily injury' or
"property damage" to which this insurance does
not apply. We may, at our discretion, investi-
gate any °occurrence" and settle any claim or
"suit" that may result. But:
(1) The amount we will pay for damages is
limited as described in Section III — Limits
Of Insurance; and
(2) Our right and duty to defend end when we
have used up the applicable limit of insur-
ance in the payment of judgments or set-
tlements under Coverages A or B or medi-
cal expenses under Coverage C.
No other obligation or liability to pay sums or
perform acts or services is covered unless ex-
plicitly provided for under Supplementary Pay-
ments — Coverages A and B.
b. This insurance applies to "bodily Injury° and
"property damage" only if:
(1) The °bodily injury" or °property damage" is
caused by an "occurrence" that takes place
in the "coverage territory"; and
(2) The "bodily injury" or °property damage"
occurs during the policy period.
c. Damages because of "bodily injury" include
damages claimed by any person or organiza-
tion for care, loss of services or death resulting
at any time from the "bodily injury".
2. Exclusions
This insurance does not apply to:
a. Expected Or Intended Injury
°Bodily injury" or *property damage' expected
or Intended from the standpoint of the insured.
This exclusion does not apply to "bodily injury"
resulting from the use of reasonable force to
protect persons or property.
b. Contractual Liability
°Bodily injury" or °property damage° for which
the insured is obligated to pay damages by
reason of the assumption of liability in a con-
tract or agreement. This exclusion does not
apply to liability for damages:
(1) That the insured would have in the absence
of the contract or agreement; or
(2) Assumed in a contract or agreement that is
an "insured contract", provided the "bodily
injury" or "property damage" occurs subse-
quent to the execution of the contract or
agreement. Solely for the purposes of liabili-
ty assumed In an "insured contract°, rea-
sonable attorney fees and necessary litiga-
tion expenses Incurred by or for a party
other than an insured are deemed to be
damages because of "bodily injury" or
"property damage", provided:
(a) Liability to such party for, or for the cost
of, that party's defense has also been
assumed in the same "insured contract";
and
CG 00 01 07 98
Copyright, Insurance Services Office, Inc., 1997 Page 1 of 13
(b) Such attorney fees and litigation ex-
penses are for defense of that party
against a civil or alternative dispute reso-
lution proceeding in which damages to
which this insurance applies are alleged.
c. Liquor Liability
"Bodily injury" or °property damage° for which
any insured may be held liable by reason of:
(1) Causing or contributing to the intoxication of
any person;
(2) The furnishing of alcoholic beverages to a
person under the legal drinking age or un-
der the influence of alcohol; or
(3) Any statute, ordinance or regulation relating
to the sale, gift, distribution or use of alco-
holic beverages.
This exclusion applies only if you are in the
business of manufacturing, distributing, selling,
serving or furnishing alcoholic beverages.
d. Workers' Compensation And Similar Laws
Any obligation of the insured under a workers'
compensation, disability benefits or unemploy-
ment compensation law or any similar law.
e. Employer's Liability
"Bodily injury" to:
(1) An "employee" of the insured arising out of
and in the course of:
(a) Employment by the insured; or
(b) Performing duties related to the conduct
of the insured's business; or
(2) The spouse, child, parent, brother or sister
of that "employee" as a consequence of Pa-
ragraph (1) above.
This exclusion applies:
(1) Whether the insured may be liable as an
employer or in any other capacity; and
(2) To any obligation to share damages with or
repay someone else who must pay damag-
es because of the injury.
This exclusion does not apply to liability as-
sumed by the insured under an "insured con-
tract".
f. Pollution
(1) "Bodily injury" or "property damage" arising
out of the actual, alleged or threatened dis-
charge, dispersal, seepage, migration, re-
lease or escape of "pollutants":
(a) At or from any premises, site or location
which is or was at any time owned or
occupied by, or rented or loaned to, any
insured. However, this subparagraph
does not apply to:
(i) "Bodily injury° if sustained within e
building and caused by smoke,
fumes, vapor or soot from equipment
used to heat that building;
(II) "Bodily injury" or °property damage"
for which you may be held liable, if
you are a contractor and the owner
or lessee of such premises, site or
location has been added to your poli-
cy as an additional insured with re-
spect to your ongoing operations per-
formed for that additional insured at
that premises, site or location and
such premises, site or location is not
and never was owned or occupied
by, or rented or loaned to, any in-
sured, other than that additional in-
sured; or
(iii) "Bodily injury° or "property damage°
arising out of heat, smoke or fumes
from a "hostile fire°;
(b) At or from any premises, site or location
which is or was at any time used by or
for any insured or others for the han-
dling, storage, disposal, processing or
treatment of waste;
(c) Which are or were at any time trans-
ported, handled, stored, treated, dis-
posed of, or processed as waste by or
for any insured or any person or organi-
zation for whom you may be legally re-
sponsible; or
Page 2 of 13
Copyright, Insurance Services Office, Inc., 1997 CG 00 01 07 98
(d) At or from any premises, site or location
on which any insured or any contractors
or subcontractors working directly or in-
directly on any insured's behalf are per-
forming operations if the °pollutants" are
brought on or to the premises, site or lo-
cation in connection with such opera-
tions by such insured, contractor or sub-
contractor. However, this subparagraph
does not apply to:
(i) °Bodily injury" or "property damage"
arising out of the escape of fuels, lu-
bricants or other operating fluids
which are needed to perform the
normal electrical, hydraulic or me-
chanical functions necessary for the
operation of "mobile equipment" or
its parts, If such fuels, lubricants or
other operating fluids escape from a
vehicle part designed to hold, store
or receive them. This exception does
not apply if the "bodily injury" or
"property damage" arises out of the
intentional discharge, dispersal or re-
lease of the fuels, lubricants or other
operating fluids, or if such fuels, lu-
bricants or other operating fluids are
brought on or to the premises, site or
location with the intent that they be
discharged, dispersed or released as
part of the operations being per-
formed by such insured, contractor
or subcontractor;
(ii) "Bodily injury" or "property damage"
sustained within a building and
caused by the release of gases,
fumes or vapors from materials
brought Into that building in connec-
tion with operations being performed
by you or on your behalf by a con-
tractor or subcontractor; or
(iii) "Bodily injury" or "property damage"
arising out of heat, smoke or fumes
from a "hostile fire".
(e) At or from any premises, site or location
on which any insured or any contractors
or subcontractors working directly or in-
directly on any insured's behalf are per-
forming operations if the operations are
to test for, monitor, clean up, remove,
contain, treat, detoxify or neutralize, or in
any way respond to, or assess the ef-
fects of, "pollutants°.
CG 00 01 07 98
(2) Any loss, cost or expense arising out of any:
(a)
Request, demand, order or statutory or
regulatory requirement that any insured
or others test for, monitor, clean up, re-
move, contain, treat, detoxify or neutral-
ize, or in any way respond to, or assess
the effects of, °pollutants"; or
(b) Claim or suit by or on behalf of a go-
vernmental authority for damages be-
cause of testing for, monitoring, cleaning
up, removing, containing, treating, de-
toxifying or neutralizing, or in any way
responding to, or assessing the effects
of, "pollutants".
However, this paragraph does not apply to
liability for damages because of °property
damage" that the insured would have in the
absence of such request, demand, order or
statutory or regulatory requirement, or such
claim or "suit" by or on behalf of a govern-
mental authority.
g. Aircraft, Auto Or Watercraft
°Bodily injury" or "property damage" arising out
of the ownership, maintenance, use or en-
trustment to others of any aircraft, "auto° or wa-
tercraft owned or operated by or rented or
loaned to any Insured. Use includes operation
and "loading or unloading".
This exclusion does not apply to:
(1) A watercraft while ashore on premises you
own or rent;
(2) A watercraft you do not own that is:
(a) Less than 26 feet long; and
(b) Not being used to carry persons or
property for a charge;
(3) Parking an "auto° on, or on the ways next
to, premises you own or rent, provided the
°auto" is not owned by or rented or loaned
to you or the insured;
(4) Liability assumed under any "insured con-
tract" for the ownership, maintenance or
use of aircraft or watercraft; or
(5) "Bodily injury" or "property damage" arising
out of the operation of any of the equipment
listed in Paragraph f.(2) or f.(3) of the defini-
tion of "mobile equipment".
Copyright, Insurance Services Office, Inc., 1997 Page 3 of 13
h. Mobile Equipment
"Bodily injury" or "property damage" arising out
of:
(1) The transportation of "mobile equipment" by
an "auto" owned or operated by or rented or
loaned to any Insured; or
(2) The use of "mobile equipment" in, or while
in practice for, or while being prepared for,
any prearranged racing, speed, demolition,
or stunting activity.
I. War
"Bodily injury' or "property damage" due to war,
whether or not declared, or any act or condition
incident to war. War includes civil war, insurrec-
tion, rebellion or revolution. This exclusion ap-
plies only to liability assumed under a contract
or agreement.
j. Damage To Property
"Property damage" to:
(1) Property you own, rent, or occupy;
(2) Premises you sell, give away or abandon, if
the "property damage" arises out of any part
of those premises;
(3) Property loaned to you;
(4) Personal property in the care, custody or
control of the insured;
That particular part of real property on which
you or any contractors or subcontractors
working directly or indirectly on your behalf
are performing operations, if the "property
damage° arises out of those operations; or
(6) That particular part of any property that
must be restored, repaired or replaced be-
cause "your work" was incorrectly per-
formed on it.
Paragraphs (1), (3) and (4) of this exclusion do
not apply to "property damage° (other than
damage by fire) to premises, including the con-
tents of such premises, rented to you for a pe-
riod of 7 or fewer consecutive days. A separate
limit of insurance applies to Damage To Pre-
mises Rented To You as described in Section
III — Limits Of Insurance.
Paragraph (2) of this exclusion does not apply if
the premises are "your work" and were never
occupied, rented or held for rental by you.
Paragraphs (3), (4), (5) and (6) of this exclusion
do not apply to liability assumed under a side-
track agreement.
Paragraph (6) of this exclusion does not apply
to "property damage" included in the "products -
completed operations hazard".
(5)
k. Damage To Your Product
"Property damage" to °your product" arising out
of It or any part of it.
I. Damage To Your Work
"Property damage" to "your work° arising out of
it or any part of it and Included in the "products -
completed operations hazard".
This exclusion does not apply if the damaged
work or the work out of which the damage aris-
es was performed on your behalf by a subcon-
tractor.
in. Damage To Impaired Property Or Property
Not Physically Injured
"Property damage" to "impaired property" or
property that has not been physically Injured,
arising out of:
(1) A defect, deficiency, inadequacy or danger-
ous condition in "your product" or "your
work"; or
(2) A delay or failure by you or anyone acting
on your behalf to perform a contract or
agreement in accordance with its terms.
This exclusion does not apply to the loss of use
of other property arising out of sudden and ac-
cidental physical injury to "your product" or
"your work" after it has been put to Its intended
use.
n. Recall Of Products, Work Or Impaired
Property
Damages claimed for any loss, cost or expense
incurred by you or others for the loss of use,
withdrawal, recall, inspection, repair, replace-
ment, adjustment, removal or disposal of:
(1) "Your product";
(2) °Your work°; or
(3) impaired property";
if such product, work, or property is withdrawn
or recalled from the market or from use by any
person or organization because of a known or
suspected defect, deficiency, inadequacy or
dangerous condition in it.
o. Personal And Advertising Injury
"Bodily injury" arising out of °personal and ad-
vertising injury".
Exclusions c. through n. do not apply to damage
by fire to premises while rented to you or tempora-
rily occupied by you with permission of the owner.
A separate limit of insurance applies to this cover-
age as described in Section III — Limits Of Insur-
ance.
Page 4 of 13
Copyright, Insurance Services Office, Inc., 1997 CG 00 01 07 98
COVERAGE B PERSONAL AND ADVERTISING
INJURY LIABILITY
1. Insuring Agreement
a. We will pay those sums that the Insured be-
comes legally obligated to pay as damages be-
cause of "personal and advertising injury to
which this insurance applies. We will have the
right and duty to defend the insured against any
"suit" seeking those damages. However, we will
have no duly to defend the insured against any
"suit" seeking damages for "personal and ad-
vertising injury to which this insurance does
not apply. We may, at our discretion, investi-
gate any offense and settle any claim or "suit"
that may result. But:
(1) The amount we will pay for damages Is
limited as described in Section III — Limits
Of Insurance ; and
(2) Our right and duty to defend end when we
have used up the applicable limit of insur-
ance in the payment of judgments or set-
tlements under Coverages A or B or medi-
cal expenses under Coverage C.
No other obligation or liability to pay sums or
perform acts or services is covered unless ex-
plicitly provided for under Supplementary Pay-
ments — Coverages A and B.
b. This insurance applies to "personal and adver-
tising injury" caused by an offense arising out of
your business but only if the offense was com-
mitted in the "coverage territory" during the pol-
icy period.
2. Exclusions
This Insurance does not apply to:
a. "Personal and advertising injury":
(1) Caused by or at the direction of the insured
with the knowledge that the act would vi-
olate the rights of another and would inflict
"personal and advertising injury";
(2) Arising out of oral or written publication of
material, if done by or at the direction of the
insured with knowledge of its falsity;
(3) Arising out of oral or written publication of
material whose first publication took place
before the beginning of the policy period;
(4) Arising out of a criminal act committed by or
at the direction of any insured;
(5) For which the insured has assumed liability
In a contract or agreement. This exclusion
does not apply to liability for damages that
the insured would have in the absence of
the contract or agreement;
CG 00 01 07 98
Arising out of a breach of contract, except
an implied contract to use another's adver-
tising idea In your "advertisement";
Arising out of the failure of goods, products
or services to conform with any statement of
quality or performance made in your °adver-
tisement';
Arising out of the wrong description of the
price of goods, products or services stated
in your °advertisement";
Committed by an insured whose business is
advertising, broadcasting, publishing or te-
lecasting. However, this exclusion does not
apply to Paragraphs 14.a., b. and c. of
"personal and advertising injury under the
Definitions Section; or
Arising out of the actual, alleged or threat-
ened discharge, dispersal, seepage, migra-
tion, release or escape of °pollutants" at any
time.
b. Any loss, cost or expense arising out of any:
(1) Request, demand or order that any insured
or others test for, monitor, clean up, re-
move, contain, treat, detoxify or neutralize,
or in any way respond to, or assess the ef-
fects of, "pollutants"; or
(2) Claim or suit by or on behalf of a govern-
mental authority for damages because of
testing for, monitoring, cleaning up, remov-
ing, containing, treating, detoxifying or neu-
tralizing, or in any way responding to, or as-
sessing the effects of, "pollutants°.
COVERAGE C MEDICAL PAYMENTS
1. Insuring Agreement
a. We will pay medical expenses as described
below for "bodily injury" caused by an accident:
(1) On premises you own or rent;
(2) On ways next to premises you own or rent;
or
(3) Because of your operations;
provided that:
(1) The accident takes place in the "coverage
territory and during the policy period;
(2) The expenses are incurred and reported to
us within one year of the date of the acci-
dent; and
(3) The injured person submits to examination,
at our expense, by physicians of our choice
as often as we reasonably require.
Copyright, Insurance Services Office, Inc., 1997 Page 5 of 13
b. We will make these payments regardless of
fault. These payments will not exceed the ap-
plicable limit of insurance. We will pay reason-
able expenses for:
(1) First aid administered at the time of an
accident;
(2) Necessary medical, surgical, x-ray and
dental services, including prosthetic devic-
es; and
(3) Necessary ambulance, hospital, profes-
sional nursing and funeral services.
2. Exclusions
We will not pay expenses for "bodily injury";
a. To any insured.
b. To a person hired to do work for or on behalf of
any insured or a tenant of any insured.
c. To a person injured on that part of premises
you own or rent that the person normally occu-
pies.
d. To a person, whether or not an "employee" of
any insured, if benefits for the "bodily injury' are
payable or must be provided under a workers'
compensation or disability benefits law or a
similar law.
e. To a person injured while taking part in athlet-
ics.
f. Included within the "products -completed opera-
tions hazard".
g. Excluded under Coverage A.
h. Due to war, whether or not declared, or any act
or condition incident to war. War includes civil
war, insurrection, rebellion or revolution.
SUPPLEMENTARY PAYMENTS — COVERAGES A
AND B
1. We will pay, with respect to any claim we investi-
gate or settle, or any "suit" against an insured we
defend:
a. All expenses we incur.
b. Up to $250 for cost ofbail bonds required be-
cause of accidents or traffic law violations aris-
ing out of the use of any vehicle to which the
Bodily injury Liability Coverage applies. We do
not have to furnish these bonds.
c. The cost of bonds to release attachments, but
only for bond amounts within the applicable lim-
It of insurance. We do not have to furnish these
bonds.
d. All reasonable expenses incurred by the in-
sured at our request to assist us in the investi-
gation or defense of the claim or °suit", includ-
ing actual loss of earnings up to $250 a day
because of time off from work.
e. All costs taxed against the insured in the "surr'.
f. Prejudgment interest awarded against the
insured on that part of the judgment we pay. If
we make an offer to pay the applicable limit of
insurance, we will not pay any prejudgment in-
terest based on that period of time after the of-
fer.
g. All interest on the full amount of any judgment
that accrues after entry of the judgment and be-
fore we have paid, offered to pay, or deposited
in court the part of the judgment that is within
the applicable limit of insurance.
These payments will not reduce the limits of insur-
ance.
2. If we defend an insured against a "suit" and an
indemnitee of the insured is also named as a party
to the "suit", we will defend that indemnitee if all of
the following conditions are met:
a. The °suit" against the indemnitee seeks dam-
ages for which the insured has assumed the
liability of the indemnitee in a contract or
agreement that is an "insured contract";
b. This insurance applies to such liability assumed
by the insured;
c. The obligation to defend, or the cost of the
defense of, that indemnitee, has also been as-
sumed by the insured in the same "insured
contract";
d. The allegations in the "suit" and the information
we know about the "occurrence" are such that
no conflict appears to exist between the inter-
ests of the insured and the interests of the in-
demnitee;
e. The indemnitee and the insured ask us to con-
duct and control the defense of that indemnitee
against such "suit" and agree that we can as-
sign the same counsel to defend the insured
and the indemnitee; and
f. The indemnitee:
(1) Agrees in writing to:
(a) Cooperate with us in the investigation,
settlement or defense of the "suit";
(b) Immediately send us copies of any de-
mands, notices, summonses or legal
papers received in connection with the
"suit";
Notify any other insurer whose coverage
is available to the indemnitee; and
(d) Cooperate with us with respect to coor-
dinating other applicable insurance
available to the indemnitee; and
(c)
Page 6 of 13
Copyright, Insurance Services Office, Inc., 1997 CG 00 01 07 98
(2) Provides us with written authorization to:
(a) Obtain records and other information
related to the "suit"; and
(b) Conduct and control the defense of the
indemnitee in such "suit°.
