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FBO Insurance Questionnaire

For a quotation to insure your commercial insurance coverages please provide the following information.

After completing and submitting your quote request to us we will email confirmation of receipt back to you. Then we will contact all the aviation insurance markets for you to find the best possible price and coverage available.  It may take up to 5 business days to obtain all options available.

(note: use your "Tab" key to advance to the next field, do not press "Enter")

 
How would you like us to contact you with your quote?  
Company
Owner/Manager
What brought you to our site today?
Select one or complete "Other"
Other, please complete
Street Address
City State Zip
 
Phone Work Phone Home
Email Fax
Airport  ID
 Airport City
 Years in Business
 
Present Insurance Company
Expires

Aircraft Coverage

Liability Limits Requested
  $500,000 Combined Single Limit including $100,000 per passenger
  $1,000,000 Combined Single Limit including $100,000 per passenger
  $1,000,000 Combined Single Limit with no passenger limitation
  Other
Medical Coverage Each Passenger $1,000 $2,500 $5,000
Additional Coverage
Student/Renter Pilot Liability
Non-Owner Liability
Non-Owned Hull Coverage    $each aircraft

Aircraft Schedule

USE R= Rental/Instruction
C= Charter

FAA Year Make/Model Insured Value R C OTHER TotalHrs Yr

Pilot Information
Chief Pilot Employed Full or Part Time for   (1) Charter and   (2) Instruction
  Name   Age Pilot Certificate Pilot Hours
Certificate Ratings S.E. Fixed Gear S.E. Ret. Gear Multi Engine Total All Types Total Last 180 Days
(1)
(2)
Please input your  current or requested pilot warranty
Fixed Tricycle Gear <201 HP
Fixed Tricycle Gear >200 HP
Tailwheel Gear <201 HP
Tailwheel Gear >200 HP
Retractable Gear <201 HP
Retractable Gear >200 HP
Multi-Engine <501 Total HP
Multi-Engine >500 Total HP
Helicopters
Sailplanes
Other
Aircraft Losses Past 5 Years

Fixed Base Operations
General Information
Applicants Occupancy:  
Applicant Is: 
Applicant occupies :
Office Square Feet
Hangar(s)   1 Square Feet     2 Square Feet
Total number of tie-downs on your premises
Average Value of Aircraft tied out $
Number of aircraft hangared Average Value of Aircraft Hangared $
Is Applicant the airport manager Yes No 
Any other locations at other airports occupied by applicant
Are Ultralight, Parachuting or Agriculture operations conducted on the premises Yes No
If yes explain
Number of vehicles owned/used by applicant: Fuel Trucks Tugs
Has applicant had any airport related losses/claims during last 5 years Yes No
If yes explain
Has any insurer canceled, declined or refused to renew any aviation insurance Yes No
If yes explain

Airport Coverage
Airport General Liability Limits Requested
     $500,000  Combined Single Limit including $100,000 per person
  $1,000,000  Combined Single Limit including $100,000 per person
  $1,000,000  Combined Single Limit with no per person limitation
Other  $
Products Liability Limits Requested
     $500,000  Combined Single Limit  including $100,000 per person
  $1,000,000  Combined Single Limit  including $100,000 per person
  $1,000,000  Combined Single Limit with no per person limitation
Other  $
Medical Coverage Each Person $1,000 $2,500 $5,000
Hangarkeepers Liability Limits
  $50,000 Each Aircraft, $100,000 Each Occurrence
$100,000 Each Aircraft, $300,000 Each Occurrence
$250,000 Each Aircraft, $500,000 Each Occurrence
$ Each Aircraft, $ Each Occurrence

Operations Information

Types of services provided by applicant and gross receipts for each operation
Fueling            $ Maintenance $
Parts Sales      $ Avionics       $
Aircraft Sales  $ Other           $

Fueling

Type of fuel sold:    
Jet Fuel Gallons Avgas Gallons Auto Fuel Gallons
Type of Fuel Storage:    
Underground Tank Above Ground Tank Fuel Truck
Fuel is dispensed from:    
Fuel Truck Fuel Island Fuel Island - Self Service

Maintenance

Type of Aircraft Maintained:    
Single Engine Multi-Engine Rotorcraft Turbine
Do you Overhaul or Manufacture:  
Engines Propellers Kit Planes Accessories
Do you Perform Any:
Major Airframe Repairs Aircraft Painting
Additional Notes
about your operation

 

P.O. Box 32  Frederick, MD 21705-0032 - Toll Free: 877-247-7767  Fax: 301-682-9793