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?	Email Mail Fax Phone Call
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)		COM ATP
(2)		COM ATP

 

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

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Additional Notes  about your operation

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