So long as the above conditions are met, attor-
neys' fees Incurred by us in the defense of that in-
demnitee, necessary litigation expenses Incurred
by us and necessary litigation expenses incurred
by the indemnitee at our request will be paid as
Supplementary Payments. Notwithstanding the
provisions of Paragraph 2.b.(2) of Section I - Cov-
erage A — Bodily Injury And Property Damage lia-
bility, such payments will not be deemed to be
damages for "bodily injury" and "property damage"
and will not reduce the limits of Insurance.
Our obligation to defend an insured's indemnitee
and to pay for attorneys' fees and necessary litiga-
tion expenses as Supplementary Payments ends
when:
a. We have used up the applicable limit of insur-
ance in the payment of judgments or settle-
ments; or
b. The conditions set forth above, or the terms of
the agreement described in Paragraph f.
above, are no longer met.
SECTION II — WHO IS AN INSURED
1. If you are designated in the Declarations as:
a. An individual, you and your spouse are insu-
reds, but only with respect to the conduct of a
business of which you are the sole owner.
b. A partnership or joint venture, you are an in-
sured. Your members, your partners, and their
spouses are also insureds, but only with re-
spect to the conduct of your business.
c. A limited liability company, you are an insured.
Your members are also insureds, but only with
respect to the conduct of your business. Your
managers are insureds, but only with respect to
their duties as your managers.
d. An organization other than a partnership, joint
venture or limited liability company, you are an
insured. Your "executive officers° and directors
are insureds, but only with respect to their du-
ties as your officers or directors. Your stock-
holders are also Insureds, but only with respect
to their liability as stockholders.
CG 00 01 07 98
2. Each of the following is also an insured:.
a. Your "employees", other than either your "ex-
ecutive officers" (if you are an organization oth-
er than a partnership, Joint venture or limited
liability company) or your managers (if you are
a limited liability company), but only for acts
within the scope of their employment by you or
while performing duties related to the conduct
of your business. However, none of these"em-
ployees" is an insured for:
(1) "Bodily injury' or "personal and advertising
injury":
(a) To you, to your partners or members (If
you are a partnership or joint venture), to
your members (if you are a limited liabili-
ty company), or to a co -"employee" while
that co -"employee° is either in the
course of his or her employment or per-
forming duties related to the conduct of
your business;
(b) To the spouse, child, parent, brother or
sister of that co -"employee" as a conse-
quence of Paragraph (1)(a) above;
(c) For which there is any obligation to
share damages with or repay someone
else who must pay damages because of
the Injury described in Paragraphs (1)(a)
or (b) above; or
(d) Arising out of his or her providing or
failing to provide professional health
care services.
(2) "Property damage" to property:
(a) Owned, occupied or used by,
(b) Rented to, in the care, custody or control
of, or over which physical control is be-
ing exercised for any purpose by
you, any of your °employees", any partner
or member (if you are a partnership or joint
venture), or any member (if you are a li-
mited liability company).
b. Any person (other than your "employee"), or
any organization while acting as your real es-
tate manager.
c. Any person or organization having proper tem-
porary custody of your property if you die, but
only:
(1) With respect to liability arising out of the
maintenance or use of that property; and
(2) Until your legal representative has been
appointed.
Copyright, Insurance Services Office, Inc., 1997 Page 7 of 13
d. Your legal representative if you die, but only
with respect to duties as such. That representa-
tive will have all your rights and duties under
this Coverage Part.
3. With respect to "mobile equipment" registered in
your name under any inciter vehicle registration
law, any person is an insured while driving such
equipment along a public highway with your per-
mission. Any other person or organization respon-
sible for the conduct of such person is also an in-
sured, but only with respect to liability arising out of
the operation of the equipment, and only if no other
insurance of any kind is available to that person or
organization for this liability. However, no person or
organization is an insured with respect to:
a. "Bodily injury" to a co -"employee" of the person
driving the equipment; or
b. "Property damage" to property owned by,
rented to, in the charge of or occupied by you
or the employer of any person who is an in-
sured under this provision.
4. Any organization you newly acquire or form, other
than a partnership, joint venture or limited liability
company, and over which you maintain ownership
or majority interest, will qualify as a Named Insured
if there is no other similar insurance available to
that organization. However:
a. Coverage under this provision is afforded only
until the 90th day after you acquire or form the
organization or the end of the policy period,
whichever is earlier;
b. Coverage A does not apply to "bodily injury" or
"property damage" that occurred before you
acquired or formed the organization; and
c. Coverage B does not apply to °personal and
advertising injury" arising out of an offense
committed before you acquired or formed the
organization.
No person or organization is an insured with respect
to the conduct of any current or past partnership, joint
venture or limited liability company that Is not shown
as a Named Insured in the Declarations.
SECTION III - LIMITS OF INSURANCE
1. The Limits of Insurance shown in the Declarations
and the rules below fix the most we will pay re-
gardless of the number of:
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or
bringing "suits".
2. The General Aggregate Limit is the most we will
pay for the sum of:
a. Medical expenses under Coverage C;
b. Damages under Coverage A, except damages
because of "bodily injury" or "property damage"
included in the °products -completed operations
hazard"; and
c. Damages under Coverage B.
3. The Products -Completed Operations Aggregate
Limit is the most we will pay under Coverage A for
damages because of °bodily injury" and °property
damage" included in the "products -completed op-
erations hazard".
4. Subject to 2. above, the Personal and Advertising
Injury Limit Is the most we will pay under Coverage
B for the sum of all damages because of all "per-
sonal and advertising injury" sustained by any one
person or organization.
5. Subject to 2. or 3. above, whichever applies, the
Each Occurrence Limit is the most we will pay for
the sum of:
a. Damages under Coverage A; and
b. Medical expenses under Coverage C
because of all "bodily injury" and "property dam-
age" arising out of any one "occurrence".
6. Subject to 5. above, the Damage To Premises
Rented To You Limit is the most we will pay under
Coverage A for damages because of "property
damage" to any one premises, while rented to you,
or in the case of damage by fire, while rented to
you or temporarily occupied by you with permission
of the owner.
7. Subject to 5. above, the Medical Expense Limit is
the most we will pay under Coverage C for all
medical expenses because of °bodily injury" sus-
tained by any one person.
The Limits of Insurance of this Coverage Part apply
separately to each consecutive annual period and to
any remaining period of less than 12 months, starting
with the beginning of the policy period shown in the
Declarations, unless the policy period is extended
after issuance for an additional period of less than 12
months. In that case, the additional period will be
deemed part of the last preceding period for purposes
of determining the Limits of Insurance.
Page 8 of 13
Copyright, Insurance Services Office, Inc., 1997 CG 00 01 07 98
SECTION IV- COMMERCIAL GENERAL LIABILITY
CONDITIONS
1. Bankruptcy
Bankruptcy or insolvency of the insured or of the
insured's estate will not relieve us of our obliga-
tions under this Coverage Part.
2. Duties In The Event Of Occurrence, Offense,
Claim Or Suit
a. You must see to it that we are notified as soon
as practicable of an °occurrence" or an offense
which may result in a claim. To the extent poss-
ible, notice should include:
(1) How, when and where the "occurrence" or
offense took place;
(2) The names and addresses of any injured
persons and witnesses; and
(3) The nature and location of any injury or
damage arising out of the °occurrence" or
offense.
b. If a claim is made or "suit" is brought against
any insured, you must:
(1) Immediately record the specifics of the
claim or "suit" and the date received; and
(2) Notify us as soon as practicable.
You must see to it that we receive written no-
tice of the claim or "suit" as soon as practica-
ble.
c. You and any other involved insured must:
(1) Immediately send us copies of any de-
mands, notices, summonses or legal pa-
pers received in connection with the claim
or "suit";
(2) Authorize us to obtain records and other
information;
(3) Cooperate with us in the investigation or
settlement of the claim or defense against
the "suit"; and
(4) Assist us, upon our request, in the en-
forcement of any right against any person or
organization which may be liable to the in-
sured because of injury or damage to which
this insurance may also apply.
d. No insured will, except at that insured's own
cost, voluntarily make a payment, assume any
obligation, or Incur any expense, other than for
first aid, without our consent.
3. Legal Action Against Us
No person or organization has a right under this
Coverage Part:
a. To join us as a party or otherwise bring us into
a "suit" asking for damages from an insured; or
CG 00 01 07 98
b. To sue us on this Coverage Part unless all of
its terms have been fully complied with.
A person or organization may sue us to recover on
an agreed settlement or on a final judgment
against an Insured obtained after an actual trial;
but we will not be liable for damages that are not
payable under the terms of this Coverage Part or
that are in excess of the applicable limit of insur-
ance. An agreed settlement means a settlement
and release of liability signed by us, the insured
and the claimant or the claimant's legal represent-
ative.
4. Other insurance
If other valid and collectible insurance is available
to the insured for a loss we cover under Coverag-
es A or B of this Coverage Part, our obligations
are limited as follows:
a. Primary Insurance
This insurance is primary except when b. below
applies. If this Insurance is primary, our obliga-
tions are not affected unless any of the other
insurance is also primary. Then, we will share
with all that other insurance by the method de-
scribed in c. below.
b. Excess insurance
This insurance is excess over:
(1) Any of the other insurance, whether prima-
ry, excess, contingent or on any other basis:
(a) That is Fire, Extended Coverage, Build-
er's Risk, Installation Risk or similar
coverage for 'your work";
(b) That is Fire insurance for premises
rented to you or temporarily occupied by
you with permission of the owner;
(c) That is insurance purchased by you to
cover your liability as a tenant for "prop-
erty damage" to premises rented to you
or temporarily occupied by you with
permission of the owner; or
(d) if the loss arises out of the maintenance
or use of aircraft, "autos" or watercraft to
the extent not subject to Exclusion g. of
Section I — Coverage A - Bodily Injury
And Property Damage Liability.
(2) Any other primary insurance available to
you covering liability for damages arising
out of the premises or operations for which
you have been added as an additional in-
sured by attachment of an endorsement.
Copyright, Insurance Services Office, Inc., 1997 Page 9 of 13
When this insurance is excess, we will have no
duty under Coverages A or B to defend the in-
sured against any "suit° if any other insurer has
a duty to defend the insured against that "suit".
If no other insurer defends, we will undertake to
do so, but we will be entitled to the insured's
rights against all those other insurers.
When this insurance is excess over other in-
surance, we will pay only our share of the
amount of the loss, if any, that exceeds the
sum of:
(1) The total amount that all such other insur-
ance would pay for the loss in the absence
of this insurance; and
(2) The total of all deductible and self -insured
amounts under all that other insurance.
We wilt share the remaining loss, if any, with
any other insurance that is not described in this
Excess Insurance provision and was not
bought specifically to apply in excess of the
Limits of Insurance shown in the Declarations
of this Coverage Part.
c. Method Of Sharing
If all of the other insurance permits contribution
by equal shares, we will follow this method al-
so. Under this approach each insurer contri-
butes equal amounts until it has paid its appli-
cable limit of insurance or none of the loss
remains, whichever comes first.
If any of the other insurance does not permit
contribution by equal shares, we will contribute
by limits. Under this method, each insurers
share is based on the ratio of its applicable limit
of insurance to the total applicable limits of in-
surance of all insurers.
5. Premium Audit
a. We will compute all premiums for this Cover-
age Part in accordance with our rules and
rates.
b. Premium shown in this Coverage Pad as ad-
vance premium is a deposit premium only. At
the close of each audit period we will compute
the earned premium for that period. Audit pre-
miums are due and payable on notice to the
first Named Insured. If the sum of the advance
and audit premiums paid for the policy period Is
greater than the earned premium, we will return
the excess to the first Named Insured.
c. The first Named Insured must keep records of
the information we need for premium computa-
tion, and send us copies at such times as we
may request.
6. Representations
By accepting this policy, you agree:
a. The statements in the Declarations are accu-
rate and complete;
b. Those statements are based upon representa-
tions you made to us; and
c. We have issued this policy in reliance upon
your representations.
7. Separation Of Insureds
Except with respect to the Limits of Insurance, and
any rights or duties specifically assigned in this
Coverage Part to the first Named Insured, this in-
surance applies:
a. As if each Named Insured were the only
Named Insured; and
b. Separately to each insured against whom claim
is made or °suit" is brought.
8. Transfer Of Rights Of Recovery Against Others
To Us
If the insured has rights to recover all or part of any
payment we have made under this Coverage Part,
those rights are transferred to us. The insured
must do nothing after loss to impair them. At our
request, the insured will bring "suit" or transfer
those rights to us and help us enforce them.
9. When We Do Not Renew
If we decide not to renew this Coverage Part, we
will mail or deliver to the first Named Insured
shown in the Declarations written notice of the
nonrenewal not less than 30 days before the expi-
ration date.
If notice is mailed, proof of mailing will be sufficient
proof of notice.
SECTION V — DEFINITIONS
1. "Advertisement" means a notice that is broadcast
or published to the general public or specific mar-
ket segments about your goods, products or ser-
vices for the purpose of attracting customers or
supporters.
2. "Auto" means a land motor vehicle, trailer or semi-
trailer designed for travel on public roads, including
any attached machinery or equipment. But °auto"
does not include "mobile equipment°.
3. "Bodily injury" means bodily injury, sickness or
disease sustained by a person, including death re-
sulting from any of these at any time.
4. "Coverage territory" means:
a. The United States of America (including its
territories and possessions), Puerto Rico and
Canada;
Page 10 of 13
Copyright, Insurance Services Office, Inc., 1997 CG 00 01 07 98
b. International waters or airspace, provided the
injury or damage does not occur in the course
of travel or transportation to or from any place
not included in a. above; or
c. All parts of the world if:
(1) The injury or damage arises out of:
(a) Goods or products made or sold by you
in the territory described in a. above; or
(b) The activities of a person whose home is
in the territory described in a. above, but
is away for a short time on your busi-
ness; and
(2) The insured's responsibility to pay damages
Is determined in a °suit" on the merits, in the
territory described in a. above or in a set-
tlement we agree to.
5."Employee" includes a °leased worker". "Employee°
does not include a "temporary worker".
6. "Executive officer" means a person holding any of
the officer positions created by your charter, con-
stitution, by-laws or any other similar governing
document.
7. "Hostile fire° means one which becomes uncontrol-
lable or breaks out from where it was intended to
be.
8. "Impaired property" means tangible property, other
than "your product" or "your work", that cannot be
used or is less useful because:
a. It incorporates "your product" or "your work"
that is known or thought to be defective, defi-
cient, inadequate or dangerous; or
b. You have failed to fulfill the terms of a contract
or agreement; if such property can be restored to use by:
a. The repair, replacement, adjustment or remov-
al -of "your product" or °your work"; or
b. Your fulfilling the 'terms of the contract or
agreement.
9."Insured contract" means:
a. A contract for a lease of premises. However,
that portion of the contract for a lease of pre-
mises that indemnifies any person or organiza-
tion for damage by fire to premises while rented
to you or temporarily occupied by you with
permission of the owner is not an "insured con-
tract";
b. A sidetrack agreement;
c. My easement or license agreement, except in
connection with construction or demolition op-
erations on or within 50 feet of a railroad;
d. An obligation, as required by ordinance, to
indemnify a municipality, except in connection
with work for a municipality;
e. An elevator maintenance agreement;
f. That part of any other contract or agreement
pertaining to your business (including an In-
demnification of a municipality in connection
with work performed for a municipality) under
which you assume the tort liability of another
party to pay for "bodily injury" or "property dam-
age° to a third person or organization. Tort lia-
bility means a liability that would be imposed by
law in the absence of any contract or agree-
ment.
Paragraph f. does not include that part of any
contract or agreement:
(1) That indemnifies a railroad for "bodily Injury"
or "property damage" arising out of con-
struction or demolition operations, within 50
feet of any railroad property and affecting
any railroad bridge or trestle, tracks, road-
beds, tunnel, underpass or crossing;
(2) That indemnifies an architect, engineer or
surveyor for injury or damage arising out of:
(a) Preparing, approving, or falling to pre-
pare or approve, maps, shop drawings,
opinions, reports, surveys, field orders,
change orders or drawings and specifi-
cations; or
(b) Giving directions or instructions, or fail-
ing to give them, if that is the primary
cause of the injury or damage; or
(3) Under which the insured, if an architect,
engineer or surveyor, assumes liability for
an injury or damage arising out of the in-
sured's rendering or failure to render pro-
fessional services, including those listed In
(2) above and supervisory, inspection, arc-
hitectural or engineering activities.
10."Leased worker° means a person leased to you by
a labor leasing firm under an agreement between
you and the labor leasing firm, to perform duties
related to the conduct of your business. "Leased
worker" does not include a "temporary worker".
11."Loading or unloading" means the handling of
property:
a. After it is moved from the place where It is
accepted for movement into or onto an aircraft,
watercraft or "auto";
b. While it is in or on an aircraft, watercraft or
°auto"; or
CG 00 01 07 98
Copyright, Insurance Services Office, Inc., 1997 Page 11 of 13
c. While it is being moved from an aircraft, water-
craft or "auto" to the place where it is finally de-
livered;
but "loading or unloading° does not include the
movement of property by means of a mechanical
device, other than a hand truck, that is not at-
tached to the aircraft, watercraft or "auto".
12."Mobile equipment° means any of the following
types of land vehicles, including any attached ma-
chinery or equipment:
a. Bulldozers, farm machinery, forklifts and other
vehicles designed for use principally off public
roads;
b. Vehicles maintained for use solely on or next to
premises you own or rent
c. Vehicles that travel on crawler treads;
d. Vehicles, whether self-propelled or not, main-
tained primarily to provide mobility to perma-
nently mounted:
(1) Power cranes, shovels, loaders, diggers or
drills; or
(2) Road construction or resurfacing equipment
such as graders, scrapers or rollers;
e. Vehicles not described in a., b., c. or d. above
that are not self-propelled and are maintained
primarily to provide mobility to permanently at-
tached equipment of the following types:
(1) Air compressors, pumps and generators,
including spraying, welding, building clean-
ing, geophysical exploration, lighting and
well servicing equipment; or
(2) Cherry pickers and similar devices used to
raise or lower workers;
f. Vehicles not described in a., b., c. or d. above
maintained primarily for purposes other than
the transportation of persons or cargo.
However, self-propelled vehicles with the fol-
lowing types of permanently attached equip-
ment are not "mobile equipment" but will be
considered "autos":
(1) Equipment designed primarily for:
(a) Snow removal;
(b) Road maintenance, but not construction
or resurfacing; or
(c) Street cleaning;
(2) Cherry pickers and similar devices mounted
on automobile or truck chassis and used to
raise or lower workers; and
(3) Air compressors, pumps and generators,
including spraying, welding, building clean-
ing, geophysical exploration, lighting and
well servicing equipment.
13."Occurrence" means an accident, including conti-
nuous or repeated exposure to substantially the
same general harmful conditions.
14."Personal and advertising injury" means injury,
including consequential "bodily injury", arising out
of one or more of the following offenses:
a. False arrest, detention or imprisonment;
b. Malicious prosecution;
c. The wrongful eviction from, wrongful entry into,
or invasion of the right of private occupancy of
a room, dwelling or premises that a person oc-
cupies, committed by or on behalf of its owner,
landlord or lessor;
d. Oral or written publication of material that
slanders or libels a person or organization or
disparages a person's or organization's goods,
products or services;
e. Oral or written publication of material that vi-
olates a person's right of privacy;
f. The use of another's advertising idea in your
"advertisement"; or
g. Infringing upon another's copyright, trade dress
or slogan In your "advertisement".
