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Fixed Base Operators Insurance Questionnaire

For a quotation to insure your FBO, please fill out the form below. After completing and submitting your quote request we will contact all of 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
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 Total /Hrs 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 
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
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