Additional Quote Requests: Pleasure & Business | Agricultural Aircraft

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This application is for Personal Renters and Flight Instructors.
I desire insurance to cover my activities as a (check one):

Personal Renter -This application is for your personal and business related use of non-owned, fixed wing, non-pressurized, land aircraft having a non-turbine single engine of 450 horsepower or less (including non-powered sailplanes) and a capacity of no more than seven (7) total passengers, and/or seats and having a standard airworthiness certificate.

Flight Instructor -This application is for your personal, business related flying and your flight instruction to others in non-owned, fixed wing, a non-pressurized, land aircraft having a non-turbine single engine of 450 horsepower or less (including non-powered sailplanes) and a capacity of no more than seven (7) total passengers and/or seats, and having a standard airworthiness certificate.
Pilot Information
Your Name
Address
City
State two letter code
Zip
Phone
E-Mail
Occupation
Age
Certificate
STD REC PVT CML ATP
Ratings
Instructor
Other
If other, describe
Total logged hours
Logged hrs. past 12 mos.
What type aircraft usually flown
Your hrs. in PIC in type:
Do you have a: CFI-Inst CFI-ME
Hrs. Flight Instructing
Flight Instruction given last 12 mos.? Yes No
Within last 36 months, have you:
Been involved in any accidents? Yes No
Cited for any FAR violation? Yes No
Had pilot's or driver's license suspended? Yes No
Been convicted of any felony or DUI charge? Yes No
If you answered “Yes” to any of the above, please contact your insurance agent.
Coverage underwritten by AIG Aviation Inc.
For more information,contact Hardy Aviation Insurance at:
1-800-721-6733.
Coverages
Liability Coverage – pays for bodily injury and property damage for
which you are legally liable arising out of your use of non-owned aircraft, but excluding physical damage to non-owned aircraft.
Personal Renter
Each Occurrence Passengers Premium Check Here
$250,000 $25,000 $95
$500,000 $50,000 $115
$500,000 $100,000 $180
$1,000,000 $100,000 $240
Flight Instructors *
Each Occurrence Passengers Premium Check Here
$250,000 $25,000 $200
$500,000 $50,000 $350
$500,000 $100,000 $500
$1,000,000 $100,000 $650
Physical Damage to Your Non-Owned Aircraft – pays for physical damage to non-owned aircraft for which you are legally liable.This coverage is only available in conjunction with Liability Coverage.

Physical Damage Limit
 Premium
Check Here
$5,000 $125
$10,000 $175
$20,000 $250
$40,000 $450
$60,000 $600
$80,000 $775
$100,000 $975
$150,000 $1,425
Decline Physical Damage Coverage

Optional Coverages
Description Premium Check
Add my employer as an additional insured ** $50
Name of Employer
Add the Civil Air Patrol Endorsement *** $50
Coverage for Acts of Terrorism under the Terrorism Risk Insurance Act of 2002 (TRIA) (MUST BE COMPLETED) - pays for bodily injury and property damage for which you are legally liable from certified acts of terrorism.
Add TRIA Coverage $50
Decline TRIA Coverage
* Flight Instructors Liability now includes comprehensive CFI Liability coverage.

** Your employer may require this coverage if you use non-owned aircraft on company business.This coverage is not available to Student or Recreational pilots. Coverage does not apply to employers who are involved in the manufacture, building, designing, selling, or distribution of aircraft, aircraft engines, parts, accessories, components, or fuel; engaged in the operation of an aircraft repair shop, sales agency, rental service, flight school, pilot training center or any other commercial flying service.

*** This coverage may be purchased to protect you against claims arising from your participation in Civil Air Patrol Activities.