15."Pollutants" mean any solid, liquid, gaseous or
thermal irritant or contaminant, including smoke,
vapor, soot, fumes, acids, alkalis, chemicals and
waste. Waste includes materials to be recycled,
reconditioned or reclaimed.
16."Products-completed operations hazard":
a. Includes all "bodily injury' and "property dam-
age" occurring away from premises you own or
rent and arising out of "your product" or "your
work" except
(1) Products that are still in your physical pos-
session; or
(2) Work that has not yet been completed or
abandoned. However, "your work" will be
deemed completed at the earliest of the fol-
lowing times:
(a) When all of the work called for in your
contract has been completed.
(b) When all of the work to be done at the
job site has been completed if your con-
tract calls for work at more than one job
site.
(c) When that part of the work done at a job
site has been put to its intended use by
any person or organization other than
another contractor or subcontractor
working on the same project.
Work that may need service, maintenance,
correction, repair or replacement, but which
is otherwise complete, will be treated as
completed.
Page 12 of 13
Copyright, Insurance Services Office, Inc., 1997 CG 00 01 07 98
b. Does not include "bodily injury" or "property
damage" arising out of:
(1)
The transportation of property, unless the
injury or damage arises out of a condition in
or on a vehicle not owned or operated by
you, and that condition was created by the
°loading or unloading" of that vehicle by any
insured;
(2) The existence of tools, uninstalled equip-
ment or abandoned or unused materials; or
Products or operations for which the classi-
fication, listed in the Declarations or in a pol-
icy schedule, states that products -
completed operations are subject to the
General Aggregate Limit.
17."Property damage" means:
a. Physical injury to tangible property, including all
resulting loss of use of that property. All such
loss of use shall be deemed to occur at the
time of the physical injury that caused it; or
b. Loss of use of tangible property that is not
physically injured. All such loss of use shall be
deemed to occur at the time of the "occur-
rence" that caused it.
18."Sult" means a civil proceeding in which damages
because of "bodily injury", "property damage" or
"personal and advertising injury" to which this in-
surance applies are alleged. "Suit" includes:
a. An arbitration proceeding in which such dam-
ages are claimed and to which the insured
must submit or does submit with our consent;
or
b. Any other alternative dispute resolution pro-
ceeding in which such damages are claimed
and to which the insured submits with our con-
sent.
19."Temporary worker" means a person who is fur-
nished to you to substitute for a permanent "em-
ployee" on leave or to meet seasonal or short-term
workload conditions.
(3)
CG 00 01 07 08
20. "Your product" means:
a. Any goods or products, other than real proper-
ty, manufactured, sold, handled, distributed or
disposed of by:
(1) You;
(2) Others trading under your name; or
(3) A person or organization whose business or
assets you have acquired; and
b. Containers (other than vehicles), materials,
parts or equipment furnished in connection with
such goods or products.
"Your product" includes:
a. Warranties or representations made at any
time with respect to the fitness, quality, durabili-
ty, performance or use of °your product"; and
b. The providing of or failure to provide warnings
or instructions.
°Your product" does not include vending machines
or other property rented to or located for the use of
others but not sold.
21."Your work" means:
a. Work or operations performed by you or on
your behalf; and
b. Materials, parts or equipment furnished In con-
nection with such work or operations.
"Your work" includes:
a. Warranties or representations made at any
time with respect to the fitness; quality, durabili-
ty, performance or use of "your work"; and
b. The providing of or failure to provide warnings
or instructions.
Copyright, Insurance Services Office, Inc., 1997 Page 13 of 13
S
Named Insured Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
SEW
Insured By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
Policy Number
G22011534008
Policy Period
03/31/2013
TO 03/31/2014
Effective Date of Endorsement
03/31/2013
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CANCELLATION CONDITION - AMENDED
Paragraph A.2.b. of the Common Policy Conditions endorsement is deleted in its entirety and replaced by
the following:
GLE0032 (12-88)
14
90 days before the effective date of the cancellation if we cancel- for any other reason.
Authorized Representative
Page 1 of I
Named Insured Academy of Model Aeronautics, Inc.
Policy Symbol
SEW
Policy Number
622011534008
Endorsement Number
Policy Period
03/31/2013 to 03/31/2014
Effective Date of Endorsement
03/31/2013
Insured By (Warne of Insurance Company)
Westchester Surplus Lines Insurance Co
SIGNATURE ENDORSEMENT
THE ONLY SIGNATURES APPLICABLE TO THIS POLICY ARE THOSE REPRESENTING THE COMPANY
NAMED ON THE FIRST PAGE OF THE DECLARATIONS.
By signing and delivering the policy to you, we state that it is a valid contract when countersigned by our
authorized representative.
ILLINOIS UNION INSURANCE COMPANY (A stock company)
525 W. Monroe Street, Suite 400, Chicago, Illinois 60661
WESTCHESTER SURPLUS LINES INSURANCE COMPANY (A stock company)
Royal Centre Two, 11575 Great Oaks Way, Suite 200, Alpharetta, GA 30022
G
CARMINE A. GIGANTI, Secretary '' / JOHN J. LUPICA. President
Authorized Representative
LD-5S23i 02011
6
"Erc-
Excess Insurance Policy Declarations
Policy No: G22011546008
Renewal of: 622011546 007
Item 11 NAMED INSURED & MAILING ADDRESS
Academy of Model Aeronautics, Inc.
[See Named Insured Endorsement - M12 (12-8911
5161 East Memorial Drive
Muncie, IN 47302
Item 2. I POLICY PERIOD
Item 3.
When Coverage Begins:
03/31/2013 12:01 A.M. Local Time At Namod Insured's Address
When Coverage Ends: 03/31/2014
12:01 A.M. Local Time At Named Insured's Address
INSURING COMPANY
Westchester Surplus Lines Insurance Co
Producer's Name & Address:
CRUMP INSURANCE SERVICES, INC.
550 W. VAN BUREN
SUITE 1500
CHICAGO, IL 60607
Producer No. 58654W
Item 4.
PREMIUM RIFLAT (except for acquisitions)
Advance Premium:
Annual Minimum Premium:
Total Amount Due:
❑ADJUSTABLE
Rate:
Estimated Annual Exposure:
Item 5. I UNDERLYING INSURANCE
See Schedule A - Schedule of Underlying insurance
WSG 039 (01-10) Page 1 of 2
2
-trc.
Excess Insurance Policy Declarations
Policy No: G22011546008
Renewal of: G22011546 007
Item 6.
LIMITS OF INSURANCE
See Endorsement EM15343
Item 7. I ATTACHED FORMS
Policy Form No. FM101.0.302 (11-93)
Endorsements as Listed on Schedule of Endorsements No. CPFS2
Item 8. I Authorization Information
Countersigned by:
WSG 039 (01-10) Page 2 of 2
3
Named insured Academy of Model Aeronautics, Inc.
Policy Symbol
MLW
Policy Number
G22011546008
Policy Period
03/31/2013
Endorsement Number
TO 03/31/2014
Effective Date of Endorsement
03/31/2013
Insured By (Name of Insurance Companyl
Westchester Surplus Lines Insurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Named Insured Endorsement
Item 1 of the Declarations, "Named Insured", is completed to read as follows:
Academy of Model Aeronautics, Inc.
Members, Clubs and Chapters of the Academy of Model Aeronautics, Inc.
Students in the Intro Pilot Training Program
Special Interest Groups as recognized by the Academy of Model Aeronautics, Inc.
and approved by the Executive Council of the Academy of Model Aeronautics, Inc.
Authorized Representative
M12 (12-89)
14
Page 1 of 1
Named Insured Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
MLW
Insured By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
Policy Number
022011646008
Policy Period
03/31/2013
To 03/31/2014
Effective Date of Endorsement
03/31/2013
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Limits Of Liability Endorsement
ITEM 6 OF THE DECLARATIONS IS AMENDED TO READ:
$ 4,000,000 EACH OCCURRENCE (ACADEMY OF MODEL AERONAUTICS, INC.)
$ 1,500,000 EACH OCCURRENCE (ANY OTHER INSURED)
S 4,000,000 GENERAL AGGREGATE (APPLICABLE PER UNDERLYING INSURANCE)
$ 4,000,000 PRODUCTS/COMPLETED OPERATIONS AGGREGATE
EXCESS OF THE LIMITS INDICATED IN ITEM 5 OF THE DECLARATIONS.
Authorized Representative
EM15343 (00/01) Page 1 of 1
16
Named Insured Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
MLW
Insured By MName of Insurance Company)
Westchester Surplus Lines Insurance Co
Policy Number
G22011546008
Policy Period
03/31/2013
TO 03/31/2014
Effective Date of Endorsement
03/31/2013
SCHEDULE A - SCHEDULE OF UNDERLYING INSURANCE
(A) COMMERCIAL $ 1,000,000 EACH °OCCURRENCE° WESTCHESTER SURPLUS IJNES
GENERAL $ 1,000,000 GENERAL AGGREGATE INSURANCE COMPANY
LIABILITY (X) PER LOCATION/PROJECT 03/31/2013 - 03/31/2014
$ 1,000,000 PRODUCTS/COMPLETED
OPERATIONS AGGREGATE
$ 1,000,000 PERSONAL & ADVERTISING
INJURY LIMIT
FEDERAL TERRORISM
RISK INSURANCE ACT
TYPE OF POLICY
COMMERCIAL $ 1,000,000 EACH "OCCURRENCE°
GENERAL
LIABILITY
WESTCHESTER SURPLUS LINES
INSURANCE COMPANY
03/31/2013 - 03/31/2014
Authorized Representative
MOO 106-03) Page 1 of 1
8
Named Insured Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
MLW
Insured By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
Policy Number
G22011546008
Policy Period
03/31/2013
To 03/31/2014
Effective Date of Endorsement
03/31/2013
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Amendment To Notice Of Cancellation
(EXCESS POLICIES)
IT IS AGREED THAT CONDITION J. CANCELLATION IS AMENDED, IN PART, AS FOLLOWS:
11. THIS POLICY MAY BE CANCELED BY THE COMPANY BY MAILING TO THE NAMED INSURED AT
THE ADDRESS SHOWN IN THIS POLICY WRITTEN NOTICE STATING WHEN, NOT LESS THAN NINETY
(90) DAYS THEREAFTER, SUCH CANCELLATION SHALL BE EFFECTIVE ..."
Authorized Representative
EM15204 (07/00) Page 1 of 1
16
EXCESS INSURANCE POLICY
In consideration of the payment of premium and in reliance upon the statements in the Declarations and
subject to all the terms of this policy, the Company named in the Declarations (a capital stock company,
herein called the company) agrees with the insured, also named in the Declarations, to provide coverage as
follows:
INSURING AGREEMENT
To indemnify the insured for that amount of loss which exceeds the amount of loss payable by underlying
policies described in the Declarations, but the Company's obligation hereunder shall not exceed the limit of
liability stated in Declarations 6.
CONDITIONS
A. Application of Underlying Insurance. Except as otherwise stated herein, and except with respect to (1)
any obligation to investigate or defend any claim or suit, or (2) any obligation to renew, the insurance
afforded by this policy shall apply in like manner as the underlying insurance described in the Declarations,
B. Maintenance of Underlying Insurance. It is warranted by the insured that the underlying policies listed in
item 5 of the declarations, or renewals or replacements thereof not more restricted, shall be maintained in
force as valid and collectible during the currency of this policy, except for any reduction of the aggregate
limits contained therein. solely by payment of claims in respect of occurrences happening during this policy
period. In the event of failure by the insured to so maintain such policies in force or to meet all conditions
and warranties subsequent to loss under such policies, the insurance afforded by this policy shall apply in
the same manner it would have applied had such policies been so maintained in force. Notice of exhaustion
of underlying insurance shall be given the company within thirty (30) days of such exhaustion.
C. Loss Payable. Liability of the company with respect to any one occurrence shall not attach unless and
until the insured, or the insured's underlying insurer, has paid the amount of underlying insurance stated in
Declaration 5. The insured shall make a definite claim for loss, for which the company may be liable within
twelve (12) months after the insured has paid any amount of excess loss, as stated in Declaration 6; or
after the insured's liability shall have been made certain by final judgment after actual trial; or by written
agreement of the insured, the claimant, and the company. Any subsequent payments made by the insured
on account of the same occurrence shall be payable by the company within thirty (30) days after additional
claim is made by the insured, and after the insured has shown proof in conformity with this policy.
D. Premium Computation. The premium for this policy shall be based upon the rating basis set forth in the
declarations and shall be computed by applying the rate set forth in the declarations to each unit of
exposure generated by the insured during the policy period. The advance premium is based upon the
estimated exposures for the policy period as stated in the declarations. Upon expiration of this policy or its
termination during the policy period, the earned premium shall be computed as thus defined. If the
computed earned premium is more than the advance premium paid, the named insured shall immediately
pay the excess to the company; if less, the company shall return the difference to the named insured; but
the company shall receive and retain the annual minimum premium for each twelve (12) months of the
policy period.
E. Assistance and Co -Operation. The company shall not be called upon to assume charge of the
settlement or defense of any claim made or proceeding instituted against the insured; but the company shall
have the right and opportunity to associate with the insured in the defense and control of any claim or
proceeding reasonably likely to involve the company. In such event the insured and the company shall
cooperate fully.
F. Expenses. Loss and legal expenses incurred by the insured with the consent of the company in the
investigation or defense of claims, including court costs and interest, shall be borne by both the company
and the insured in the proportion that each party's share of loss bears to the total amount of such loss.
Salaries and expenses of the insured's employees shall not be considered as part of the above expenses.
Expenses thus paid by the company shall be paid in addition to the limit of liability stated in Declaration 6.
FM 101.0.302 (11-931 Page 1 of 4
7
G. Notice of Occurrence. Upon the happening of an occurrence reasonably. likely to involve the company
hereunder, written notice shall be given as soon as practicable to the company or any of its authorized
agents, Such notice shall contain particulars sufficient to identify the insured and the fullest information
obtainable at the time. .
The insured shall give like notice of any claim made on account of such occurrence, If legal proceedings are
begun, the insured, when requested by the company, shall forward to it each paper thereon, or a copy
thereof, received by the insured or the insured's representatives, together with copies of reports of
investigations made by the insured with respect to such claim proceedings.
H. Appeals. in the event the insured or the insured's underlying insurer elects not to appeal a judgment
which exceeds the underlying insurance, the company may elect to do so at its own expense, and shall be
liable for the taxable costs, disbursements and interest incidental thereto, but in no event shall the liability
of the company for excess loss exceed the amount set forth in Declaration 6.
I. Subrogation. In the event of payment under this policy, the company will participate with the insured
and any underlying insurer in the exercise of all the insured's rights of recovery against any person or
organization liable therefore. Recoveries shall be applied first to reimburse any interest (including the
insured) that may have paid any amount, with respect to liability in excess of the limit of the company's
liability hereunder, then to reimburse the company up to the amount paid hereunder, and lastly to reimburse
such interests (including the insured), to whom this insurance is excess as are entitled to claim the residue,
if any. Such expenses incurred in the exercise of rights of recovery shall be apportioned among all interests
in the ratio of their respective losses for which recovery is sought.
J. Cancellation. This policy may be cancelled by the named insured by surrender thereof to the company
or any of its authorized agents, or by mailing to the company written, notice stating when thereafter such
cancellation shall be effective. This policy may be cancelled by the company by mailing to the named
insured at the address shown in this policy written notice stating when, not less than thirty (30) days
thereafter, such cancellation shall be effective. The mailing of notice as aforesaid shall be sufficient notice
and the effective date of cancellation stated in the notice shall become the end of the policy period.
Delivery of such written notice either by the named insured or by the company shall be equivalent to
mailing.
Premium adjustment shall be made by the company either at the time cancellation is effected or as soon as
practicable thereafter.. The check of the company or its representative, mailed or delivered, shall be
sufficient tender of any refund due the named insured.
If this policy insures more than one named insured, cancellation may be effected by the first of such named
insureds for the account of all insureds; •and notice of cancellation by the company to such first named
insured shall be notice to all insureds. Payment of any unearned premium to such first named insured shall
be for the account of all interests therein.
K. Other Insurance. If other valid and collectible insurance is availableto the insured which covers a loss
also covered by this policy, other than insurance that is specifically purchased as being in excess of this
policy, this policy shall operate in excess of, and not contribute with, such other insurance.
IN WITNESS WHEREOF, the company has caused this policy to be signed by its chairman of the board and
secretary but this policy shall not be valid unless completed by the attachment hereto of a Declarations
page countersigned by a duly authorized representative of the company.
PM 101.0.302 (11-93)
,8
Page 2 of 4
NUCLEAR ENERGY LIABILITY
EXCLUSION ENDORSEMENT
It is agreed that:
I. This policy does not apply:
(a) to injury, sickness, disease, death, destruction or loss
1. with respect to which an insured under the policy is also an insured under a nuclear energy
liability policy issued by Nuclear Energy Liability Insurance Underwriters or Nuclear Insurance
Association of Canada, or would be an insured under any such policy but for its termination
upon exhaustion of its limit of liability; or
2. resulting from the hazardous properties of nuclear material and with respect to which (a) any
person or organization is required to maintain financial protection pursuant to the Atomic Energy
Act of 1954., or any law amendatory thereof, or (b) the insured is, or had its policy not been
issued would be, entitled to indemnity from the United States of America, or any agency
thereof, under any agreement'entered into by the United States of America, or any agency
thereof, with any person or organization;
(b) to injury, sickness, disease, death, destruction or loss resulting from the hazardous properties of
nuclear material, if
1. the nuclear material (a) is at any nuclear facility owned by, or operated by or on behalf of, an
insured or (b) has been discharged or dispersed therefrom:
2, the nuclear material is contained in spent fuel or waste at any time possessed, handled, used,
processed, stored, transported or disposed of by or on behalf of an insured; or
3. the injury, sickness, disease, death, destruction or loss arises out of the furnishing by an
insured of services, materials, parts or equipment in connection with the planning, construction,
maintenance, operation or use of any nuclear facility, but if such facility is located within the
United States of America, its territories or possessions or Canada, this exclusion (3) applies
only to injury to or destruction of or loss of property at such nuclear facility.
II. As used in this endorsement:
"hazardous properties" include radioactive, toxic or explosive properties;
"nuclear material" means source material, special nuclear material or byproduct material;
"source material", "special nuclear material", and "by-product material" have the meanings given them in
the Atomic Energy Act of 1954 or in any law amendatory thereof;
"spent fuel" means any fuel element or fuel component, solid or liquid, which has been used or exposed to
radiation in a nuclear reactor;
"waste" means any waste material (1) containing byproduct material and (2) resulting from the operation by
any person or organization of any nuclear facility included within the definition of nuclear facility under
paragraph (1) or (2) thereof;
"nuclear facility" means
1. any nuclear reactor,
FM 101.0.302 (11.93)
9
Page 3 of 4
2. any equipment or device designed or used for (a) separating theisotopes of uranium or
plutonium, (b) processing or utilizing spent fuel, or (c) handling, processing or packaging waste.
3. any equipment or device used for processing, fabricating or alloying of special nuclear material if
at any time the total amount of such material in the custody of the insured at the premises
where such equipment or device is located consists of or contains more than 25 grams of
plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium
235.
4. any structure, basin, excavation, premises or place prepared or used for the storage or disposal
of waste.
and includes the site on which any of the foregoing is located, all operations conducted on such site and all
premises used for such operations;
"nuclear reactor" means any apparatus designed or used to sustain nuclear fission in self-supporting chain
reaction or to contain a critical mass of fissionable material;
With respect to injury to or destruction of or loss of property, the word "injury" or "destruction" or "loss"
includes all forms of radioactive contamination of property;
All other terms and conditions of this policy remain unchanged.
Authorized Representative
FM 101.0.302 (11-931 Page 4 of 4
10
Named Insured Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
MLW
Policy Number
1322011546008
Policy Period
03/31/2013
TO 03/31/2014
Effective Date of Endorsement
03/31/2013
Insured By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
DEFENSE EXPENSE AMENDATORY
Condition F. of the Excess Insurance Policy shall be deleted in its entirety.
Authorized Representative
EM 15219 108.001 Page 1 of 1
17
t
Named Insured Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
MLW
Insured By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
Policy Number
G22011546008
Policy Period
03/31/2013 TO 03/31/2014
Effective Date of Endorsement
03/31/2013
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CARE, CUSTODY OR CONTROL EXCLUSION TO REAL PROPERTY
This policy does not apply to "Property Damage" to:
1. Property owned, rented or occupied by the insured;
2. Premises sold, given away or abandoned by the insured if the "Property Damage" arises out of any
part of those premises; or
3. Real property loaned to the insured.
For the purpose of this exclusion, "Property Damage" is defined by the underlying insurance described in
the Declarations.
EM15211 (08-00)
22
Authorized Representative
Page 1 of 1
-46 -
Named Insured Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
MLW
Policy Number
G22011546008
Policy Period
03/31/2013
TO 03/31/2014
Effective Date of Endorsement
03/31/2013
Insured By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CARE, CUSTODY OR CONTROL EXCLUSION TO PERSONAL
PROPERTY
This policy does not apply to "Property Damage" to:
1. Personal property loaned to the insured; or
2. Personal property in the care, custody or control of the insured.
For the purpose of this exclusion, "Property Damage" is defined by the underlying insurance described in
the Declarations.
Authorized Representative
EM15212 108-00) Page 1 of 1
23
'Named Insured Academy of Model Aeronautics, Inc.
Endorsement Number
Policy Symbol
MLW
Policy Number
G22011546008
Policy Period
03/31/2013 TO 03/31/2014
Effective Date of Endorsement
03/31/2013
Insured By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED OPERATIONS EXCLUSION
This policy does not apply to any liability or damage arising out of the operations designated below:
Any "Park Pilot Member"
"Park Pilot Member" means an Academy of Model Aeronautics member who has applied for and by
payment of dues received by the Academy of Model Aeronautics is accepted as a special membership
class designated "Park Pilot Member". A "Park Pilot Member" is an insured only for aeromodeling activity
in which a "model aircraft" within the definition of °Park Pilot Model Aircraft° results in a claim or suit.
"Park Pilot Model Aircraft" means a 'model aircraft" weighing not more than three (3) pounds at takeoff,
designated for a maximum speed of sixty (60) miles per hour, and either hand launched or propelled by an
electric motor, rubber band or similar non -combustion engine. The "Park Pilot Model Aircraft" must be
flown within the pilot's line of sight at all times and must be either remotely controlled or on a line
tethered to the pilot during flight.
Authorized Representative
EM16329106-01) Page 1 of 1
24
Named Insured Academy of Model Aeronautics, Inc.
Endorsement Number
Polley Symbol
MLW
Insured By (Name of Insurance Company)
Westchester Surplus Lines Insurance Co
Policy Number
G22011546008
Policy Period
03/31/2013 10 03/31/2014
Effective Dare of Endorsement
03/31/2013
SIGNATURE ENDORSEMENT
THE ONLY SIGNATURES APPLICABLE TO THIS POLICY ARE THOSE REPRESENTING THE COMPANY
NAMED ON THE FIRST PAGE OF THE DECLARATIONS.
By signing and delivering the policy to you, we state that it is a valid contract when countersigned by our
authorized representative.
ILLINOIS UNION INSURANCE COMPANY (A stock company)
525 W, Monroe Street, Suite 400, Chicago, Illinois 60661
WESTCHESTER SURPLUS LINES INSURANCE COMPANY (A stock company)
Royal Centre Two, 11575 Great Oaks Way, Suite 200, Alpharetta, GA 30022
•
CARMINE A. GIGANTI, Secretary
B0-5923( (12/11)
JOHN J. LUPICA, President
Authorized Representative
U
CHUBS
Special Risk
INSURANCE PROGRAM
Issued by
FEDERAL INSURANCE COMPANY
FOR
ACADEMY OF MODEL AERONAUTICS
Chubb Underwriting Office: FEDERAL INSURANCE COMPANY
Suite 4700
233 South Wacker Drive
Chicago, IL 60606-6303
Words and phrases that appear in bold print have special meaning and are defined in the Definitions
section(s) of this policy. Defined terms include the plural.
Throughout this policy the words "We", "Us" and "Our" refer to the Company providing this insurance.
Please Read This Policy Carefully
BTA5000
Table of Contents
Insuring Agreement 3
Premium Summary 4
Schedule Of Benefits 5
Hazards 9
Contract 10
I - Insurance 10
II - Eligibility 11
III - Extensions 12
IV - Maximum Payment for Multiple Losses and Multiple Benefits 12
V - Territory 12
VI - Exclusions 12
VII - Definitions 14
VIII - General Provisions 23
Endorsements 33
Applications 37
BTA5001
2
Insuring Agreement
Section I
Chubb Group of Insurance Companies
15 Mountain View Road, P.O. Box 1615
Warren, New Jersey 07061-1615
Policyholder's Name and Address:
ACADEMY OF MODEL AERONAUTICS
5151 E MEMORIAL DR
MUNCIE, IN 47302
Policy Number: 9906-03-58
Effective Date: 01/01/2012
Anniversary Date: January 1
BTA5002
Issued by the stock insurance company
indicated below:
FEDERAL INSURANCE COMPANY
Incorporated under the laws of
INDIANA
Section II Policy Period and Company
Policy Period
From: 01/01/2012 To: 01/01/2013
12:01 A.M. standard time at the Policyholder's address shown in Section I of the Insuring Agreement.
This insurance is provided by the Company in consideration of payment of the required premium.
The insurance under this policy begins on the Effective Date shown in Section I of the Insuring Agreement.
The insurance under this policy ends on the last day of the Policy Period shown in Section II of the Insuring
Agreement.
The Policyholder's acceptance of this policy terminates any prior policy of the same policy number, effective
with the inception of this policy.
Company
The Company issuing this policy has caused this policy to be signed by it's authorized officers, but this
policy shall not be valid unless also signed by a duly authorized representative of the Company.
FEDERAL INSURANCE COMPANY (Incorporated under the laws of INDIANA)
President
BTA5004
e
Secretary
ReS_
Authorized Representative
Premium Summary
Section I - Premium Due Date
On the 15th day of each quarter following the quarter for which coverage was in force.
Section II - Premium Payment
The Policyholder shown in Section I of the Insuring Agreement is responsible for the collection and
remittance of all required premiums. Premiums are calculated and payable as follows:
BTA5006
4
Schedule of Benefits
Chubb Group ofInsurance Companies
15 Mountain View Road, P.O. Box 1615
Warren, New Jersey 07061-1615
Policyholder's Name:
ACADEMY OF MODEL AERONAUTICS
Issued by the stock insurance company
indicated below:
FEDERAL INSURANCE COMPANY
Incorporated under the laws of
INDIANA
BTA6000
Section I - Insured Persons
The following are the Insured Persons under this policy:
Class Description
1 All members of the policyholder in good standing, excluding park pilot members.
BTA6002
If, subject to all the terms and conditions of this policy a person is eligible for insurance under multiple
Classes of Insured Persons described above, then such person will only be insured under the Class which
provides the Insured Person the largest Benefit Amount for the loss that has occurred.
BTA6004
Section II - Qualification Period
For Insured Persons in an eligible Class on the Effective Date: none
For Insured Persons entering an eligible Class after the Effective Date: none
BTA6008
Section III - Hazards
The following are the Hazards for which insurance applies:
Class Hazard(s)
1 Covered Activities
If, subject to all the terms and conditions of this policy an Insured Person has insurance for covered loss
on the date of an Accident, covered under multiple Hazards described above, then only one Benefit Amount
will be paid. This Benefit Amount shall be the largest Benefit Amount applicable under all such Hazards.
BTA6010 (Ed. 7/06)
Section IV - Benefits
A) Principal Sum
The following are Principal Sums for each Class:
Class Hazard
1 Covered Activities
BTA6012
Principal Sum
$10,000
B) Accidental Death and Dismemberment Benefits:
This benefit applies to all Classes of Insured Persons. The following are Losses insured and the
corresponding Benefit Amount expressed as a percentage of the Principal Sum:
Class(es)
All
Accidental:
Loss of Life
Loss of Speech and Loss of Hearing
Loss of Speech and one of Loss of Hand, Loss of Foot or Loss of Sight
of One Eye
Loss of Hearing and one of Loss of Hand, Loss of Foot or Loss of Sight
of One Eye
Loss of Hands (Both), Loss of Feet (Both), Loss of Sight or a combination
of any two of Loss of Hand, Loss of Foot or Loss of Sight of One Eye
Loss of Hand, Loss of Foot or Loss of Sight of One Eye
(Any one of each)
Loss of Speech or Loss of Hearing
Loss of Thumb and Index Finger of the same hand
This Benefit Amount is subject to Section IV - Maximum
Benefits, of the Contract.
BTA6016
Benefit Amounts (Percentage
of Principal Sum)
100%
100%
100%
100%
100%
50%
50%
25%
Payment for Multiple Losses and Multiple
If an Insured Person has multiple Losses as the result of one Accident, then We will pay only the single
largest Benefit Amount applicable to the Losses suffered, as described in Section IV - Maximum Payment
For Multiple Losses and Multiple Benefits of the Contract.
BTA6018
C) Additional Benefits
The following are Benefit Amounts for all other benefits provided under this policy:
Accident Medical Expense
Class 1
Maximum Benefit Amount $25,000
Deductible $750
Dental Benefit Amount $250
The Benefit Amounts shown above for Dental are part of, and not in addition to, the Maximum Benefit
Amount for Accident Medical Expense. Payment of these Benefit Amounts reduces and does not increase
the Benefit Amount for Accident Medical Expense.
This Benefit Amount is not subject to Section IV - Maximum Payment for Multiple Losses and Multiple
Benefits, of the Contract.
BTA6039
Total Loss of Use
Class 1
Loss of Use of:
One Hand or One Foot
Both Hands or Both Feet or a combination of One hand and One Foot
One Arm or One Leg
Both Arms or Both Legs or a Combination of One Ann and One leg
Both Arms and Both Legs
Elimination Period365 days
Benefit Amount
(Percentage of
Principal Sum)
25%
50%
50%
100%
100%
This Benefit Amount is subject to Section IV - Maximum Payment for Multiple Losses and Multiple
Benefits, of the Contract.
BTA6086
Section V - Aggregate Limit of Insurance
$250,000 per Accident
If more than one (1) Insured Person suffers a Loss in the same Accident, then We will not pay more than
the Aggregate Limit of Insurance shown above. If an Accident results in Benefit Amounts becoming
payable, which when totaled, exceed the applicable Aggregate Limit of Insurance shown above, then the
Aggregate Limit of Insurance will be divided proportionally among the Insured Persons, based on each
applicable Benefit Amount.
BTA6088
Insurance only applies for the Classes, Hazards, Benefits and Losses that are specifically indicated as
insured.
BTA6090
Hazards
Covered Activity Hazard
Covered Activity Hazard means all circumstances, subject to the terms and conditions of this policy, arising
from and occurring while a Primary Insured Person is participating in Covered Activity.
Covered Activity means all those activities set forth below for which a Primary Insured Person is insured
under this policy.
Covered Activity:
While engaged in hobby modeling activities involving
model aircraft, model rockets, model cars, and model
boats; including model operation and related activity,
model construction, or maintenance, club site
construction or maintenance, and participation in
hobby events or shows.
BTA5529
Contract
Section I - Insurance
Subject to all the terms and conditions of this policy and the payment of required premium, We will
provide the following insurance:
Accidental Death and Dismemberment
We will pay the applicable Benefit Amount, shown in Section IV -B of the Schedule of Benefits, if an
Accident results in a covered Loss not otherwise excluded. The Accident must result from an insured
Hazard and occur while an Insured Person is insured under this policy, while it is in force. The covered
Loss must occur within one (1) year after the Accident.
BTA5010
Accident Medical Expense
We will reimburse up to the Maximum Benefit Amount for Accident Medical Expense if Accidental
Bodily Injury causes an Insured Person to first incur Medical Expenses for care and treatment of the
Accidental Bodily Injury within ninety (90) days after an Accident. The Benefit Amount for Accident
Medical Expense is payable only for Medical Expenses incurred within 365 day(s) after the date of the
Accident causing the Accidental Bodily Injury. The Benefit Amount is subject to the Deductible and
Maximum Benefit Amount as shown in Section IV -C of the Schedule of Benefits. The Benefit Amount
for Accident Medical Expense is payable in addition to any other applicable Benefit Amounts under this
policy.
Payment of the Maximum Benefit Amount for Accident Medical Expense is also subject to the following:
Dental Benefit Amount
If, due to Accidental Bodily Injury, an Insured Person requires dental care and treatment, then Our
payment for such treatment will not exceed the Dental Benefit Amount, shown in Section IV -C of the
Schedule of Benefits.
In no event will Our total payments for an Insured Person's dental care and treatment, physical therapy,
orthopedic appliances, transportation and Medical Expense exceed the Maximum Benefit Amount for
Accident Medical Expense, shown in Section IV -C of the Schedule of Benefits.
Deductible
The Deductible for Accident Medical Expense, shown in Section IV -C of the Schedule of Benefits, will
be deducted from any Benefit Amount for Accident Medical Expense that We pay. This Deductible applies
separately to each Insured Person and each Accident.
Limitation on Accident Medical Expense
The Benefit Amount for Accident Medical Expense does not apply to charges and services:
1) for which an Insured Person has no obligation to pay;
2) for any injury where worker's compensation benefits or occupational injury benefits
are payable;
3) for any injury occurring while fighting, except in self-defense;
4) for treatment that is educational, experimental or investigational in nature or that
does not constitute accepted medical practice; or
5) for treatment by a person employed or retained by the Policyholder
10
6) for treatment involving conditions caused by Repetitive Motion Injuries, or
cumulative trauma and not as the result of an Accidental Bodily Injury.
This insurance applies only to Medically Necessary charges and services.
BTA5031IN
Total Loss of Use
We will pay the applicable Benefit Amount for Total Loss of Use, after the Elimination Period, both
shown in Section IV -C of the Schedule of Benefits, if an Accidental Bodily Injury causes an Insured
Person to suffer Total Loss of Use.
BTA5076
Section II - Eligibility, Effective Date and Termination
Eligibility
A person becomes insured under this policy if:
1) such person is a member of an eligible Class of Insured Persons as shown in Section I of the
Schedule of Benefits;
2) such person has completed any required Qualification Period as shown in Section II of the Schedule
of Benefits; and
3) the required premium for such person has been paid.
BTA5080
Effective Date of Insurance for an Insured Person
Insurance for an Insured Person becomes effective on the latest of:
1) the effective date of this policy;
2) the date on which such person first meets the eligibility criteria as an Insured Person; or
3) the beginning of the period for which required premium is paid for such Insured Person.
BTA5082
Termination of Insurance for an Insured Person
Insurance for an Insured Person automatically terminates on the earliest of:
1) the termination date of this policy;
2) the expiration of the period for which required premium has been paid for such Insured Person;
3) the date on which a person no longer meets the eligibility criteria as an Insured Person.
BTA5084
11
Section III - Extensions Of Insurance
Extensions of Insurance are subject to the provisions of Section I -Insurance of the Contract, and all other
policy terms and conditions.
Disappearance
If an Insured Person has not been found within one (1) year of the disappearance, stranding, sinking, or
wrecking of any Conveyance in which an Insured Person was an occupant at the time of the Accident,
then it will be assumed, subject to all other terms and conditions of this Policy, that an Insured Person has
suffered Loss of Life insured under this policy.
BTA5088
Exposure
If an Accident resulting from an insured Hazard causes an Insured Person to be unavoidably exposed to
the elements and as a result of such exposure an Insured Person has a Loss, then such Loss will be insured
under this policy.
BTA5090
Section IV - Maximum Payment for Multiple Losses and Multiple Benefits
For any Benefit Amount identified as subject to this provision in the Schedule of Benefits, payment of such
Benefit Amount will reduce the Principal Sum. If, subject to all the terms and conditions of this policy,
an Insured Person is entitled to receive payment of multiple Benefit Amounts as the result of one (1)
Accident, then the maximum We will pay for all benefits shall not exceed the Principal Sum.
For any Benefit Amount identified as not subject to this provision in the Schedule of Benefits, payment of
such Benefit Amount will be in addition to any Principal Sum payable under this policy.
If, subject to all the terms and conditions of this policy, an Insured Person suffers multiple covered Losses
as the result of one (1) Accident, then We will only pay the single largest Benefit Amount applicable to
all such covered Losses.
For the purposes of this provision the definition of Loss includes Total Loss of Use.
BTA5092
Section V - Territory
This insurance applies worldwide.
BTA5094
Section VI - General Exclusions
The following exclusions apply to all benefits or Hazards under this policy. Additional exclusions,
limitations or conditions may also apply to specific benefits or Hazards. Please read this entire policy
carefully.
12
Owned Aircraft, Leased Aircraft, or Operated Aircraft
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting
from, directly or indirectly, an Insured Person being in, entering, or exiting any aircraft:
1) owned, leased or operated by the Policyholder or on the Policyholder's behalf; or
2) operated by an employee of the Policyholder on the Policyholder's behalf.
BTA5095 (Ed. 7/06)
Aircraft Pilot or Crew
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting
from, directly or indirectly, an Insured Person being in, entering, or exiting any aircraft while acting or
training as a pilot or crew member.
This exclusion does not apply to passengers who temporarily perform pilot or crew functions in a life -
threatening emergency.
BTA5098 (Ed. 7/06)
Disease or Illness
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting
from, directly or indirectly, an Insured Person's emotional trauma, mental or physical illness, disease,
pregnancy, childbirth or miscarriage, bacterial or viral infection, bodily malfunctions or medical or surgical
treatment thereof.
