Hangar Premises Liability Application
Applicant Name
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
First Name
Last Name
Desired Effective Date
*
-
Month
-
Day
Year
Date
Airport Identifier
*
Airport Name
*
Is mailing address the same as the Hangar location address?
*
Yes
No
Location Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the hangar on a private or public airport?
*
Public
Private
Is the hangar owned or leased by the named insured?
*
Owned
Leased
Is the Insured a Hangar Association or an Airport?
*
Yes
No
Is the Hangar subleased to any other entity?
*
Yes
No
Does applicant have air shows, contests or exhibitions on premises.
*
Yes
No
Is the Hangar shared with any other entity?
*
Yes
No
Who is responsible for maintenance of these premises?
*
Does the Insured use the Hangar for any type of Commercial Operations?
*
Yes
No
If yes, describe operations:
Annual Receipts
Rows
Prior 12 Months
Current 12 Months
Next 12 Months (estimated)
Gross Receipts
Does the Insured currently have an Aviation CGL policy with another carrier having more than 90 days left in the policy period?
*
Yes
No
Will the hangar be used for any third-party storage of property?
*
Yes
No
Desired Coverages
Desired Premises Liability (Bodily Injury & Property Damage)
*
$1,000,000
$2,000,000
$3,000,000
Other
Additional Coverages Desired
Medical Expense (For emergency services & pays regardless of liability)
Products/Completed Operations
On Premises Auto Liability
Personal Injury & Advertising Injury
Fire Legal Liability (Damage to Premises Rented)
Hangarkeeper's Liability
Rows
Desired
Per Aircraft Limit
Per Loss Limit
Hangarkeeper's Limits
War & TRIA (Terrorism Coverage) desired?
*
Yes
No
Current Insurance (If Applicable)
Rows
Insurance Company
Premises Liability Limit
Premium
Expiration Date
Deductibles
Current Insurance
Past Claims
Has Insured been involved in an aviation incident or accident resulting in a loss or claim within the past 5 years?
*
Yes
No
If yes, describe:
Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: