Fixed Base Operators Application

If you would like to request an online quote please complete the form below. This information is for internal use only; none of the following will be distributed to any other parties. See our privacy statement for more information.

Name of Insured:
Street Address:
*City:
*Province:
Postal Code:
*Please provide Email Address or Day Phone:
Email Address:
Day Phone:
Fax:
Name and addresses of all subsidiary corporations to be covered:

Management Personnel: Individual     Corporation     Partnership Other: Name Age Position and Duties Years Experience as Operator

Applicant is:
A.M.O. Approved - Repair Station, Number:

Premises Liability

Limits:
$ CSL PD

Airport:
*City:
*Province:
Private Airport     F.A.A. Tower     Run Way Lights Paved Runways / Length of Longest Runway: Ft.
Are there any other locations to be insured?		Yes     No
If Yes, give location(s) Operations conducted and whether premises are owned or leased:
List each building occupied by applicant and indicate part occupied and Purpose of each.

Interest of Applicant in Airport

Owner     General Lessee     Tenant     Sub-Tenant Other -
If applicant is Tennant of Lessee, does he have any Contractural Agreement concerning the leased premises?:		Yes     No
Does applicant sub-lease any portion of premises to others? (Excluding individual aircraft storage):		Yes     No
Are any scheduled airlines or irregular air carriers refueled?:		Yes     No
Any jets?:		Yes     No
If yes, please provide explanation:
List number and type of fueling vehicles operated:

Products Liability

Limits (if different from premises liability):
$ CSL BI PD

Estimated Gross Income from the Following:

Sale of New Aircraft:		$		Aircraft Repairs and Servicing (Parts and Labor):		$
Sale of Used Aircraft:		$		Parts not Installed:		$
Sale of Fuel and Oil:		$		Restaurant:		$

Do you require a contract for repairs? Yes     No

Hangarkeepers Liability

Limits: $ Each Aircraft $ Each Occurrence

Average number of non-owned aircraft in your care and custody:

Highest Value Aircraft: $ Total Value: $

Aircraft Liability Coverage and Limits

		Bodily Injury Liability (Excluding Passengers)		Each Person:			Each Occurrence:
		Property Damage Liability					Each Occurrence:
		Passenger Bodily Injury Liability		Each Person:			Each Occurrence:
		Single Limit		Each Occurrence Limited To:			Per Seat:

Basic Description of Fixed Base Operator
Insurance Program

Airport Liability Insurance:

Premises Liability - Typical limits for this coverage are $1,000,000 CSL. Each Occurrence for bodily injury Liability to the Public and Property Damage Liability. This insurance is similar to the type of coverage every homeowner or business man carries to protect himself against bodily injury or property damage claims by members of the public who have an express or implied invitation to enter and use the premises. It also covers any vehicles used on the airport, which are not licensed for highway use, such as aircraft refuelers, low tugs, etc. Excluded is the insured's liability for product sales, repair work and coverage for property damage to non-owned aircraft left in his care, custody or control. These coverages are available by endorsement as set forth below.

Products Liability - Typical limits are the same as outlined above for Premises Liability. This part of the policy fills the gap in the Premises policy by providing protection for the insured's liability in connection with sale of products, such as aircraft, gas and oil, repairs and services, etc. Among typical claims would be a claim by someone who purchased fuel and then later crashed alleging engine failure due to fuel contamination. Another example might be a claim arising from the sales of a used aircraft with the purchaser alleging the accident was caused by a defective aircraft. Another case might be the customer's aircraft crashing because of faulty repair work done by the insured's shop.

Hangarkeeper's Liability (In Flight) - This insurance provides legal liability for hull damage, for the insured or his employees, resulting from damage to non-owned aircraft in their care custody and control. For  example, if the insured's hangar collapses on a customers aircraft or a customers aircraft falls off a jack stand,  this insurance will protect the insured for legal liability for damages caused to the aircraft.

Aircraft Liability Insurance (Owned Aircraft) - Typical limits for this insurance are $1,000,000 CSL/Each Occurrence for Bodily Injury and Property Damage including Passengers. This coverage protects the insured's legal liability for injury to members of the public or passengers and for damage to the property of others, arising out the use of any of his owned aircraft.