This exclusion does not apply to an Insured Person's bacterial infection caused by an Accident or by
Accidental consumption of a substance contaminated by bacteria.
BTA5102 (Ed. 7/06)
Incarceration
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting
from, directly or indirectly any occurrence while an Insured Person is incarcerated after conviction.
BTA5106
Intoxication Exclusion
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting
from, directly or indirectly, an Insured Person being intoxicated, at the time of an Accident. Intoxication
is defined by the laws of the jurisdiction where such Accident occurs.
BTA5108
13
Narcotic Exclusion
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting
from, directly or indirectly, an Insured Person being under the influence of any narcotic or other controlled
substance at the time of an Accident. This exclusion does not apply if any narcotic or other controlled
substance is taken and used as prescribed by a Physician.
BTA5l 12
Service in the Armed Forces
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting
from, directly or indirectly, an Insured Person participating in military action while in active military
service with the armed forces of any country or established international authority. However, this exclusion
does not apply to the first sixty (60) consecutive days of active military service with the armed forces of
any country or established international authority.
BTA5116
Suicide or Intentional Injury
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting
from, directly or indirectly, an Insured Person's suicide, attempted suicide or intentionally self-inflicted
injury.
BTA5120
War
This insurance does not apply to any Accident, Accidental Bodily Injury or Loss caused by or resulting
from, directly or indirectly, a declared or undeclared War.
BTA5126IN
Section VII - Definitions
For the purpose of these definitions, the singular includes the plural and the plural includes the
singular, unless otherwise noted.
14
Accident or Accidental
Accident or Accidental means a sudden, unforeseen, and unexpected event which:
1) happens by chance;
2) arises from a source external to an Insured Person;
3) is independent of illness, disease or other bodily malfunction or medical or surgical
treatment thereof;
4) occurs while the Insured Person is insured under this policy which is in force; and
5) is the direct cause of loss.
BTA5600
Accidental Bodily Injury
Accidental Bodily Injury means bodily injury, which:
1) is Accidental;
2) is the direct cause of a loss; and
3) occurs while an Insured Person is insured under this policy, which is in force.
Accidental Bodily Injury does not mean a Repetitive Motion Injury.
BTA5602 (Ed. 7/06)
Actively at Work or Active Work
Actively at Work, or Active Work means a person is performing the material and substantial duties of his
or her regular occupation for compensation.
BTA5606
Benefit Amount
Benefit Amount means the amount stated in the Schedule of Benefits for this policy which applies:
1) at the time of an Accident;
2) to an Insured Person; and
3) for the applicable Hazard.
BTA5612
Class
Class means the categories of Insured Persons described in Section I of the Schedule of Benefits.
BTA5628
Company
Company means FEDERAL INSURANCE COMPANY.
BTA5648
15
Conveyance
Conveyance means any motorized craft, vehicle or mode of transportation licensed or registered by a
governmental authority with competent jurisdiction.
BTA5650
Covered Activity
Covered Activity means those activities set forth in the Covered Activities Hazard, and for which an
Insured Person is insured under the policy.
BTA5652
Dependent Child
Dependent Child means a Primary Insured Person's:
1) natural child from the moment of birth or an adopted child from the date of placement
with a Primary Insured Person, without regard to financial dependency, marital status,
attendance at an Institution of Higher Learning to age twenty four (24); or
2) grandchild, stepchild, blood relative or those under legal custody provisions who are
financially dependent for 50% or more or their total support, regardless of residency, or
enrollment at an Institution of Higher Learning to age twenty four (24)
The Dependent Child also includes a child classified as an Incapacitated Dependent Child.
A Dependent Child enrolled at an Institution of Higher Learning will be covered to age twenty five (25).
BTA5662IN
Elimination Period
Elimination Period means the consecutive amount of time, shown in Section IV -C of the Schedule of
Benefits, that must elapse before a Benefit Amount becomes payable. The Elimination Period begins on
the first day of an Insured Person's Loss. Benefit Amounts are not payable, nor do they accrue, during an
Elimination Period.
BTA5670
Full-time Employee
Full-time Employee means an employee who works at least 30 hours per week.
BTA5684
Hazard
Hazard means the circumstances for which this insurance is provided as stated in Section III of the Schedule
of Benefits and described in the Hazard Section of this policy.
BTA5696
16
Hospital
Hospital means a public or private institution which:
1) is licensed in accordance with the laws of the jurisdiction where it is located;
2) is accredited by the Joint Commission on Accreditation of Hospitals;
3) operates for the reception, care and treatment of sick, ailing or injured persons as in -patients;
4) provides organized facilities for diagnosis and medical or surgical treatment;
5) provides twenty-four (24) hour nursing care;
6) has a Physician or staff of Physicians; and
7) is not primarily a day clinic, rest or convalescent home, assisted living facility or similar
establishment and is not, other than incidentally, a place for the treatment of alcoholics or
drug addicts.
BTA5712
Immediate Family Member
Immediate Family Member means an Insured Person's:
1) Spouse;
2) children including adopted children and stepchildren;
3) legal guardians or wards;
4) siblings or siblings -in-law;
5) parents or parents -in-law;
6) grandparents or grandchildren;
7) aunts or uncles;
8) nieces and nephews.
Immediate Family Member also means a Spouse's children, including adopted children and stepchildren;
legal guardians or wards; siblings or siblings -in-law; parents or parents -in-law; grandparents or grandchildren;
aunts or uncles; nieces or nephews.
BTA5716
Incapacitated Dependent Child
Incapacitated Dependent Child means a child who, as a result of being mentally or physically challenged,
is permanently incapable of self-support and permanently dependent on a Primary Insured Person for
support and maintenance. The incapacity must have occurred while the child was:
1) under the age of nineteen (19); or
2) under the age of twenty five (25) if enrolled as a full-time student at an Institution of Higher
Learning.
BTA5718
17
Institution ofHigherLearning
Institution of Higher Learning means any accredited public or private college, university, professional
trade or vocational school beyond the twelfth (12th) grade.
BTA5724
Insured Person
Insured Person means a person, qualifying as a Class member under Section I of the Schedule of Benefits:
1) who elects insurance; or
2) for whom insurance is elected,
3) and on whose behalf premium is paid.
BTA5728
Leased Aircraft
Leased Aircraft means an aircraft not owned by the Policyholder, which is subject to a written lease
agreement between the Policyholder and the lessor. The Policyholder uses the aircraft as it wishes for the
term of the written lease agreement. The Policyholder cannot alter or sell the aircraft without the consent
of the lessor. Leased Aircraft does not include aircraft which are chartered for single trips.
BTA5730 (Ed. 7/06)
Loss
Loss means Accidental:
Loss of Foot
Loss of Hand
Loss of Hearing
Loss of Life
Loss of Sight
Loss of Sight of One Eye
Loss of Speech
Loss of Thumb and Index Finger
Total Loss of Use
Loss must occur within one (1) year after the Accident.
BTA5732
Loss of Foot
Loss of Foot means the complete severance of a foot through or above the ankle joint. We will consider
such severance a Loss of Foot even if the foot is later reattached. If the reattachment fails and amputation
becomes necessary, then We will not pay an additional Benefit Amount for such amputation.
BTA5734
18
Loss of Hand
Loss of Hand means complete severance, as determined by a Physician, of at least four (4) fingers at or
above the metacarpal phalangeal joint on the same hand or at least three (3) fingers and the thumb on the
same hand. We will consider such severance a Loss of Hand even if the hand, fingers or thumb are later
reattached. If the reattachment fails and amputation becomes necessary, then We will not pay an additional
Benefit Amount for such amputation.
BTA5736
Loss of Hearing
Loss of Hearing means permanent, irrecoverable and total deafness, as determined by a Physician, with
an auditory threshold of more than 90 decibels in each ear. The deafness cannot be corrected by any aid or
device, as determined by a Physician.
BTA5738
Loss of Life
Loss of Life means death, including clinical death, as determined by the local governing medical authority
where such death occurs within 365 days after an Accident.
BTA5740
Loss of Sight
Loss of Sight means permanent loss of vision. Remaining vision must be no better than 20/200 using a
corrective aid or device, as determined by a Physician.
BTA5742
Loss of Sight of One Eve
Loss of Sight of One Eye means permanent loss of vision of one eye. Remaining vision in that eye must
be no better than 20/200 using a corrective aid or device, as determined by a Physician.
BTA5744
Loss o eech
Loss of Speech means the permanent, irrecoverable and total loss of the capability of speech without the
aid of mechanical devices, as determined by a Physician.
BTA5748
Loss of Thumb and Index Finger
Loss of Thumb and Index Finger means complete severance, through the metacarpal phalangeal joints,
of the thumb and index finger of the same hand, as determined by a Physician. We will consider such
severance a Loss of Thumb and Index Finger even if a thumb, an index finger or both are later reattached.
If the reattachment fails and amputation becomes necessary, then We will not pay an additional Benefit
Amount for such amputation.
BTA5750
19
Medical Expense
Medical Expense means the Reasonable and Customary Charges for Medical Services for the care and
treatment of Accidental Bodily Injuries sustained in an Accident.
BTA5752
Medically Necessary
Medically Necessary means a medical or dental service, supply or course of treatment which:
1) is ordered or prescribed by a Physician;
2) is appropriate and consistent with the patient's diagnosis;
3) is in accord with current accepted medical or dental practice; and
4) could not be eliminated without adversely affecting the patient's condition.
BTA5758
Medical Services
Medical Services means Medically Necessary services, including but not limited to:
1) medical care and treatment by a Physician;
2) Hospital room and board and Hospital care, both inpatient and outpatient;
3) drugs and medicines required and prescribed by a Physician;
4) diagnostic tests and x-rays prescribed by a Physician;
5) transportation of an Insured Person in an emergency transportation vehicle from the
location where such Insured Person becomes injured to the nearest Hospital where
appropriate medical treatment can be obtained;
6) dental care and treatment due to Accidental Bodily Injury;
7) physical therapy, including diathermy, ultrasonic, whirlpool or heat treatment, adjustment,
manipulation, massage and the office visit associated with such therapy;
8) treatment performed by a licensed medical professional when prescribed by a Physician,
if hospitalization would have been otherwise required;
9) rental of durable medical equipment;
10) artificial limbs and other prosthetic devices;
11) orthopedic appliances or braces.
12) eyeglasses, contact lenses and other vision or hearing aids
BTA5760 (Ed. 7/06)
Operated Aircraft
Operated Aircraft means any aircraft not owned by the Policyholder but over which the Policyholder
exercises control. Operated Aircraft includes an aircraft for which the Policyholder pays operating expenses.
BTA5768
Other Plan
For Medical Services
Other Plan means any other group insurance or payment source for Medical Services, including any group
insurance and group subscriber contract, uninsured group or group type coverage group coverage through
20
health maintenance organizations and other prepayment group practice and individual practice plans, group
health coverage, Medicare or other government benefits except Medicaid, including automobile insurance
"fault" or "no-fault".
For Disability
Other Plan means disabilty insurance, worker's compensation insurance; or coverage provided or required
by any law or statute, employer sick leave or salary continuation plan, or similar benefit provided or required
by a governmental plan or program.
BTA5770IN
Owned Aircraft
Owned Aircraft means any aircraft to which the Policyholder holds legal or equitable title.
BTA5772
Physician
Physician means a licensed practitioner of the healing arts, acting within the scope of his or her license to
the extent provided by the laws of the jurisdiction in which medical treatment is provided. Physician does
not include:
1) an Insured Person;
2) an Immediate Family Member.
3) the Insured Person's employer or business partner.
4) the policyholder.
BTA5782
Policyholder
Policyholder means the entity identified in the Insuring Agreement.
BTA5786
Primary Insured Person
Primary Insured Person means an Insured Person who:
1) has a direct relationship with the Policyholder; and
2) where applicable, elects insurance under this policy.
BTA5790
Principal Sum
Principal Sum means the amount of insurance appearing in Section Iv -A of the Schedule of Benefits
applicable to each Class.
BTA5792
21
Proof of Loss
Proof of Loss means written evidence acceptable to Us that an Accident, Accidental Bodily Injury or
Loss has occurred.
BTA5794
Reasonable and Customary Charge
Reasonable and Customary Charge means the lesser of:
1) the usual charge made by Physicians or other health care providers for a given service or
supply; or
2) the charge We reasonably determine to be the prevailing charge made by Physicians or
other health care providers for a given service or supply in the geographical area where it
is furnished.
BTA5804
Repetitive Motion Injury
Repetitive Motion Injury means bursitis, stress fracture, strain, shin splints, Osgood Schlatter Disease,
Chondromalacia, stress fractures, tendinitis and Carpal Tunnel Syndrome.
BTA5609
Souse
Spouse means an Insured Person's husband or wife or who is recognized as such by the laws of the
jurisdiction in which the Primary Insured Person resides.
BTA5828
Subsidiary
Subsidiary means any organization in which:
1) more than 50% of the outstanding securities or voting rights representing the present right
to vote for election of directors is owned or controlled, directly or indirectly, in any
combination by the Policyholder; or
2) the Policyholder exercises management control.
BTA5832
Total Loss of Use
Total Loss of Use means the permanent and total inability to function of:
1) One Hand or One Foot;
2) Both Hands or Both Feet or a Combination of One Hand and One Foot;
3) One Arm or One Leg;
4) Both Arms or Both Legs or a Combination of One Arm and One Leg;
5) Both Arms and Both Legs,
as determined by a Physician, approved by Us.
BTA5852
22
War
War means:
1) hostilities following a formal declaration of War by a governmental authority;
2) in the absence of a formal declaration of War by a governmental authority armed, open
and continuous hostilities between two countries; or
3) armed, open and continuous hostilities between two factions, each in control of territory,
or claiming jurisdiction over the geographic area of hostility.
BTA5858IN
We, Us and Our
We, Us and Our means FEDERAL INSURANCE COMPANY.
BTA5860
Section VIII - General Provisions
Addition of New Insured Persons
Any new person who meets the eligibility criteria for the Class(es) described in Section I of the Schedule
of Benefits, Insured Persons, will automatically be an Insured Person under this policy.
BTA5150
Benefit Assignment
An Insured Person may assign Benefit Amounts other than those for Loss of Life. Such assignment must
be in writing, signed by the Insured Person and filed with the Policyholder. The assignment shall be
provided to Us at the time of claim or at such other time as We may require. We do not assume the
responsibility for the validity of any assignment.
BTA5154
Beneficiary
A) Designation
An Insured Person has the right to designate a beneficiary. The Primary Insured Person shall have the
sole right to designate a beneficiary for any Dependent Child who is a minor. All beneficiary designations
must be:
1) in writing;
2) filed with the Policyholder; and
3) provided to Us at the time of claim; or
4) at such other time as We may require
B) Change
The Insured Person, and no one else, unless there is an irrevocable assignment, has the right to change the
beneficiary except as set forth above. The Insured Person does not need the consent of anyone to do so.
All beneficiary changes must be:
23
1) in writing;
2) filed with the Policyholder; and
3) provided to Us at the time of claim or at such other time as We may require.
We do not assume any responsibility for the validity of these changes.
C) Payment
The Benefit Amount for covered Loss of Life will be paid to the beneficiary designated by an Insured
Person. Any Benefit Amount payable due to the Loss of Life of a Dependent Child or for an Insured
Person who is not competent to give a release will be paid to the parent or guardian.
If an Insured Person has not chosen a beneficiary or if there is no beneficiary alive when the Insured
Person dies, then We will pay the Benefit Amount for Loss of Life to the first surviving party in the
following order:
1) the Insured Person's Spouse;
2) in equal shares to the Insured Person's surviving children;
3) in equal shares to the Insured Person's surviving parents;
4) in equal shares to the Insured Person's surviving brothers and sisters;
5) the Insured Person's estate.
All other Benefit Amounts are paid to the Insured Person, unless otherwise directed by an Insured Person
or an Insured Person's designee, or unless otherwise noted in this policy.
BTA5158IN
Cancellation, Nonrenewal and Grace Period
A) Grace Period
The Policyholder is entitled to a grace period of forty-five (45) days from the premium due date for the
payment of premium due. This policy will continue in force during the grace period. The grace period does
not apply to the first premium payable during the policy term. Failure to pay the first premium on or before
the due date will immediately terminate this policy as of inception. We are not required to provide notification
of such termination.
BTA5160IN
B) Cancellation, Nonrenewal
The Policyholder may cancel this policy, or any of its individual insurance benefits, by sending Us written
notice stating when cancellation is to take effect. The effective date of cancellation may not be earlier than
the date notice is postmarked or transmitted.
We may cancel this policy, or any of its individual insurance benefits, if the Policyholder fails to pay the
premium within the grace period of forty-five (45) days after the premium due date. We will send written
notice stating the effective date of cancellation, which will be no earlier than thirty one (31) days after the
premium due date.
We may cancel this policy, or any of its individual insurance benefits, for reasons other than nonpayment
of premium by sending written notice stating when thereafter such cancellation shall take effect. If this is a
multi -year policy, then We may cancel the policy, or any of its individual insurance benefits, by sending
written notice at least forty-five (45) days prior to the Anniversary Date shown in the Insuring Agreement.
24
We may nonrenew this policy by sending written notice at least forty-five (45) days before the expiration
date of the Policy Period shown in the Insuring Agreement.
We will send notice of cancellation or nonrenewal to the Policyholder at its last known address. If the notice
is mailed, proof of mailing will be considered proof of cancellation or nonrenewal.
The Policyholder is required to immediately provide notice of cancellation or nonrenewal to all Insured
Persons.
The earned premium will be computed on a pro -rata basis. Any unearned premium will be returned to the
Policyholder as soon as practicable.
BTA5162IN
Certificate
When required by law, We will issue to the Policyholder for delivery to the Primary Insured Person a
Certificate of Insurance. The Certificate of Insurance will describe the benefits, exclusions, limitations, and
conditions of this policy and state to whom benefits are payable. Any subsequent changes to this policy will
also apply to the existing Certificates of Insurance.
BTA5164
Changes
This policy can only be changed by a written endorsement that becomes a part of this policy. The endorsement
must be approved by one of Our officers and signed by one of Our authorized representatives. No agent
has the authority to change this policy or waive any of its provisions.
BTA5166
Concealment or Fraud
Insurance under this policy is void if:
1) the Policyholder or any Insured Person has intentionally concealed or misrepresented any material
fact relating to this policy before or after a Loss; or
2) the Policyholder or any Insured Person files a false report of a Loss.
BTA5165
Compliance by Policyholder and Insured Person
We have no duty to provide insurance under this policy unless the Policyholder, the Insured Person and
the beneficiary, if applicable, have fully complied with all the terms and conditions of this policy.
BTA5168
Coordination of Benefits
This Coordination of Benefit provision does not apply to medical expenses resulting from disease or
illness.
When the Insured Person has coverage from more than one Plan, We coordinate benefits, with those
benefits payable by all other plans so that payments from these plans are not duplicated. This coordination
will be based on all Allowable Expenses. We will include in the calculation benefits a person could receive
for which he or she did not apply.
