Services

Commercial Lines Insurance Personal Lines Insurance Life Insurance Health Insurance Employee Benefits Package Bonds Aviation Marina Mining Watercraft IBO

Aviation

A broad field of protection covering both domestic and international operations of aircraft owned and leased, involving hulls, liability, passenger liability and airport and hangerkeepers liability. Our agency has a special expertise in aircraft in that two of its principals are licensed pilots and the agency operates a small twin engine aircraft.

Company Name

Last Name

First Name

Occupation

AOPA Number

EAA Number

Co-Owner Last Name

Co-Owner First Name

Co-Owner Occupation

Co-Owner AOPA Number

Co-Owner EAA Number

Email

Street Address

City

State

Zip

Home Phone

Business Phone

Fax

Coverages

Liability Limits

$500,000 Combined Single Limit With $100,000 per passenger.
$1,000,000 Combined Single Limit With $1,000,000 per passenger.
$1,000,000 Combined with no per passenger limitation.

Amount
Million Combined Single Limit With no passenger limitation.

Medical Coverage Each Passenger

$1,000
$3,000
$5,000

Aircraft Information

FAA Number

Year

Make

Model

Value

Use (Pleasure, Business, Other)

Aircraft Is Based At

Aircraft Is Hangared Or Tied Down

Present Insurance Company

Insurance Expires

PILOT 1 INFORMATION

Name

Age

License

Ratings

Total Flight Time

Hours in Model

Hours in Rotorwing

Hours in Retractable Gear

Hours in Tailwheel

Hours in Multi-Engine

Name of School
(Include date of completion.)

Date of Completion

PILOT 2 INFORMATION