CERTIFICATE OF LIABILITY INSURANCE ~ PllOOUCB1 FAX •

Attn: Ext:

THIS CEI'lTIRCATE IS ISSUED AS A MATTEI'l OF INFOI'lMATION ONLY AND CONFEI'lS NO fliGHTS UPON THE CERTIRCATE HOLDER. THIS CEI'lTIRCATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.

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COVERAGES 11-liS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE B<E~ ISSUED TO THE INSURED NAMED ABOVE fOR THE POLICY P£RIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION Of ANY CONTR~CT OR OTHER OOCUMENI WITH RESPECT TO WHICH THIS CERnFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AfFORDED BY THE POLICIES DESCRI~D HEREIN IS SUBJECT TO AU THE !l:RMS. EXCLUSIONS AND CONDIOONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ·c;;T ......... :;~·~;·;~~~-~~ .......... r.-... -... -.. ;;;;~·~;;~~~~~-~ .... ·-·-.. TPOi.icv£mCTIV£ .... P<>ucv·rn;iRA-noNT'_ ........................ ~~~~~ ... -........... _._ .. ____ ,

U1l i ; i DA"C (MM/00/YY) DATE (MM/DD!YY) i

! AUTOMOBILE IJABIUTY 11

! r--1~YAUTO t-· .. ~ : ! ! ALL OWNED AUTOS ! . ....... ~ L..j SCHEOULED AUTOS :,, 1 1 HIRED AUTOS .... l . ! ! NONOWNEO AUTOS i ..-.~- · . ! ! ! t-uo.l 0

10 !Automobile l.loblllly Is reqcired tor. Permittees wilh vehicle$.

1 GI\RAG€ IJABIUT'I !,

r·-·] ANY AUTO ~4 ! f· .. 1----------;

B i EXCESS l.IABIUTY 1'··-.. I 1 UMBRELLA FORM ~-.. ~ I ! OTHER THAN UMBRELLA FORM

WOOI<fRS OOMPENSAOON AND EMPLOYERS' UABIUT'I

THE PROPRIETOR , .. -, INCL [ Pl\RTNERS;<XE&TIVE , ... ; ! OfFICERS ARE: 1 1 EXCL !

OTHER

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. . l OOMBINED SINGLE LIMIT : $ @ @) ~ ....................... -................. -·-··~ .............. . E BODILY lt-IJ\JRY i $ r,;;, j (Per person) i ~ t---·"'"-""*'''"'·''"''''''+''''' '"''"'"""'''"' ... "'

l~~;;r .. _ .. __ ........ l~ .... ~--.. ·--·--···m J PROPERTY DAMAGE : $ @

lAUTOONLY.£AACCIOENT 1$ ~-·· · ·· ··················· · ····· · ··-:- · ·········-·· · ····-·········· 1 OTHER THAN AUTO ONLY; 1

c::::::§~~:~(~~~i(::::r~:::::~:=:::::::::::::::::: i AGGREGATE ! $

:EACH OCCURRENC£ i $ ~ .............. -·-·········· .. ··--.. +-·-·················· ........ . 1 AGGREGATE 1 S ..................................... ~ ......... ,_ ........... - ·-·· 1 ; s ! ; ~AIIIllliiV ' : 011<!. i Lff:~£~:~.E:~~:::~:~::rL::::::::::::::::~=:=:: ! EL DISEASE~CY UMIT I $ !--··--··--···~··-----·--··---··"'--··--···-···· ............ .. 'EL DISEASE-EA EMPLOYEE i S

@) A*por1 Premise$ Uci:llly (Of~ Uci:llly) Is req,Jired for lllllcensed AbA whlcles.

DESCRIPTION OF OPERATlONS/LOCAOONS/VEliiCLES/SPECIAL ITEMS (!) Ills lJ'lders10od O'ld agreed lh011t:e Cer1illcate Holder Is nc:rned os odc:lt1ooollnsJred bu1 only with raspect to perrrlttee opero1fonS ot the nomed lnsued

oJ Atporl.

CERTIRCATE HOLDER CANCELLATION

® STATE OF HAWAII DEPARTMENT OF TRANSPORTATION AIRPORTS DIVISION (Name and address of airport)

® SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELED OR MATERIALLY CHANGED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAJL30 DAYS WRITTEN NOTICE TO THE CERTlACATE HOLDER NAMED TO THE LEFT.

INSTRUCTIONS for

CERTIFICATE OF INSURANCE

GENERAL

7/1/99

Please refer to the attached sample Certificate of Insurance. If there is insufficient space in any block, provide the required information in a separate document (endorsement) that is attached to and made an integral part of the Certificate of Insurance.

ALL PERMITTEES

The following applies to all commercial service permittees.

1. Name of insured must be the same as the name of the applicant for the permit.

2. General Liability insurance is required for all permittees.

3. The policy number of each type of insurance must be stated. However, a temporary binder for 30 days may be used. A new certificate must be issued to reflect such policy number within 30 days.

4. The expiration date of each type of insurance must be specified.

5. The minimum liability limit for Bodily Injury is $500,000 and $50,000 for Property Damage. If Bodily Injury and Property Damage are not· stated separately, the combined single limit must be at least $500,000. (On most certificates of Insurance, the Combined single Limit is indicated under "General Aggregate" or "Each Occurance" or both. )

6. If the minimum limit is not met for the General Liability (or any other type of required insurance), the balance of the minimum limit of liability must be reflected in excess liability.

7. The following "Additional Insured" statement shall be entered into this block:

wit is understood and agreed that the certificate holder is named as additional insured but only with respect to permittee operations of the named insured at Airport."

8. The "CERTIFICATE HOLDER" shall be:

State of Hawaii Department of Transportation Airports Division (Name and address of airport)

9. The pre-printed "CANCELLATION" clause delineated in most Certificates of Insurance shall be amended as follows (add underscored material; delete material in brackets):

"Should any of the above described policies be cancelled or materially changed before the expiration date thereof, the issuing company will ( endeavor to] mail ~ days written notice to the certificate holder named to the_left. (But failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agent or representatives.]"

PERMITTEES WITH VEHICLES

The following applies to commercial service permittees operating vehicles on the public roadways of the airport in connection with the permitted activities.

10. Automobile Liability (in addition to General Liability) insurance is required.

a. Specific covered vehicles need not be listed or stated on the Certificate of Insurance if "Any Auto" block is checked.

b . Specific covered vehicles must be listed or stated on a separate document attached to the Certificate of Insurance and validated by the insurance carrier if any of the following blocks are checked:

(1) All owned Autos

(2) Scheduled Autos

(3) Hired Autos

(4) Non-owned Autos

c. The following types of coverage are required :

(1) Bodily Injury and Property Damage; or

(2) Combine d single limit (BI and PD)

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11. If combined single limit (BI and PD) is stated, the minimum liability limit shall be:

a. Ground transportation permittees

1 to 7 passenger capacity .... $ 250,000 8 to 17 passenger capacity . . . 500,000 18 or more passenger capacity .. 1,000,000

b. Other permittees

Any passenger capacity ..... $ 300,000

12. The minimum liability limit for Bodily Injury (per person) shall be ........ $ 100,000

13. The minimum liability limit for Bodily Injury (per accident) shall be:

a. Ground transportation permittees

1 to 7 passenger capacity .... $ 200,000 8 to 17 passenger capacity . . . 500,000 18 or more passenger capacity .. 1,000,000

b . Other permittees

Any passenger capacity .. . .. $ 300,000

14. The minimum liability limit for Property Damage shall be ... . ... . . . ... . . $ 50,000

AOA VEHICLES

The following applies to commercial service permittees whose vehicles require access to the Airport Operational Area (AOA).

15. Licensed Vehicles

Automobile Liability and General Liability (combined single limit, Bodily Injury and Property Damage, per occurrence) shall be required in the applicable minimum limits specified below :

a. Honolulu International Airport

(1) Standard AOA Clearance . • . $5,000,000

Any portion of a public airport, f rom which access by the public is prohibited by fences or appropriate signs, and which i s not leased

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(2)

or demised to anyone for exclusive use and includes runways, taxiways, all ramps, cargo ramps and apron areas, aircraft parking and storage areas, fuel storage areas, maintenance areas, and any other area of a public airport used or intended to be used for landing, takeoff, or surface maneuvering or aircraft or used for embarkation or debarkation of passengers.

Limited AOA Clearance . $1,000,000

Operations restricted to Diamond Head and Ewa Concourses second level roadways and connecting third level main terminal roadway only, with entry and exit via Security Access Po~nt "C" (primary) and Point "A" (secondary).

b. Other Airports

Standard AOA Clearance. ... $1,000,000

16. Unlicensed Vehicles

Airport Premises Liability (or General Liability) shall be required in the applicable minimum limits specified below:

a. Honolulu International Airport

Standard AOA Clearance. .... $5,000.000

b. Other Airports

Standard AOA Clearance ......... $1,000.000

Attachment

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