25
Allowable Expense means those necessary reasonable and customary expenses, covered at least in part by
one or more Plans for which the Insured Person has coverage. When a Plan provides benefits as a service
instead of a cash payment, the reasonable value of each service provided will be considered an Allowable
Expense and a benefit paid by This Plan.
Plan means group insurance and group subscriber contacts; uninsured arrangements of group or group -type
coverage; or group or group -type coverage through health maintenance organizations (HMOs) and other
prepayment, group practice, and individual practice plans.
Plan includes medical benefits coverage in group, group -type, and individual automobile "no fault" and
traditional automobile "fault" type contracts.
Plan may include Medicare or other governmental benefits, except a state plan under Medicaid.
Plan does not include the following:
Individual or family insurance contracts;
Individual or family subscriber contracts;
Individual or family coverage through health maintenance organizations.
Individual or family coverage under other prepayment, group practice, and individual practice
plans.
Group or group -type hospital indemnity benefits of one hundred dollars ($100) per day or less.
School accident -type coverage covering grammar, high school, and college students for accidents
only, including athletic injuries, either on a twenty-four (24) hour basis or on a to and from school
basis.
A state plan under Medicaid, or plan when, by law, its benefits are in excess of those of any private
insurance plan or other non -government plan.
Each contract or other arrangement for coverage is a separate Plan. Also, if an arrangement has two parts
and COB rules apply only to one of the two, each of the parts is a separate Plan.
Primary Plan means a Plan which pays Allowable Expenses regardless of the existence of any other Plan.
Secondary Plan means any Plan which is not considered a Primary Plan.
This Plan means the medical or dental benefits provided by this policy.
Claim Determination Period means a calendar year. However, it does not include any part of a year during
which a person has no coverage under This Plan, or any part of a year before the date this COB provision
or a similar provision takes effect.
Order of Benefit Rules
To apply this provision We must first determine whether a Plan is considered a Primary Plan or a Secondary
Plan. This is done by applying the Order of Benefit Rules in sequence. Once a Plan is determined to be a
Primary Plan all other Plans are Secondary Plans.
A Plan is always considered a Primary Plan if it does not have a COB provision or has a COB provision
which is different than this one.
When all Plans have the same COB provision, then the Plan which covers a person as an active
employee is the Primary Plan.
The Plan which covers a Dependent Spouse as an active employee is the Primary Plan. If he or she
has no coverage, then his or her spouse's Plan is the Primary Plan.
When parents are not separated or divorced, the Plan which covers the Child of the parent whose
birthday falls earlier in the year is the Primary Plan. If, however the birthday of both parents fall on
26
the same date, the Plan which covered the parent for the longer period of time becomes the Primary
Plan. The parents' year of birth is not relevant in this determination.
When the other Plan's COB provision does not contain this rule, but instead has a rule based on the
parent's gender, and as a result the Plans do not agree, then the Plan with "Gender Rule" becomes the
Primary Plan.
When parents are separated or divorced, the Plan which covers the parent with custody of the Child
is the Primary Plan. If that parent has no coverage then the Plan of that parent's spouse (the stepparent)
becomes the Primary Plan. If neither of these parents have coverage, then the Plan of the parent
without custody of the child becomes the Primary Plan.
This rule does not apply, however, when a court decree establishes financial responsibility for the
child's health or dental care. Then the rule above will determine which Plan is the Primary Plan.
When a Plan covers a person as a laid off or retired employee, then that Plan is the Secondary Plan
for that person as well as for their covered Dependents. When the other Plan does not have this rule
and as a result the Plans do not agree then we ignore this rule.
When no rule described above determines an order of benefit payment the Plan which covers the person
for the longest period of time becomes the Primary Plan.
When This Plan is the Primary Plan We pay This Plan's benefit as if all other Plans did not exist. When
This Plan is a Secondary Plan, however we pay a reduced benefit which when added to the benefit paid
by all other Plans will be no more than 100% of all Allowable Expenses.
As a Secondary Plan We apply only the actual reduced portion of the benefit We pay against any Maximum
Benefit provision.
Additionally the difference between what We would have paid, had We not coordinated benefits and the
amount of the benefit We do pay is accumulated by Us. We then use this accumulated amount to pay
Allowable Expenses which are not covered by This Plan. This might include but is not limited to Deductibles,
copayments, coinsurance amounts and other charges not paid.
In order to obtain all benefits available, an Insured Person must file a claim under each Plan. In any event
no Plan is liable for more than the benefits it would have paid had a COB provision not been applied.
Right to Information
We have the right to decide what facts We need to coordinate benefits. We may get this information from
or give them to any other Plan. We do not have to tell or get consent of any person to do this. If We request
it an Insured Person must provide Us with any information We need to pay a claim.
Payment Recovery
If a Plan makes a payment which should have been paid by This Plan, We may reimburse the Plan which
made the payment. This payment will then be treated as if it were a benefit paid by this Plan and will not
be paid again.
Should We make a payment, however which is actually payable by another Plan, then We have the right
to recover that excess amount from the person to whom the payments were made or from any other Plan.
BTA5169IN
Claim Notice
Written Claim Notice must be given to Us or any of Our brokers or appointed agents within twenty (20)
days after the occurrence or commencement of any Loss covered by this policy or as soon as reasonably
possible. Notice must include enough information to identify the Insured Person and Policyholder. Failure
27
to give Claim Notice within twenty (20) days will not invalidate or reduce any otherwise valid claim if
notice is given as soon as reasonably possible.
BTA5170
Claim Forms
When We receive notice of a claim, We will send the Insured Person or the Insured Person's designee,
within fifteen (15) days, forms for giving Proof of Loss to Us. If the Insured Person or the Insured Person's
designee does not receive the forms, then the Insured Person or an Insured Person's designee should send
Us a written description of the Loss. This written description should include information detailing the
occurrence, type and extent of the Loss for which the claim is made.
BTA5172
Claim Proof of Loss
For claims involving disability, complete Proof of Loss must be given to Us within ninety (90) days after
commencement of the period for which We are liable. Subsequent written proof of the continuance of such
disability must be given to Us at such intervals as We may reasonably require.
For all claims except those involving disability, complete Proof of Loss must be given to Us within ninety
(90) days after the date of Loss, or as soon as reasonably possible.
Failure to give complete Proof of Loss within these time frames will not invalidate or reduce any otherwise
valid claim if notice is given as soon as reasonably possible.
BTA5174IN
Claim Payment
For benefits payable involving disability, We will pay the Insured Person the applicable Benefit Amount
no less frequently than monthly during the period for which We are liable. All payments by Us are subject
to receipt of complete Proof of Loss.
For all benefits payable under this policy except those for disability, We will pay the Insured Person or
beneficiary the applicable Benefit Amount immediately after We receive complete Proof of Loss.
The Benefit Amount for covered Loss of Life will be paid to the beneficiary designated by an Insured
Person. Any Benefit Amount payable due to the Loss of Life of a Dependent Child or for an Insured
Person who is not competent to give a valid release will be paid to the parent or guardian.
If an Insured Person has not chosen a beneficiary or if there is no beneficiary alive when the Insured
Person dies, then We will pay the Benefit Amount for Loss of Life to the first surviving party in the
following order:
1) the Insured Person's Spouse ;
2) in equal shares to the Insured Person's surviving children;
3) in equal shares to the Insured Person's surviving parents;
4) in equal shares to the Insured Person's surviving brothers and sisters;
5) the Insured Person's estate;
All other Benefit Amounts are paid to the Insured Person, unless otherwise directed by an Insured Person
or an Insured Person's designee, or unless otherwise noted in the policy.
BTA5176IN
28
Claim and Suit Cooperation
In the event of a claim under this policy, the Policyholder, the Insured Person, if applicable, must fully
cooperate with Us in Our handling of the claim, including, but not limited to, examinations under oath, the
timely submission of all medical and other reports, production of all records and documents requested by
Us and permission to make copies of such records or documents, and full cooperation with all physical
examinations and autopsies that We may require. If We are sued in connection with a claim under this
policy, then the Policyholder, the Insured Person must fully cooperate with Us in the handling of such
suit. The Policyholder, the Insured Person must not, except at their own expense, voluntarily make any
payment or assume any obligation in connection with any suit without Our prior written consent.
BTA5178IN
Entire Contract and Application
This policy, the Policyholder's application and the Primary Insured Person's application, if any, together
with the endorsements attached to this policy, constitute the entire contract of insurance. If an application
is completed by the Policyholder or Primary Insured Person in connection with this policy, then We will
attach the application to the policy when the policy is issued.
BTA5182
Governing Jurisdiction and Conformance With Statutes
This policy is governed by the laws of the jurisdiction in which it is delivered to the Policyholder. Any
terms of this policy which are in conflict with the applicable statutes, laws or regulations of the jurisdiction
in which this policy is delivered are amended to conform to such statutes, laws or regulations. Any terms
of a certificate which are in conflict with the applicable statutes, laws or regulations of the jurisdiction in
which the certificate is delivered are amended to conform to the statutes, laws or regulations of the jurisdiction.
BTA5184 (Ed. 7/06)
Inadvertent Error
The insurance provided under this policy will not be prejudiced by the failure on the part of the Policyholder
to transmit reports, collect and remit premium or comply with any of the terms and conditions of this policy
when such failure is due to an inadvertent error or clerical mistake, provided that such inadvertent error or
clerical mistake is corrected promptly upon discovery.
An inadvertent error or clerical mistake by Us or by the Policyholder may be corrected upon discovery with
notice by the Policyholder to Us or by Us to the Policyholder.
BTA5I86
Informational and Advertising Material
The Policyholder and its representatives must gain Our prior written approval of all material used for
advertising and solicitation relating to this policy, regardless of the medium in which such material appears.
We will not be responsible for any increase in payment or any changes in insurance resulting from such
materials that have not been approved by Us.
BTA5188
29
Legal Action Against Us
No legal action may be brought to recover on this policy until sixty (60) days after We have been given
complete Proof of Loss. No such action may be brought after three (3) years from the time complete Proof
of Loss is required to be given. No such action may be brought unless there has been full compliance with
all of the terms of this policy.
In no case will We be liable for benefits that are not payable under the terms of this policy or that exceed
the applicable Benefit Amounts or limits of insurance of this policy.
BTA5190
Liberalization
If We adopt any changes:
1) within forty-five (45) days prior to the policy effective date shown in the Insuring
Agreement; or
2) during the Policy Period,
which broaden this insurance without an additional premium charge, then the Insured Person will
automatically receive the benefit of the broadened insurance.
BTA5192
Newly Acquired or Newly Formed Organizations
If the Policyholder acquires or forms another entity that becomes a Subsidiary, then at the Policyholder's
request, We will enroll all eligible employees of such Subsidiary as soon as possible subject to the following
requirements:
1) all eligible employees of such Subsidiary fit the Class Description shown in Section I
of the Schedule of Benefits;
2) the Subsidiary is acquired or formed during the Policy Period;
3) the Policyholder reports the name of the Subsidiary within ninety (90) day(s) after its
acquisition or formation together with such information that We at our sole discretion
may require to determine the additional premium; and
4) the Policyholder pays the additional required premium.
Item three (3) above does not apply to a Subsidiary with less than 100 eligible employees unless the number
of eligible employees for such Subsidiary exceeds ten percent (10%) of the insured group.
This insurance does not apply if the Policyholder advises Us in writing that it does not seek insurance under
this policy for such newly acquired or formed Subsidiary.
BTA5194
Physical Examination and Autopsy
We have the right to have an Insured Person examined by a Physician approved by Us, as often as
reasonably necessary while a claim is open. We may also have an autopsy done by a Physician, unless
prohibited by law. Any examinations or autopsies that We require will be done at Our expense.
BTA5193
30
Premium Payment
The Policyholder will collect and remit to Us all premium due under this policy, subject to the grace period.
Premium is adjustable. The earned premium is calculated for each reporting period based on the applicable
rates and exposures. The Policyholder must keep records of the information We need to calculate the
premium and send Us copies of these records for each reporting period.
The earned premium will be computed on a pro -rata basis. Any unearned premium will be remitted to the
Policyholder as soon as practicable.
BTA5196
Premium Provisions
The Policyholder will pay all required premium due under this policy, subject to the grace period. Annual
Premiums and Deposit Premiums are due at the beginning of the Policy Period and each future Anniversary
Date unless otherwise indicated on the Premium Summary.
If premiums are adjustable, then We will compute the earned premium for each audit reporting period based
on the applicable rates and exposures. The Policyholder must keep records of the information We need to
perform the adjustment and send Us copies at Our request.
If the policy is written subject to adjustment shown in the Premium Schedule, then the Policyholder must
report to Us the complete information for the reporting period shown in the Premium Summary. The
Policyholder must submit the reports within the specified number of days after the end of each Reporting
Period.
At the earlier of the end of the Policy Period or the policy termination, earned premium will be determined
based on the reported values or exposures. If the resulting earned premium is less than the Deposit Premium,
if any, then We will return the excess to the Policyholder. If the resulting earned premium is greater than
the Deposit Premium, if any, then We will bill the Policyholder for the additional premium. The Policyholder
will pay Us, within thirty (30) days, any additional premium generated from the premium adjustment.
BTA5197
Premium Rate Change
We may change the premium rates for this policy on the Anniversary Date. We will give the Policyholder
at least forty five (45) days prior written notice of such change.
BTA5198
Records and Audit
We may examine the Policyholder's books and records relating to this policy at any reasonable time during
the policy term and up to three (3) years after expiration of this policy or until final adjustment and settlement
of all claims under this policy, whichever is later.
The Policyholder must maintain information pertaining to Insured Persons including but not limited to
each Insured Person's Benefit Amount, Class, Salary, enrollment form, if any, and beneficiary designations
or assignments.
BTA5204
31
Statements by Policyholder or Insured Person and Incontestability
We will not use any statements, except fraudulent misstatements, made by the Policyholder or the Insured
Person to void the insurance or reduce benefits payable under this policy, or to otherwise contest the validity
of this policy, unless such statements are contained in a written document signed by the Policyholder or
the Insured Person. If We rely on such statements for this purpose, then We will provide a copy of the
written document to the Policyholder, the Insured Person or the Insured Person's designee or beneficiary,
as appropriate.
We will consider all statements made by the Policyholder and the Insured Person to be representations
and not warranties.
Except for nonpayment of premium, We will not use statements made by the Policyholder or the Insured
Person regarding insurability to contest the validity of this policy when the statements are made more than
two (2) years after this policy has been in force during the Insured Person's lifetime.
Nothing in this section will preclude Us from asserting at any time defenses based upon a claimant's
ineligibility for insurance under this policy, or upon any other policy provision or condition.
BTA5206
Titles of Paragraphs
The titles of the various paragraphs of this policy and any endorsements attached to this policy are inserted
solely for convenience of reference and do not limit or affect in any way the provisions to which they relate.
BTA5208
Workers' Compensation
The benefits payable under this policy are not in lieu of and do not affect any requirement for workers'
compensation insurance.
BTA5210
32
NOTICE TO POLICYHOLDERS REGARDING FILING COMPLAINTS
WITH THE DEPARTMENT OF INSURANCE
Questions regarding your Policy or coverage should be directed to:
Federal Insurance Company
202 Hall's Mill Road
Whitehouse Station, New Jersey 08889
1 877 297 4225
If you (a) need the assistance of the governmental agency that regulates insurance; or (b) have a complaint
you have been unable to resolve with your insurer you may contact the Department of Insurance by mail,
telephone or email:
State of Indiana
Depat Intent of Insurance
Consumer Insurance Division
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204
Consumer Hotline (800) 622 4461; (317) 232 2395
Complaints can be filed electronically at www.in.gov/idoi
4022
33
CHUBS
Summary of the Indiana and Health Insurance
Association Guarantee Act and Notice
SUMMARY DOCUMENT
The Indiana Life and Health Insurance Guaranty Association provides coverage of claims under some
types of policies if the insurer becomes impaired or insolvent. COVERAGE MAY NOT BE AVAILABLE
FOR YOUR POLICY. Even if coverage is provided, there are significant limits and exclusions. Coverage
is always conditioned on residence in this state. Other conditions may also preclude coverage.
The Indiana Life and Health Insurance Guaranty Association will respond to any questions you may have
which are not answered by this document. Your insurer and agent are prohibited by law from using the
existence of the association or its coverage to sell you an insurance policy.
You should not rely on availability of coverage under the Indiana Life and Health Insurance Guaranty
Association when selecting an insurer.
You may contact the Indiana Life and Health Insurance Guaranty Association as follows:
Indiana Life and Health Insurance Guaranty Association
251 E. Ohio Street Suite 1070
Indianapolis, IN 46204
(317)636-8204
www.inlifega
You may contact the Indiana Department of Insurance as follows:
Indiana Department of Insurance
311 W. Washington Street
Indianapolis, IN 46204
(317) 232-2385
www.in. og vidoi
4025
34
PRIVACY POLICY AND PRACTICES
THIS NOTICE IS BEING SENT TO THE MASTER POLICYHOLDER OF A GROUP INSURANCE
POLICY. IT DESCRIBES CHUBB'S POLICY FOR HANDLING CERTAIN PERSONAL
INFORMATION OF ITS INDIVIDUAL CUSTOMERS.
Chubb has been serving the insurance needs of our customers for more than a century. To continue to provide
innovative products and services that respond to your insurance needs, Chubb collects certain personal
information about you, which is described below in The Personal Information We Collect. At Chubb, we
respect the privacy of our customers. We do not sell or share our customer lists with anyone else for the
purpose of marketing their products to you. Chubb's personal information handling practices are regulated
by law, and this Privacy Policy describes those practices.
The Personal Information We Collect . Chubb collects personal information about you and the members
of your household to conduct business operations, provide customer service, offer new products, and satisfy
legal and regulatory requirements.
We may collect the following categories of information about you from these sources:
Information from you directly or through your agent, broker, or, automobile assigned risk plan, including
information from applications, worksheets, questionnaires, claim forms or other documents (such as
name, address, driver's license number, and amount of coverage requested).
Information about your transactions with us, our affiliates or others (such as products or services
purchased, claims made, account balances and payment history).
Information from a consumer reporting agency (such as motor vehicle reports).
Information from other non -Chubb sources (such as prior loss information and demographic information).
Information from visitors to our websites (such as that provided through online forms and online
information collecting devices known as "cookies"). Chubb does not use "cookies" to retrieve information
from a visitor's computer that was not originally sent in a "cookie".
Information from an employer, benefit plan sponsor, benefit plan administrator or master policyholder
for any Chubb individual or group insurance product that you may have (such as name, address and
amount of coverage requested).
The Personal Information We Share . Chubb may disclose the personal information we collect to service,
process, or administer business operations such as underwriting and claims and for other purposes such as
the marketing of products or services, regulatory compliance, the detection or prevention of fraud, or as
otherwise required or allowed by law. These disclosures may be made without prior authorization from you,
as permitted by law.
