ProductionInsurance.com
  A Service of Supple-Merrill & Driscoll, Inc.

 

  

 

 Non-Owned Aircraft Application Instructions

  1. Please complete and submit this online application for a free, no-obligation quote.

  2. Please be sure to provide all required information in order to receive a quotation.

  3. Glossary of Terms.

 

  Program Information

This is a secure application.  Strong cryptography is implemented via the Secure Sockets Layer protocol.  Our Privacy Policy.

  PDF Application (Fillable)

 
 

( indicates required information)

Applicant Information

Name of Company / Organization:
Entity:

Full Name of Contact:
Number:
Fax:
Street Address:
City, State: ,
Zip/Postal Code:

Email:

We will never rent, sell, or share your email address.

Website:
Applicant Type:

 

Production Details

Total Budget for Production:
Title of Production:
Type of Production:
State:
Additional Location Details:

Synopsis:

Input a brief description of the shoot.

Coverage Dates of the Production:

to

to

to

If insuring rented equipment start with pick-up and end with drop-off day.

Number of Episodes:
Length of Episode:
Total Number of Shoot Days:

 

Desired Limits

Non-Owned Aircraft Liability:

Up to $100,000,000

Non-Owned Aircraft Hull Physical Damage:

Up to $25,000,000

 

Policy Term

Annual Policy Term

Effective Date:

Short Term Coverage

Coverage Dates of the Aerial Operations:

to

to

to

 

Professionally Flown Charter

Does the applicant have non-owned aircraft exposures

with professional pilots?

Yes  No

If Yes, please answer the following questions:

What is the maximum passenger seating on the largest aircraft chartered?

What is the average passenger load?
What are the lowest liability limits carried on these aircraft?
How many hours of Chartered exposures: In the Last 12 Months:   In the Next 12 Months:

Aircraft Information

 

 

Charter Company

 

Aircraft Type Additional Insured Require Certificate
1. Yes  No Yes  No
2. Yes  No Yes  No
3. Yes  No Yes  No
4. Yes  No Yes  No
5. Yes  No Yes  No
6. Yes  No Yes  No

 

 

Non-Professionally Flown Charter

Does the applicant have non-owned aircraft exposures

with non-professional pilots?

Yes  No

If Yes, please answer the following questions:

What is the maximum passenger seating on the largest aircraft chartered?

What is the average passenger load?
What are the lowest liability limits carried on these aircraft?
How many hours of use is estimated for non-pro flown, non-owned aircraft:

Last 12 Months

Next 12 Months

What type of aircraft do your employees use?

 

Aircraft Underwriting

Will the aircraft be used for any of the following?

Powerline Patrol

Pipeline Patrol

Offshore

Logging

Cruise Ship

Casinos

Instructional & Rental

Filming

Medivac

Sports Teams

Aerial Photo

Agriculture

Does the applicant have any non-owned exposures involving any of the following types of aircraft?

Balloons

Home Builts

Ultralights

Military Aircraft

Hang Gliders

Blimps

Does the applicant have any non-owned aircraft exposures outside of the following areas?

USA

Canada

Mexico

Western Europe

 

Does the applicant have any non-owned aircraft exposures inside Alaska? Yes  No

 

Exposures

Does the applicant have any written procedures relating to use of aircraft?

Yes  No

What are the applicant's minimum internal written requirements for liability limits from aircraft owners/operators?
Is the applicant an Additional Insured for any aircraft on the owners/operator's policy? Yes  No

 

Insurance History
Has the applicant had any aircraft/aviation losses, claims or incidents?

Yes  No

Has any insurer cancelled, declined or refused to renew any aviation insurance policy?

Yes  No

 

Notes

 

 

 

 

Terms and Conditions

Please carefully review the Terms and Conditions below:

  • Please read all exclusions indicated on quotation.

  • The quotation received is not binding on the Insurer in any way.

  • By clicking 'Submit Application' you are not agreeing to purchase coverage.  Via email, you will receive a free, no-obligation insurance quotation.

  • Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and (NY: substantial) civil penalties. (Not applicable in CO, HI, NE, OH, OK, OR, VT). In DC, LA, ME, TN and VA, insurance benefits may also be denied.
  • Please note that once coverage is bound, the policy cannot be cancelled.

  • The insurance quotation will be based solely on the coverages and limits selected on this application.

  • Please ask your Supple-Merrill & Driscoll, Inc. representative to explain coverage details, exclusions, limits or other provisions of any insurance policy.

Type your name below, to indicate that you have read

and accepted the Terms and Conditions above:

 

 

 

  

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ProductionInsurance.com is the entertainment division of Supple-Merrill & Driscoll, Inc.  California License 0517777.

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