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Call us direct at
303.420.4774

AVIATION INSURANCE
"The Business Insurance Specialists"

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Engines & Components:
$
Sale of fuel and oil(excluding Pumping Fees):
$
$                                              estimated next 12 months
All of Premises
AIRCRAFT OPERATORS: PLEASE COMPLETE SEPARATE AIRCRAFT INSURANCE APPLICATION
Applicant's Name
Mailing Address
Name of Airport
Other
Individual
Partnership
Joint Venture
Corporation
FBO
FAA Certified Repair Station
Number of years in business
Under this management
At this location
Number of employees
PREMISES
List all buildings, hangars, ramps and all other premises to be insured
Part of Premises
Tenant
Owner
General Lessee of Premises
Who is responsible for maintenance of these premises?
Applicant                                      have air shows, contests, or
exhibitions on premises
Does
Does Not
List all autos and mobile equipment such as aircraft tugs or fuel trucks used solely on the airport premises
Runways are
Paved
Unpaved
Shortest runway is
Approach obstructions?
Yes
No
If yes, explain
PRODUCTS & COMPLETED OPERATIONS
Total Gross Receipts: $
Describe products and services:
Types of aircraft worked on:
Applicant is a dealer or distributor for:
Professional Training Courses attended by your employees:
ESTIMATED GROSS RECEIPTS NEXT 12 MONTHS FOR REPAIR OF:
Airframe & Components:
$
% Fixed Wing
% Rotorwing
% Rotorwing
% Fixed Wing
% Major Overhauls
% "Hot Section" repairs
Other
Avionics: $
Propellers: $
Rotorsystems : $
ESTIMATED GROSS RECEIPTS NEXT 12 MONTHS FOR REPAIR OF:
Airframe painting: $
Sale of parts, not installed:
New: $
Used: $
Pumping Fees:
$
Does Applicant fuel/defuel any airlines?
Yes
No
If yes, explain
Used: $
Sale of aircraft
New: $
Sale of food/beverages(including vending machines): $
Sale of other items and services: $
Describe
Describe
Airline servicing (other than fuel): $
Has Applicant performed any engine or airframe
modification work?
Yes
No
Describe
Has Applicant ever sold, serviced or repaired ultra-light or home-build aircraft?
Yes
No
Describe

aviation insurance by
MOUNTAIN INSURANCE BROKERS


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Welcome to the aviation insurance section of Mountain Insurance Brokers. Contact James German 720-974-1718 jgerman@mountaininsurance.com or you can fill out the form below with any information you may already have. (leave blank if uncertain)

Contact Mountain Insurance today (303) 420-4774 and speak with a live agent

We are an Independent Agency which means we represent all the companies listed in efforts to find our customers the best insurance value for their money.

 

Aviation Insurance

Introduction to
Aviation Insurance


Single-engine/Multi-engine Turboprops & Conversions & Turbine/VLJs, Aerial Application Use, Antique Aircraft, Helicopters, Experimental Aircraft, Sport Pilot, Sailplanes, Warbirds, Airports, and Hangars are some of the aviation products we can write. Please contact James German our in-house specialist for more information, call: (720) 974-1718.

