Repair and Service

Policy Contact Information
  • Business / Individual's Name:
  • Contact Person:
  • Primary Phone:
  • Secondary Phone: Email:
  • Location (City, State):
  • Airport Name:
  • Airport Identifier:
  • Business Status:
    • Click here if you're a new startup company
    • Click here if you're an existing business
    We're a new startup.
    We're an existing company.

    Number of years in business:

    Exp. Insurance Co.:

    Exp. Date:

Insured Employee
    Insured is:
  • A&P Mechanic
    I/A
  • If an A&P mechanic, please enter the number of years' experience:
  • Describe experience working for other operations:
  • Please list any management experience/responsibilities:
  • Are there going to be additional employees?
    • How many?
  • Do you carry Worker's Compensation insurance?
Premises Liability Limit:
  • $1,000,000
    $2,000,000
    $

Facility:

  • Hangar(s)?
    • How Many?
  •  
  • Office?
    • Total Area Square Footage: Year Built: Construction:
  • Alarm?
  • Sprinkler?
  • Tie Downs?
    • How Many?
Products & Completed Operations Liability
  • What type of maintenance do you perform?
    Light Aircraft Only
    Turbines
    Engine Overhauls
    Single Engine Aircraft
    50 Hour and 100 Hour Inspections
    Propeller Overhauls
    Multi Engine Aircraft
    Routine Maintenance
    Avionics Repair
    Pistons Only
  •  
  • Please list any other maintenance performed:
    Estimated Annual Gross Receipts for Repair & Service
    Estimated Annual Gross Receipts for Avionics Repair
    Operations Liability Limit:
    $1,000,000
    $2,000,000
    $
  •  
  •  
  • HANGARKEEPERS LIABILITY COVERAGE REQUESTED?