July 18, 2019
Coming Soon!

Aviation General Liability Quote

Conour Insurance, Inc. | 2075 Columbiana Road Suite 1 Birmingham, AL 35216

Phone: (205) 822-7020 | Toll Free: (855) 755-2013 | Fax: (855) 755-7713

Aviation Operations
First Name
Last Name
Business Name:
Address
City
State
Zip Code
Phone:
Fax:
Email Address *
Applicant Is Individual  Partnership  Joint Venture  Corporation  Other
Type of Business FBO  FAA Certified Repair Station  Other
Premises
List all buildings, hangers, ramps and all other premises to be insured:
Applicant occupies: All  Part of Premises
Applicant is Owner  Tenant  General Lessee of Premises
Who is responsibnle for maintenance of these premises?
Applicant has air shows, contests or exhibitions on Premises? Yes  No
List all autos and mobile equipment such as aircraft tugs or fuel trucks used solely on the airport premises:
Runways Paved  Unpaved
Shortest runway is
Approach obstructions? Yes  No
Describe runway obstructions
Products & Completed Operations
Products & Services
Total Gross Receipts $
(Last 12 Months)
Projected Gross Receipts
(Estimated Next 12 Months)
Describe Products & Services
Types of aircraft worked on
Applicant is a dealer or distributor for:
EstGross
Estimated Gross Receipts Next 12 Months For:
  Total Amount
(in dollars)
% Fixed Wing % Rotowing
Airframe & Components
Engines & Components
Products & Completed Operations (more)
Estimated Gross Rceipts Next 12 Months for:
Avionics
(Repair)
Propellers
(Repair)
Rotosystems
(Repair)
Airframe Painting
Sale of "New" Parts
(Not Installed)
Sale of "Used" Parts
(Not Installed)
Sale of Fuel & Oil
(Excluding Pumping Fees)
Pumping Fees
(Fuel & Oil)
Does Applicant Fuel / Defuel any Airlines? Yes  No
If Yes (above) Type of Aircraft:
Sale of "New" Aircraft
Sale of "Used" Aircraft
Sale of Food / Beverages
(including vending machines)
Sale of Other Items and Services
Describe Other Items & Services
Airline Servicing
(Other than fuel)
Describe Airline Servicing
Has Applicant Performed any Engine or Airframe Modification Work? Yes  No
Describe (above)
Has applicant ever sold, serviced or repaired "ultra-light" or "homebuilt" aircraft? Yes  No
Describe (above)
Hangerkeeper's Liability
Aircraft in Applicant's care, custody or control
Average value any one aircraft
Average Total All Aircraft
Average Number
(of aircraft)
Maximum value any one aircraft
Average Number
Maximum total All aircraft
Construction, Demolition & Alterations
Projected contract costs for next 12 months.
By Applicant:
Describe:
By Independent Contractors:
Describe:

Does the Applicant assume liability of others? Yes (Email Contracts assuming liab. of others  No
Claims History & Far Violations
List all claims and far violations for past 10 years
  Date Amount (including all expenses) Cause/Violation
1
2
3
4
5
Coverages & Limits Requested
The policy period reflects coverage at the applicant's address beginning and ending at 12:01 AM
Policy Period From
Policy Period Until

Products/Completed Operations Aggregate Limit
General Aggregate Limit
(other than Products/Completed OPerations)
Personal and Advertising Injury Aggregate Limit
Each Occurance Limit
Fire Damage Limit
(any one fire)
Medical Expense Limit
(any one person)
Hangerkeeper's Liability Coverage
(Each Aircraft Limit)
Hangerkeeper's Liability Coverage
(Each Loss Limit)
Hangerkeeper's Liability Coverage Deductible
(each Aircraft)
Total Advance Premium
Policy Deductible
Each Occurance
Annual Aggregate
Other coverage, restrictions, endorcements:
Current Insurance
Name of Insurance Company:
Expiration Date:
Coverages:
Limits:
Deductible:
Premium: $
* = Required Field