Other
Type of Aircraft
Instrument Class
Instructor Class
Named Insured
Make & Model Aircraft to be Flown
Date of Birth
Occupation
Show percent of work time spent on non-flying duties
Education (Advise Diplomas and Degrees if any)
Employed by
Address
Business Phone
Home Phone
List previous employers and positions for last 5 years
Number:
Limitations:
Class:
Expiration Date:
Limitations:
Student:
Since
Private
Commercial
Sr. Commercial
Airline (ATP)
Instructor
Instrument
Night
Single Engine-Land
Single Engine-Sea
Center Line Thrust
Multi-Engine, Land
Multi-Engine, Sea
Type rated in
Rotorcraft
Glider
A&P Mechanic
Other
Name & Location of School
Type of Aircraft
Date
Graduated
Yes
No
Date
Type of Aircraft
Name & Location of School
Graduated
Yes
No
Initial Type Training
Recurrency Training
Full-Axis Motion Flight Simulator Training
Ground School Only
Aerial Applicator School
Aerial Applicator School
Ground School Only
Full-Axis Motion Flight Simulator Training
Recurrency Training
Initial Type Training
State
City
Zip/Postal Code
1. Have you ever had an aircraft claim, incident or accident?
Yes
No
2. Have you ever been cited or fined for violation of an aviation
    regulation?
Yes
No
3. Has your pilot certificate ever been suspended or revoked?
Yes
No
4. Have you ever been convicted of a felony or are you under
    indictment for a felony?
Yes
No
5. Have you ever been convicted of driving a motor vehicle
    under the influence of alcohol or narcotics, or of reckless
    driving?
Yes
No
6. Has your drivers license ever been suspended or revoked?
Yes
No
7. Have you ever been convicted of or are you under
    indictment in a legal action involving drugs or narcotics?
Yes
No
8. Have you ever had or been treated for a chemical
    dependency?
Yes
No
Class
Insured Make and Model
Make and
Model
Total
Last
90 Days
Last 12
Months
Instrument
6 Months
Co-Pilot
Hours
Co-Pilot
Hours
Last 12
Months
Last
90 Days
Total
Make and
Model
Class Sigle-Engine
Fixed Gear
Instrument
6 Months
Instrument
6 Months
Class Single-Engine
Retractable
Make and
Model
Total
Last
90 Days
Last 12
Months
Co-Pilot
Hours
Instrument
6 Months
Class Multi-Engine
Piston
Make and
Model
Total
Last
90 Days
Last 12
Months
Co-Pilot
Hours
Co-Pilot
Hours
Instrument
6 Months
Last 12
Months
Last
90 Days
Total
Make and
Model
Class
Turbo-Prop
Co-Pilot
Hours
Instrument
6 Months
Last 12
Months
Last
90 Days
Total
Make and
Model
Class
Jet
Co-Pilot
Hours
Instrument
6 Months
Last 12
Months
Last
90 Days
Total
Make and
Model
Class Number of Water
Landings and Takeoffs
Class -Helicopter-Recip
-Turbine -Sling Load
Make and
Model
Total
Last
90 Days
Last 12
Months
Instrument
6 Months
Co-Pilot
Hours
9. Are you regularly using any medication?
Yes
No
Explain fully each "Yes" answer
Pilots Signature
Today's Date
AIRMAN CERTIFICATE NUMBER
MEDICAL:
CURRENT CERTIFICATES AND RATINGS
FLIGHT & GROUND SCHOOL TRAINING COURSES
ANSWER ALL QUESTIONS
LOGGED PILOT HOURS
PILOT QUALIFICATIONS
Applicant is:
Type of Business:
Applicant occupies:
Applicant is:
for the last 12 months
AVIATION GENERAL LIABILITY INSURANCE APPLICATION
PERSONAL PLEASURE & BUSINESS FIXED-WING AIRCRAFT INSURANCE APPLICATION
Combined Single Limit  of Liability (Bodily Injury and Property Damage)
$
Excluding Passengers Ea. Occurrence
Coverage Effective:
from
Name of Applicant(s)
Applicant's Address
Applicant's Telephone Numbers: Home
Work
Business or Occupation of Applicant(s)
until
Applicant is the sole owner of the aircraft, other than
Are any other aircraft owned by, rented or used by or on behalf of Applicant?
Model aircraft
Uses
No. of hours per year
Has any insurance company cancelled or refused to renew
your aircraft insurance? (Note: MMissouri Applicants. Do not respond)
Yes
No
Please Explain
Expiration Date of current insurance
Name of current Insurance Company
AIRCRAFT
Year Make & Model
#
Total Seats
Date of the Last Annual
Airport Name (Location) City, State
Hangared
Tied Down
COVERAGE
Insured Value   $
Storage
Flight
Taxi
Not-In-Motion
In-Motion
Deductibles      $
Line Holder and Address
Including Passengers limited to Ea. Occurrence
Loss Payee Only
Breach of Warranty
Lien Amount
Medical Payments    $
TOTAL PREMIUM
TOTAL PREMIUM
Medical Payments    $
Lien Amount
Breach of Warranty
Loss Payee Only
Including Passengers limited to Ea. Occurrence
Line Holder and Address
Deductibles      $
In-Motion
Not-In-Motion
Taxi
Flight
Storage
Insured Value   $
COVERAGE
Airport Name (Location) City, State
Date of the Last Annual
Total Seats
#
Year Make & Model
Combined Single Limit  of Liability (Bodily Injury and Property Damage)
$
AIRCRAFT
Excluding Passengers Ea. Occurrence
$
$
Tied Down
Hangared
$
$

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