Sharing Personal Information With Others . Chubb may disclose the personal information we collect to
affiliated and non-affiliated parties for processing and servicing transactions, such as reinsurers, insurance
agents or brokers, property and automobile appraisers, auditors, claim adjusters, third party administrators
and, in the case of group insurance, employers, benefit plan sponsors, benefit plan administrators or master
policyholders. For example, Chubb may disclose personal information to our affiliates and other parties that
perform services for us such as customer service or account maintenance. Specific examples include mailing
information to you and maintaining or developing software for us. Chubb may also disclose personal
information to nonaffiliated parties as permitted by law. For example, we may disclose information in
response to a subpoena, to detect or prevent fraud, or to comply with an inquiry or requirement of a
government agency or regulator.
Sharing Personal Information With Service Providers or for Joint Marketing . Chubb may disclose
the personal information we collect to agents and brokers so that they can market our financial products and
services and to service providers who perform functions for us. Any such disclosure is required to be subject
to an agreement with us that includes a confidentiality provision. We do not disclose personal information
35
to other financial institutions with which we may have joint marketing arrangements; however, we reserve
the right to do so in the future, subject to the other financial institution entering into an agreement with us
that includes a confidentiality provision.
Confidentiality and Security of Personal Information . Access to personal information is allowed for
business purposes only. The people who have access to personal information, including employees of Chubb
and its affiliates, and non -employees performing business functions for Chubb, are under obligations to
safeguard such information. Chubb maintains physical, electronic, and procedural safeguards to guard your
personal information
Personal Health Information . Under certain circumstances, we also collect personal health information
about our customers, such as information regarding an accident, disability or injury, for underwriting or
claim purposes. Chubb does not disclose your personal health information for marketing purposes unless
we have your express consent.
Personal Information of Former Customers . Chubb's personal information privacy policy also applies
to former customers.
Changes in Privacy Policy . Chubb may choose to modify this policy at any time. We will notify customers
of any modifications at least annually.
Definitions.
"Chubb" means the following companies on whose behalf this notice is given:
Chubb & Son Inc.
Chubb & Son Inc. (of Illinois)
Chubb Custom Insurance Company
Chubb Custom Market, Inc.
Chubb Indemnity Insurance Company
Chubb Insurance Company of New Jersey
Chubb Lloyds Insurance Company of Texas
Chubb Multinational Managers, Inc.
Chubb National Insurance Company
Executive Risk Indemnity Company
Executive Risk Specialty Insurance Company
Federal Insurance Company
Great Northern Insurance Company
Northwestern Pacific Indemnity Company
Pacific Indemnity Company
Quadrant Indemnity Company
Texas Pacific Indemnity Company
Vigilant Insurance Company
"Customer" and "you" mean any individual who obtains or has obtained a financial product or service from
Chubb that is to be used primarily for personal, family or household purposes. This notice applies to customers
only.
"Personal information" means non-public personal information, which is defined by law as personally
identifiable financial information provided by you to Chubb, resulting from a transaction with or any service
performed for you by Chubb, or otherwise obtained by Chubb. Personal information does not include publicly
available information as defined by applicable law.
Chubb Group of Insurance Companies
Accident Benefits and Life Department
Attention: Privacy Inquiries
202 Hall's Mill Road, P.O. Box 1600
Whitehouse Station, New Jersey, 08889-1600
Form 44-02-2087 (Ed. 9/08)
36
r
6Huan
Federal Insurance Company
peclat Risk' ante App
bcatio
Section I Policyholder Information
Name of Policyholder: ACADEMY OF MODEL AERONAUTICS
Address 5151 E MEMORIAL DR
City MUNCIE State IN Zip Code 47302
Phone Number:
Contact Name:
Effective Date: 01/01/2012
Policy Number: 9906-03-58
A) CLASS OF S t REII° ERSO\
1 All members of the polieyholde
B) PRINCIPAL-SUIV
1 $10,000
C), HAZARD .:
1 Covered Activities
INSURANCE REQUESTED
in good standing, excluding park pilo
D) ACCIDENTAL DEATH AND DISMEivIBEI
Class
All
Accidental:
Loss of Life
Loss of Speech and Loss of Hearing
Loss of Speech and one of Loss of Hand, Loss of Foot or Loss of Sight of One Eye 100%
Loss of Hearing and one of Loss of Hand, Loss of Foot or Loss of Sight of One Eye 100%
Loss of Hands(Both), Loss of Feet(Both), Loss of Sight or a combination of any two of Loss100%
of Hand, Loss of Foot or Loss of Sight of One Eye
Loss of Hand, Loss of Foot or Loss of Sight of one Eye (Any one of each)
Loss of Speech or Loss of Hearing
Loss of Thumb and Index Finger of the same Hand
E) ADDITIONALGENE
Benefit Amounts (Percentage of
Principal Sum)
100%
100%
50%
50%
25%
CLASS
BENEFIT
BENEFIT AMOUNT
1
Accident Medical Expense
$25,000
Deductible $750
Dental Benefit Amount $250
1
Total Loss Of Use
$10,000
Loss of Use of: % of Principal Sum
One Hand or One Foot 25%
Both Hands or Both 50%
Feet or a Combination
of One Hand and One
Foot
One Arm or One Leg 50%
Both Arms or Both 100%
Legs or a
Combination of One
Arm and One Leg
Both Arms and Both 100%
Legs
Elimination Period 365 days
Aggregate Limit of Insurance
The Aggregate Limit of Insurance applies:
$250,000 per Accident
Employee Retirement Income Security Act
Is this plan subject to Employee Retirement Income Security Act (ERISA) regulations? (Y/N)
Policy Acceptance
The undersigned declares that all information provided in this application and any attachments hereto is true and correct. The undersigned
understands that all information provided in this application and any attachments hereto is material to the insurer's decision to provide
this insurance, and that insurance will be provided, at the insurer's sole discretion, in reliance upon the truth of such information. It is
hereby agreed and understood this insurance is provided by the Company in consideration of payment of the required premium. The
insurance under the policy begins on the Effective Date shown in the Insuring Agreement of the policy. The acceptance of the policy
terminates any prior policy of the same policy number, effective with the inception of the policy.
raud Warning
Any person who, knowingly and with intent to defraud any insurance company or other person, files an application for insurance
containing any false information, or conceals for the purpose of misleading, information concerning any material fact thereto,
commits a fraudulent insurance act, which is a crime.
Name of Policyholder:
Date
BT 3000 APP (Rev. 09/2006)
Signature
Q
Title
Company Authorized Representative
IriOO-EL f4V1f�TIOn
STUO-51CL.U-El
Academy of Model Aeronautics
5161 East Memorial Drive, Muncie, IN 47302
Phone (765) 287-1256, FAX (765) 289-4248
www.modelaircraft.org
193( 752011
AMA
ACADEMY OF MODEL AERONAUTICS
Academy of Model Aeronautics Liability Insurance Program for Site Owners
The AMA General Liability Insurance Program insuring AMA, members, and clubs for liability
resulting from aeromodeling activities includes broad and unique coverage for flying site
owners. AMA recognizes the importance of providing site owners with insurance to protect them
for potential liability for injury or damage resulting from club activities on a flying site and has
negotiated a custom policy with a major insurer to provide such coverage.
This policy has special coverage provisions for site owners as follows:
1. Westchester Surplus Lines Insurance Company has an A.M. Best rating of A+ XI and is a
member of the ACE USA Group, a large insurance organization with an A.M. Best rating
of A+ XV.
2. Authorization for AMA to issue certificates of insurance naming site owners as additional
insured. This is the equivalent of issuing an endorsement to the policy and assures the site
owner of coverage equal to coverage for AMA, its members, and clubs.
3. Site owner's coverage is primary. This means that the AMA policy pays on the site
owner's behalf without involvement of the site owner's own insurance.
4. Acts voiding coverage by any other insured may not apply to site owners. Should an
AMA member or club either do something, or fail to do something that voids coverage
for that member or club, the site owner still could have coverage under this policy.
5. Contractual liability coverage. This coverage clause reinforces the club's contractual
obligations (if any) to indemnify and hold harmless the site owner for injury or damage in
connection with the club's use of the site.
6. The $2,500,000 aggregate limit of liability applies per location (flying site). This limit of
liability usually exceeds the site owner's requirements and the per location aggregate
means the site owner does not share the limit with other site owners. It has the effect of a
separate policy for each site owner.
7. The insurer must give AMA 90 days notice of cancellation or non -renewal. This allows
ample time for AMA to replace the coverage and to notify certificate holders of the
change in coverage. AMA pays the entire annual premium at the beginning of the policy
year so the policy cannot be cancelled for nonpayment.
While this policy provides very broad coverage, as with any policy, there are limitations and
exclusions. The actual policy should be reviewed and site owners may want to consult their
insurance agent, insurance advisor, or risk manager.
Coverage questions must be directed to AMA Headquarters in Muncie, Indiana; (765) 287-1256,
ext. 251.
ACO
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM1DD/TYYY)
2/28/2013
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
The Harry A. Koch Co.
P.O. Box 45279
Omaha NE 68145-0279
INSURED
Academy of Model Aeronautics, Inc.
&/or Affiliated &/or Associated Chartered
Clubs, Chapters & Members Thereof
5161 E. Memorial Drive
Muncie IN 47302
C NTACT
NAME:
PHONE
(AIC. No. Ext):402-861-7000
E-MAIL
ADDRESS:
1 FAX
(A/C. No):
INSURER(S) AFFORDING COVERAGE
INSURER A :Westchester Surplus Lines Insurance
INSURER B:
NAIL!
10172
INSURER C:
INSURER D:
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER: 29080832
REVISION NUMBER:
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.
LTRR TYPE OF INSURANCE A� SUBR
POLICY NUMBER POLICY EFF POLICY EXP LIMITS
(MM10D/YYYY) (MMlDD/YYYY)
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
`CLAIMS -MADE X OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
IPOLICY n J� LOC
Y
Y
G22011534008
3/31/2013
3/31/2014
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$1,000,000
MED EXP (Any one person)
PERSONAL & ADV INJURY
$300,000
$0
$1,000,000
GENERAL AGGREGATE
$1,000,000
PRODUCTS - COMP/OP AGG
$1,000,000
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AU fOS
SCHEDULED
AUTOS
NON -OWNED
AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
(Per accident)
UMBRELLA LIAR
EXCESS LIAB
DED n RETENTION $
OCCUR
CLAIMS -MADE
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
YIN
N
EACH OCCURRENCE
AGGREGATE
TORY LIM S i I ER
El. EACH ACCIDENT
El. DISEASE - EA EMPLOYEE
E.L. DISEASE- POLICY LIMIT
A
Excess Liability
Y
Y
022011546008
3/31/2013
3/31/2014
Limits per Occ $1,500,000
General Aggregate $4,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Drake Family Partnership, LLLP is an additional insured, primary and non-contributing as respects to any additional insured site owner.
Location: APPROXIMATELY 1/2 MILE SOUTH EAST RESIDENCE 40 34.54 N 104 49.10 W Club: 2356 LOVE -AIR R/C INC
CERTIFICATE HOLDER
CANCELLATION
Drake Family Partnership, LLLP
10010 Highway 14
Ault CO 80610
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
Academy of Model Aeronautics National Model Aircraft Safety Code
Effective January 1, 2011
A. GENERAL: A model aircraft is a non -human -carrying aircraft capable of sustained flight in the atmosphere. It may not exceed limitations of this code and is
intended exclusively for sport, recreation and/or competition. All model flights must be conducted in accordance with this safety code and any additional
rules specific to the flying site.
1. Model aircraft will not be flown:
(a) In a careless or reckless manner.
(b) At a location where model aircraft activities are prohibited.
2. Model aircraft pilots will:
(a) Yield the right of way to all man carrying aircraft.
(b) See and avoid all aircraft and a spotter must be used when appropriate. (AMA Document #540 -D -See and Avoid Guidance.)
(c) Not fly higher than approximately 400 feet above ground level within three (3) miles of an airport, without notifying the airport operator.
(d) Not interfere with operations and traffic patterns at any airport, heliport or seaplane base except where there is a mixed use agreement.
(e) Not exceed a takeoff weight, including fuel, of 55 pounds unless in compliance with the AMA Large Model Aircraft program. (AMA Document 520-A)
(f) Ensure the aircraft is identified with the name and address or AMA number of the owner on the inside or affixed to the outside of the model aircraft.
(This does not apply to model aircraft flown indoors).
(g) Not operate aircraft with metal -blade propellers or with gaseous boosts except for helicopters operated under the provisions of AMA Document #555.
(h) Not operate model aircraft while under the influence of alcohol or while using any drug which could adversely affect the pilot's ability to safely control
the model.
(i) Not operate model aircraft carrying pyrotechnic devices which explode or burn, or any device which propels a projectile or drops any object that
creates a hazard to persons or property.
Exceptions:
Free Flight fuses or devices that burn producing smoke and are securely attached to the model aircraft during flight.
Rocket motors (using solid propellant) up to a G -series size may be used provided they remain attached to the model during flight. Model rockets
may be flown in accordance with the National Model Rocketry Safety Code but may not be launched from model aircraft.
Officially designated AMA Air Show Teams (AST) are authorized to use devices and practices as defined within the Team AMA Program
Document (AMA Document #718).
(j) Not operate a turbine -powered aircraft, unless in compliance with the AMA turbine regulations. (AMA Document#510-A).
3. Model aircraft will not be flown in AMA sanctioned events, air shows or model demonstrations unless:
(a) The aircraft, control system and pilot skills have successfully demonstrated all maneuvers intended or anticipated prior to the specific event.
(b) An inexperienced pilot is assisted by an experienced pilot.
4. When and where required by rule, helmets must be properly worn and fastened. They must be OSHA, DOT, ANSI, SNELL or NOCSAE approved or
comply with comparable standards.
B. RADIO CONTROL (RC)
1. All pilots shall avoid flying directly over unprotected people, vessels, vehicles or structures and shall avoid endangerment of life and property of others.
2. A successful radio equipment ground -range check in accordance with manufacturer's recommendations will be completed before the first flight of a new or
repaired model aircraft.
3. At all flying sites a safety line(s) must be established in front of which all flying takes place (AMA Document #706 -Recommended Field Layout):
(a) Only personnel associated with flying the model aircraft are allowed at or in front of the safety line.
(b) At air shows or demonstrations, a straight safety line must be established.
(c) An area away from the safety line must be maintained for spectators.
(d) Intentional flying behind the safety line is prohibited.
4. RC model aircraft must use the radio -control frequencies currently allowed by the Federal Communications Commission (FCC). Only individuals properly
licensed by the FCC are authorized to operate equipment on Amateur Band frequencies.
5. RC model aircraft will not operate within three (3) miles of any pre-existing flying site without a frequency -management agreement (AMA Documents #922 -
Testing for RF Interference; #923- Frequency Management Agreement)
6. With the exception of events flown under official AMA Competition Regulations, excluding takeoff and landing, no powered model may be flown outdoors
closer than 25 feet to any individual, except for the pilot and the pilot's helper(s) located at the flight line.
7, Under no circumstances may a pilot or other person touch a model aircraft in flight while it is still under power, except to divert it from striking an individual.
This does not apply to model aircraft flown indoors.
8. RC night flying requires a lighting system providing the pilot with a clear view of the model's attitude and orientation at all times.
9. The pilot of a RC model aircraft shall:
(a) Maintain control during the entire flight, maintaining visual contact without enhancement other than by corrective lenses prescribed for the pilot.
(b) Fly using the assistance of a camera or First -Person View (FPV) only in accordance with the procedures outlined in AMA Document #550.
C. FREE FLIGHT
1. Must be at least 100 feet downwind of spectators and automobile parking when the model aircraft is launched.
2. Launch area must be clear of all individuals except mechanics, officials, and other fliers.
3, An effective device will be used to extinguish any fuse on the model aircraft after the fuse has completed its function,
D. CONTROL LINE
1. The complete control system (including the safety thong where applicable) must have an inspection and pull test prior to flying.
2. The pull test will be in accordance with the current Competition Regulations for the applicable model aircraft category.
3. Model aircraft not fitting a specific category shall use those pull -test requirements as indicated for Control Line Precision Aerobatics.
4. The flying area must be clear of all utility wires or poles and a model aircraft will not be flown closer than 50 feet to any above -ground electric utility lines.
5. The flying area must be clear of all nonessential participants and spectators before the engine is started.
Academy of Model Aeronautics
5161 East Memorial Drive
Muncie, Indiana 47302
(765) 267-1256 — Business
(765) 289-4248 — Fax
(800) 435-9262 — Membership Services
http://www.modelaircraft.org
tat gaer
1
AMA
SINCE 1936
FLYING SITE SAFETY AND
OPERATIONAL RULES
The Official AMA National Model Aircraft Safety Code is a
basic document for ALL AMA chartered clubs. Every member
should be familiar with the Safety Code, and new members should
receive instruction about this code.
Each club should also develop a carefully structured set of
rules for their club's flying site. These rules should cover two (2)
areas:
1) Safety rules for actual flying, and
2) Operational rules which include items concerning
times of operation, penults required, emergency
numbers, etc.
Following is a generic sample of a set of rules designed to
supplement the required current Official AMA National Model
Aircraft Safety Code. This example is not intended to represent the
specific needs of all flying sites. It is, rather, intended to be a guide
to help each club develop rules which specifically meet the
individual site situation.
CXPDF\535-B.doc 03/2008 IM
FLYING SITE SAFETY RULES
1. Deliberate flying behind the safety line is prohibited.
2. Each transmitter must display frequency identification.
3. Taxiing is not allowed in the pit area.
4. It is strongly recommended that members do not fly alone.
5. Children should not be permitted beyond the spectator area unless under the direct
supervision of an adult or under flight instruction.
6. The established club frequency control plan will be in force at all times.
7. Control line equipment shall be inspected before the initial flight each day.
8. Helicopter flights are allowed in designated areas only.
9. Sailplane high start lines are to run parallel to active runway.
10. Direction of flight is determined by the wind direction, etc.
11. Flight operations will stop during electrical storms.
12. Models will fly only in predesignated areas, and will yield right-of-way to full-size
aircraft.
FLYING SITE OPERATIONAL RULES
1. NO flying before 9:00 a.m.
2. Only pilots and assistants are allowed on the safety line.
3. Mufflers are required on all models. (db limit recommended).
4. Testing of engines is to be performed in specific designated areas.
5. Shelter may not be used as a pit area.
6. The AMA Safety Code will be displayed when the field is open for flying.
7. Fliers operating models must display AMA membership cards for easy identification.
8. Pilots shall make appropriate announcement when taking off, landing, or emergency
situations.
9. Compliance to these safety rules is the responsibility of each participant.
10. First aid kits are to be carried by designated members.
11. Post emergency numbers: Hospital
Police , and Public phone location
12. All non -participants must be behind a partial barrier during Control Line Speed flying.
C:\PDF\535-B.doc 03/2008 IM
"SEE AND AVOID" GUIDANCE
A. General:
1. The primary means to avoid collisions between all aircraft flying within our
National Airspace System (NAS) is "See and Avoid."
2. Vigilance must be maintained by each person operating an aircraft (whether
model or manned) so as to "see and avoid" other aircraft.