Hull Insurance (Owned or Leased Aircraft) - This insurance covers physical damage to the insured's owned aircraft. It is very important that the aircraft be insured for their current market value (not for the amount of mortgages involved). In the event of a loss, the insurance company has the option to either pay for the cost of repairs or settle on a total loss basis and if the aircraft is under insured, the owner could end of getting considerably less for his airplane than it's worth. For example, let's assume a $50,000 airplane is insured for only $35,000 and a $15,000 loss occurs. The insurance company could choose the option to total the aircraft rather than paying for cost of repairs and the Insured would end up getting only $35,000 less the applicable deductible for this airplane worth much more.

Use This Area For Additional Comments or Explanations

Description and Use of Aircraft

Aircraft 1: Canadian registration letters:   Year of MGF.   1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Make and Model:   Seats Incl. Crew:   Land     Sea     Ampb Current Value:   Bal. Due if *B.O.W. Required:   Estimated Annual Flying Hours: Private & Demo:     Rental:     Instr.:     Charter:

Aircraft 2: Canadian registration letters:   Year of MGF.   1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Make and Model:   Seats Incl. Crew:   Land     Sea     Ampb Current Value:   Bal. Due if *B.O.W. Required:   Estimated Annual Flying Hours: Private & Demo:     Rental:     Instr.:     Charter:

Aircraft 3: Canadian registration letters:   Year of MGF.   1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Make and Model:   Seats Incl. Crew:   Land     Sea     Ampb Current Value:   Bal. Due if *B.O.W. Required:   Estimated Annual Flying Hours: Private & Demo:     Rental:     Instr.:     Charter:

Aircraft 4: Canadian registration letters:   Year of MGF.   1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Make and Model:   Seats Incl. Crew:   Land     Sea     Ampb Current Value:   Bal. Due if *B.O.W. Required:   Estimated Annual Flying Hours: Private & Demo:     Rental:     Instr.:     Charter:

The Above Are: Hangared     Tied Down

Mortgagee Name:
Address:

Loss History and Previous Aviation Insurance

List all losses within the last five years:

Date:   January February March April May June July August September October November December / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Type of Aircraft:   Amount of Claim: $   Cause of Loss:

Date:   January February March April May June July August September October November December / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Type of Aircraft:   Amount of Claim: $   Cause of Loss:

Date:   January February March April May June July August September October November December / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Type of Aircraft:   Amount of Claim: $   Cause of Loss:

Date:   January February March April May June July August September October November December / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Type of Aircraft:   Amount of Claim: $   Cause of Loss:

Has any insurer cancelled, declined, sent notice of cancellation, or refused to renew any aviation insurance? Yes     No

Name of Last or   Present Aircraft Insurance Company:   

Staff Pilots

Name:      Age: Valid Ratings Held: Com'l     Instrument     CFI     ATP     Other     Total Logged Hours Retract. Gear Hours Multi-Engine Hours Float Plane Hours Last 12 months

Name:      Age: Valid Ratings Held: Com'l     Instrument     CFI     ATP     Other     Total Logged Hours Retract. Gear Hours Multi-Engine Hours Float Plane Hours Last 12 months

Name:      Age: Valid Ratings Held: Com'l     Instrument     CFI     ATP     Other     Total Logged Hours Retract. Gear Hours Multi-Engine Hours Float Plane Hours Last 12 months

Name:      Age: Valid Ratings Held: Com'l     Instrument     CFI     ATP     Other     Total Logged Hours Retract. Gear Hours Multi-Engine Hours Float Plane Hours Last 12 months

Territory required:
Canada only
Canada and continental USA (excluding Alaska)

Is any pilot to be approved flying on a waiver? Yes    No

Ever been penalized or disciplined for violating A.M.O regulations?
Yes    No

If "Yes", give details below:

Minimum staff pilot flying hours required for charter flights:

For single engine charter: Total pilot hours.
For multi-engine charter: Total pilot hours
(including hours in multi-engine)
Exceptions:

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The above statements are true and correct to
the best of my knowledge and belief:    

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