Request A Quote

Raymond B. Lawson, Managing Director
Email: rlawson@aerospaceinsure.com
Ext. 101 / Direct: (305) 776 6736

If you would like to a quotation, please fill-out the form below.

 

Request A Quote

Services
Insurance Markets
Programs


Name of Insured *
Street Address
Address Line 2
City *
State *
Zip Code
E-mail Address *
Phone No. *
Fax No.
Name and addresses of all subsidiary corporations to be covered

Management Personnel

Management Personnel
If "Other" please specify
Name
Age
Position and Duties
Years Experience as Operator
Name
Age
Position and Duties
Years Experience as Operator
Name
Age
Years Experience as Operator

Applicant is:

F.A.A. Approved - Repair Station, Number
V.A. Approved - Flight School
Ground School

Premises Liability:

Limits
Airport
City *
State *
Length of Longest Runway (ft)
Are there any other locations to be insured?
If Yes, give location(s) Operations conducted and whether premises are owned or leased
List each building occupied by applicant and indicate part occupied and Purpose of each.
Interest of Applicant in Airport
If Other, please specify
If applicant is Tennant of Lessee, does he have any Contractural Agreement concerning the leased premises?
Does applicant sub-lease any portion of premises to others? (Excluding individual aircraft storage)
If yes, please provide explanation
Are any scheduled airlines or irregular air carriers refueled?
List number and type of fueling vehicles operated
Any jets?

Products Liability

Limits (if different from premises liability)

Estimated Gross Income from the Following

Sale of New Aircraft
Sale of Used Aircraft
Sale of Fuel and Oil
Aircraft Repairs and Servicing (Parts and Labor)
Parts not Installed
Restaurant
Do you require a contract for repairs?

Hangarkeepers Liability

Limits:
Each Aircraft
Each Occurrence
Average number of non-owned aircraft in your care and custody
Highest Value Aircraft ($)
Total Value ($)
Do you ever fly non-owned aircraft?
If "Yes", describe purpose and maximum value

Non-Ownership Aircraft Liability

Passengers carried for hire
Maximum seating capacity (Total Seats) of any non-owned aircraft
Number of Staff Pilots?
Estimated hours flown annually in non-owned aircraft

Aircraft Liability Coverage and Limits

Non-ownership Liability desired
Each Person
Each Occurrence
Each Occurrence
Each Person
Each Occurrence
Each Occurrence Limited To
Per Seat
Use This Area For Additional Comments or Explanations

Aircraft 1:

F.A.A. Registration Number
Make and Model
Year of MGF.
Seats Incl. Crew
Current Value
Bal. Due if *B.O.W. Required

Estimated Annual Flying Hours:

Private & Demo
Rental
Instr.
Charter

Aircraft 2:

F.A.A. Registration Number
Make and Model
Year of MGF.
Seats Incl. Crew
Current Value
Bal. Due if *B.O.W. Required

Estimated Annual Flying Hours:
Private & Demo
Rental
Instr.
Charter

Aircraft 3:

F.A.A. Registration Number
Make and Model
Year of MGF.
Seats Incl. Crew
Current Value
Bal. Due if *B.O.W. Required

Estimated Annual Flying Hours:

Private & Demo
Rental
Instr.
Charter

Aircraft 4:

F.A.A. Registration Number
Make and Model
Year of MGF.
Seats Incl. Crew
Current Value
Bal. Due if *B.O.W. Required

Estimated Annual Flying Hours:

Private & Demo
Rental
Instr.
Charter

Aircraft 5:

F.A.A. Registration Number
Make and Model
Year of MGF.
Seats Incl. Crew
Current Value
Bal. Due if *B.O.W. Required

Estimated Annual Flying Hours:
Private & Demo
Rental
Instr.
Charter
The Above Are
Mortgagee Name
Address

Loss History and Previous Aviation Insurance

List all losses within the last five years:

Date (MM/DD/YYYY)
Type of Aircraft
Amount of Claim ($)
Cause of Loss
Date (MM/DD/YYYY)
Type of Aircraft
Amount of Claim ($)
Cause of Loss
Date (MM/DD/YYYY)
Type of Aircraft
Amount of Claim ($)
Cause of Loss
Date (MM/DD/YYYY)
Type of Aircraft
Amount of Claim ($)
Cause of Loss
Date (MM/DD/YYYY)
Type of Aircraft
Amount of Claim ($)
Cause of Loss
Has any insurer cancelled, declined, sent notice of cancellation, or refused to renew any aviation insurance?
Name of Previous Aircraft Insurance Company

Staff Pilots

Name
Age
Total Logged Hours
Retract. Gear Hours
Multi-Engine Hours
Last 12 months
Name
Age
Total Logged Hours
Retract. Gear Hours
Multi-Engine Hours
Last 12 months
Name
Age
Total Logged Hours
Retract. Gear Hours
Multi-Engine Hours
Last 12 months
Name
Age
Total Logged Hours
Retract. Gear Hours
Multi-Engine Hours
Last 12 months
Is any pilot to be approved flying on a waiver?
Ever been penalized or disciplined for violating F.A.A. (C.A.A.) regulations?
If "Yes", give details below:

Minimum staff pilot flying hours required for charter flights

Total Pilot Hours For single engine charter
Total Pilot Hours For multi-engine charter
(including how many hours in multi-engine)
Exceptions
Please let us know how you heard about us:
If other, please specify
The above statements are true and correct to the best of my knowledge and belief. *