3. Model aircraft must avoid manned aircraft. Our privilege to fly model aircraft in
the NAS depends on our commitment to remain "well clear" of maimed aircraft.
4. Simply avoiding an actual collision is not enough. A "near miss" is not
acceptable.
5. Unless flying at a mixed -use site where manned and model aircraft routinely share
airspace through their own site -specific rules, model aircraft must fly sufficiently far
away from manned aircraft so as not to create a collision hazard.
6. Model aircraft flying must not only be safe, it must be perceived to be safe by the
greater manned aviation community. Modelers must continually demonstrate their
respect for the safety of manned aircraft by remaining vigilant and well clear.
7. Whenever a potential conflict arises between model aircraft and manned aircraft,
the pilot of the model aircraft must always give way to the manned aircraft.
8. The pilot of a model aircraft must never assume the pilot of a manned aircraft can
see the model or will perform any maneuver to avoid the model's flight path.
9. Visual Line of Sight is required by the Safety Code. It means that visual
contact with the aircraft must be maintained without enhancement other than by
corrective lenses prescribed for the model aircraft pilot. All RC flying must remain
clear of clouds smoke or any other obstruction to the line of sight.
10. "Blue Sky" is a term used to explain the method used to increase separation
between a model and a maimed aircraft in the same vicinity. The modeler should
maneuver the aircraft in such a way as to increase the amount of blue sky perceived
between the model and the manned aircraft. By increasing the blue sky separation,
the question about depth perception is taken out of the equation and the modeler need
not worry whether the model is closer to him than the manned aircraft or further away.
Increasing the blue sky between the model and the manned aircraft automatically
increases separation between them.
11. A modeler should never place any consideration for the well-being of the model
aircraft above the safety of manned aircraft. Maneuvering to avoid the conflict may
require that the model aircraft be sacrificed.
12. Free flight models should not be launched with relatively low altitude manned
aircraft in sight and downwind or headed downwind from the launch site.
8/2012
B. Spotters:
1. Before a flight, the pilot must insure that the spotter understands his/her duties
and expectations.
2. A spotter should be used to assist in monitoring the surrounding airspace for
manned aircraft whenever a flight is expected to exceed 400 feet above the ground
and that operation is expected to be in proximity to known manned aircraft traffic
such as at a mixed -use facility or within three miles of an airport. The spotter must
have sufficient visual acuity and be mature enough to take this responsibility very
seriously.
3. A spotter should also be prepared to assist his/her pilot in the event that another
model aircraft or spectators become endangered or in turn are perceived to be a
danger to the pilot or the pilot's model aircraft.
4. If a model aircraft pilot experiences what he or she considers a near miss
with a manned aircraft, that model aircraft pilot should notify AMA Headquarters
with a written report of the incident, including action taken by the model aircraft pilot
to avoid the manned aircraft. This report is intended to help the modeler, the club,
and the AMA capture as much detail as possible so that it may be used to assist all
parties in recalling the particulars of the incident at a later time. Call 1-800-435-9262
(1-800-IFLYAMA) extension 230 or 251 for assistance with this report.
8/2012
NOTICE OF APPLICATION
FOR TEMPORARY ASSEMBLY
Pursuant to the Weld County Code, a public hearing will be held in the Chambers of the
Board of County Commissioners of Weld County, Colorado, Weld County Administration
Building, 1150 O Street, Assembly Room, Greeley, Colorado 80631, at the time specified.
If a court reporter is desired, please advise the Clerk to the Board, in writing, at least five
days prior of the hearing. The cost of engaging a court reporter shall be borne by the
requesting party. In accordance with the Americans with Disabilities Act, if special
accommodations are required in order for you to participate in this hearing, please contact the
Clerk to the Board's Office at (970) 336-7215, Extension 4226, prior to the day of the hearing.
The complete case file may be examined in the office of the Clerk to the Board of County
Commissioners, 1150 O Street, Greeley, Colorado 80631. E -Mail messages sent to an
individual Commissioner may not be included in the case file. To ensure inclusion of your
E -Mail correspondence into the case file, please send a copy to egesick@co.weld.co.us
DOCKET #: 2013-58
DATE: August 12, 2013
TIME: 9:00 a.m.
APPLICANT:
Love -Air R/C, Inc.
c/o Michael Harrington
6112 Ashton Court
Fort Collins, Colorado 80525
REQUEST: Application for a temporary assembly of more than 350 persons on September 13,
14, and 15, 2013
LEGAL DESCRIPTION: Lot B of Recorded Exemption #2769; being part of the W1/2NE1/4 of
Section 18, Township 7 North, Range 66 West of the 6th P.M., Weld County, Colorado
LOCATION: 12760 Highway 14, Ault, Colorado 80610 (See Legal Description for precise
location.)
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
DATED: July 25, 2013
PUBLISHED: July 31, 2013, in the Fort Lupton Press
Affidavit of Publication
NOTICE OF APPLICATION
FOR TEMPORARY ASSEMBLY
Pursuant to the Weld County Code, a public hearing will be held.
in the Chambers of the Board of County Commissioners of Weld
County, Colorado, Weld County Administration Building, 1150 0
Street, Assembly Room, Greeley, Colorado 80631, at the time
specified.
Ifa court reporter is desired, please advise the Clerk to the
Board, in writing, at least five days prior of the hearing. The cost
of engaging a court reporter shall be borne by the requesting
party.In accordancewith the Americans with Disabilities Act, if
special accommodations are required in order for you to partici-
pate in thishearing, please contact the Clerk to the Board's Of-
fice at (970) 336-7215, Extension 4226, prior to the day of the
hearing.
The complete case file may be examined in the office of the
Clerk to the Board of County Commissioners, 1150 0 Street,
Greeley, Colorado 80631. E -Mail messages sent to an individu-
al Commissioner may not be included in the case file. To en-
sure inclusion of your E Mail correspondence into the case file,
please send a copy to egesickeco.weld.ce.us
DOCKET #:2013-58
DATE: August12,2013
TIME: 9:00 am.
APPLICANT:
Love -Air R/C Inc.
c/o Michael Harrington
6112 Ashton Court -
Fort Collins, Colorado 80525 -
REQUEST: Application for a temporary assembly of more than
350 persons on September 13, 14, and 15, 2013
LEGAL DESCRIPTION: Lot B of Recorded Exemption #2769;
being part of the W1/2NE1/4 of Section 18, Township 7 North, -
Range 66- West of the 6th P.M., Weld County, Colorado
LOCATION: 12760 Highway 14, Ault, Colorado 80610 (See Le-
gal Description for precise location.)
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
DATED: July 25, 2013
The Tribune
=h31,2013 -
STATE OF COLORADO
County of Weld,
I Desirea Larson
SS.
of said County of Weld, being dulysworn, say
that I am an advertising clerk of
THE GREELEY TRIBUNE,
that the same is a daily newspaper of general
circulation and printed and published in the City of
Greeley, in said county and state; that the notice or
advertisement, of which the annexed is a hue copy,
has been published in said daily newspaper for
consecutive (days): that the notice was published in
the regular and entire issue of every number of said
newspaper during the period and time of
publication of said notice, and in the newspaper
proper and not in a supplement thereof; that the
fast publication of said notice was contained in the
Thirty-first day of July A.D. 2013 and the
last publication thereof: in the issue of said
newspaper bearing the date of the
Thirty-first day of July A.D. 2013 that
said The Greeley Tribune has been published
continuously and uninterruptedly during the period
of at least six months next prior to the first issue
thereof contained said notice or advertisement
above referred to; that said newspaper has been
admitted to the United States mails as second-class
matter under the provisions of the Act of March
3,1879, or any amendments thereof; and that said
newspaper is a daily newspaper duly qualified for
publishing legal notices and advertisements within
the meaning of the laws of the State of Colorado.
July 31, 2013
Total Charges: $9.34
31st day of Ju
My Commission Expires 6/14/2017
Notary Public
ROBERT LITTLE
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 20014018494
MY COMMISSION EXPIRES JUNE 14, 2017
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FOR
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MONEY
ORDER
BY
Tammy Waters
From: Brad Yatabe
Sent: Friday, June 14, 2013 10:58 AM
To: Tammy Waters
Subject: RE: Warbirds over the Rockies
Attachments: image001.jpg
Thanks for checking. You might let them know that this will be brought up at the hearing and left up to the Board to decide.
Since there have been no issues in the past and presuming they provide the insurance they have always provided, I am fine with
the $1000.00, but the Board will ultimately make the call. Thanks.
Brad Yatabe
Assistant Weld County Attorney
1150 O Street
Mailing Address: P.O. Box 758, Greeley, CO 80632
tel: (970) 356-4000 ext. 4396
fax: (970) 352-0242
STATEMENT OF CONFIDENTIALITY & DISCLAIMER: The information contained in this email message is attorney privileged and
confidential, intended only for the use of the individual or entity named above. If the reader of this message is not the intended
recipient, you are hereby notified that any dissemination, distribution or copy of this email is strictly prohibited. If you have
received this email in error, please notify us immediately by replying and delete the message.
From: Tammy Waters
Sent: Friday, June 14, 2013 10:56 AM
To: Brad Yatabe
Subject: RE: Warbirds over the Rockies
It looks like they always did $3,000 in the past.
Tammy Waters
Deputy Clerk to the Board
1150 O Street(P.O. Box 758/Greeley, CO 80632
tel: (970) 336-7215 X5226
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may
contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by
return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any
attachments by anyone other than the named recipient is strictly prohibited.
From: Brad Yatabe
Sent: Friday, June 14, 2013 10:17 AM
To: Tammy Waters
Subject: RE: Warbirds over the Rockies
Can you check to see if they posted $3,000.00 in the past couple of years? I think $1,000.00 is probably fine and I'll mention the
amount at the hearing but I'd like to know what they have posted in the past. Thanks.
1
Brad Yatabe
Assistant Weld County Attorney
1150 O Street
Mailing Address: P.O. Box 758, Greeley, CO 80632
tel: (970) 356-4000 ext. 4396
fax: (970) 352-0242
STATEMENT OF CONFIDENTIALITY & DISCLAIMER: The information contained in this email message is attorney privileged and
confidential, intended only for the use of the individual or entity named above. If the reader of this message is not the intended
recipient, you are hereby notified that any dissemination, distribution or copy of this email is strictly prohibited. If you have
received this email in error, please notify us immediately by replying and delete the message.
From: Tammy Waters
Sent: Friday, June 14, 2013 9:12 AM
To: Brad Yatabe
Subject: Warbirds over the Rockies
Hi Brad,
Michael Harrington just dropped off the temporary assembly application for the Warbirds over the Rockies event. He only
brought in a $1,000.00 check instead of the normal $3,000.00 that we hold in lieu of a bond. Is this satisfactory for this event
where we have granted them the permit for several years and have not had any issues or should I get him to bring in another
check for $2,000.00?
Thank you,
Tammy Waters
Deputy Clerk to the Board
1150 O Street)P.O. Box 758/Greeley, CO 80632
tel: (970) 336-7215 X5226
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may
contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by
return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any
attachments by anyone other than the named recipient is strictly prohibited.
2
Department of Planning Services
1555 N 17th Ave
Greeley, CO 80631
(970) 353-6100
Weld County Referral
Date: June 17, 2013
APPLICANT: LOVE -AIR R/C, INC./VVARBIRDS OVER THE ROCKIE
C/O MICHAEL HARRINGTON
EVENT LOCATION: 12760 HIGHWAY 14 AULT, COLORADO 80610
EVENT DATE: SEPTEMBER 13, 14 and 15, 2013, FROM 9:00 A.M. - 4:00 PM
The Weld County Building Inspection Department finds no buildings permit or code violation
complaints for this property over the last year. The Building Inspection department has no
concerns
Frank Piacentino
Department of Building Inspection
MEMORANDUM
TO: Tammy Waters, Clerk to the Board DATE: 06/18/13
FROM: Janet Carter E.I., Public Works
SUBJECT: Temporary Assembly Warbirds Over the Rockies
The Weld County Public Works Department has reviewed this proposal. Our requirements are as follows:
REQUIREMENTS:
1. No parking will be allowed on Weld County Roadways.
2. Approximately 1,500 vehicles will require parking on the property
3. Please submit a Traffic Control Plan (TCP) prepared by a certified Traffic Control Supervisor (TCS)
4. This area is not in a Special Flood Hazard Area (SFHA) as determined by the Federal Emergency
Management Agency (FEMA).
5. Please submit an Incident Command Plan for the Office of Emergency Management.
6. The Colorado Department of Transportation (CDOT) has jurisdiction over all accesses to the state
highways. Please contact Gloria Hice-Idler at the Greeley office (970-350-2148 or 970-350-2163) to
verify the access permit or for any additional requirements that may be needed. (State Highway 14)
Page - 1 - of l June 18, 2013
C:\Users\twaters\AppData\Local\Microsoft\Windows\Temporary Internet Files \Content.Outlook\8Y5YCYXC\Temp Assembly Warbirds 061813.DOC
MEMORANDUM
To: Tammy Waters, Deputy Clerk to the Board June 26, 2013
From: Bethany Salzman, Zoning Compliance Officer, Dept. of Planning Services
Subject: LC0022
Review of the following request for a Temporary Assembly Permit by the Department of Planning Services
shows the following:
Applicant:
Warbirds Over the Rockies
do Michael Harrington
6112 Ashton Ct
Ft Collins CO 80525
Site Location:
LARC Flying Site — Drake Field
12760 Hwy 14
Ault CO 80610
Dates of Event:
September 13-15, 2013; 9:00 AM - 4:00 PM
Zone District: A (Agricultural)
Currently there are no active zoning violations on the above mentioned property.
This property has not obtained a Use by Special Review (USR) permit.
SERVICE, TEAMWORK, INTEGRITY, QUALITY
To: Weld County Board of Commissioners
From: Deputy Lisa Carpenter
Date: July 1, 2013
RE: Love -Air R/C, Inc./Warbirds over the rockies
Dear Commissioners,
I have researched and no reported calls for service for Love -Air R/C, Inc./Warbirds over
the rockies located at 12760 Highway 14, Ault, CO 80610 for the Calendar year of 2012 to
present day. I find no grounds for disapproval for the renewal of the liquor license.
Respectfully Sub
eputy Lisa Carpenter
Community Resource Officer
Weld County Sheriff's Office
1950 "O" Street
Greeley, CO 80631
TEMPORARY ASSEMBLY REVIEW FORM
Date: June 26, 2013
TO: Deputies Lisa Carpenter and Mark Mellon
FROM: CTB
SUBJECT: Temporary Assembly Check
Please review all records on the following property for any associated reports during the last
year and return your report to the Weld County Clerk to the Board's Office prior to July 1,
2013. Your report will be used by the Board of County Commissioners in considering issuance
of a Temporary Assembly Permit. A .pdf copy of the application materials is attached for your
review.
PLEASE RESPOND NO LATER THAN: JULY 1, 2013
APPLICANT: LOVE -AIR R/C, INC./WARBIRDS OVER THE ROCKIES
C/O MICHAEL HARRINGTON
EVENT LOCATION: 12760 HIGHWAY 14
AULT, COLORADO 80610
EVENT DATE: SEPTEMBER 13, 14 and 15, 2013, FROM 9:00 A.M. - 4:00 PM
No concerns
Depu ys Initials
The Sheriffs Office had a concern and the deputy has mutually
worked with the property owner to correct the concern.
(Complete Attached Worksheet)
Unresolved concerns exist requiring a Probable Cause Hearing
scheduled by the Board of County Commissioners.
(Complete Attached Worksheet)
Please notify at Extension
Board of Commissioner's Temporary Assembly hearing.
of the date and time of the
Temporary Assembly Worksheet
The following concerns are noted:
The property owner and the Sheriffs Office have collectively agreed to implement the following
to correct concerns noted above: (A time line and corrective action should be listed for each
concern)
Property Owner, Please Print Date
Property Owner Signature D- •uty"' ignature
Use another sheet of paper or attach separate proposal to this packet if needed.
Attach copies of all reports associated with this property for the last year.
Both the Deputy and the Owner of the establishment will be required to attend the Temporary
Assembly Hearing to testify to the above agreement.
Tammy Waters
From: Roy Rudisill
Sent: Friday, June 28, 2013 3:55 PM
To: Tammy Waters; Bethany Salzman; Janet Carter; Frank Piacentino; Deb Adamson
Cc: Brad Yatabe
Subject: RE: Warbirds over the Rockies - Temp Assembly
Attachments: image004.jpg; image003.jpg
No concerns for OEM, I received the Incident Action Plan from Mr. Herrington and they should be set.
Director Roy Rudisill
Weld County Office of Emergency Management
1150 0 St. Greeley Co. 80632
970-304-6540 Office
970-381-0417 Cell
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for
the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by return
e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the
contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
From: Tammy Waters
sent: Wednesday, June 26, 2013 10:13 AM
To: Bethany Salzman; Janet Carter; Roy Rudisill; Frank Piacentino; Deb Adamson
Cc: Brad Yatabe
Subject: RE: Warbirds over the Rockies - Temp Assembly
Resend the previous scan was incomplete.
Thanks,
Tammy Waters
Deputy Clerk to the Board
1150 O Street)P.O. Box 758)Greeley, CO 80632
tel: (970) 336-7215 X5226
1
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed
and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please
immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents
of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
From: Tammy Waters
Sent: Friday, June 14, 2013 9:56 AM
To: Bethany Salzman; Janet Carter; Roy Rudisill; Frank Piacentino; Deb Adamson
Cc: Brad Yatabe
Subject:
Please review all records on the following property for any associated reports during the last year and return
your report to the Weld County Clerk to the Board's Office prior to July 1, 2013. Your report will be used by
the Board of County Commissioners in considering issuance of a Temporary Assembly Permit. A .pdf copy of
the application materials is attached for your review.
PLEASE RESPOND NO LATER THAN: JULY 1, 2013
APPLICANT: LOVE -AIR R/C, INC./WARBIRDS OVER THE ROCKIES
C/O MICHAEL HARRINGTON
EVENT LOCATION: 12760 HIGHWAY 14
AULT, COLORADO 80610
EVENT DATE: SEPTEMBER 13, 14 and 15, 2013, FROM 9:00 A.M. - 4:00 PM
Tammy Waters
Deputy Clerk to the Board
1150 O Street P.O. Box 758'Greeley, CO 80632
tel: (970) 336-7215 X5226
Confidential' y Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed
and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please
immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents
of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
2
Memorandum
TO: Tammy Waters
From: Dan Joseph
DATE: July 12, 2013
SUBJECT: Warbirds Over the Rockies Temporary
Assembly
In response to your request, Environmental Health Services has reviewed the Temporary
Assembly Permit, for Warbirds over the Rockies located at 10010 Highway 14, in Ault,
Colorado.
After reviewing the application, the Department does not have any concerns or comments.
Should you have any questions regarding this matter, please contact me at extension 2206
or via e-mail at djoseph(w)co.weld.co.us.
Thank you.
CC: Cindy Salazar, Environmental Health Services
Debra Adamson, Environmental Health Services
Hello