URLThis field is for validation purposes and should be left unchanged.General Applicant InformationApplicant Entity Type:(Required) Individual Partnership Corporation LLC Joint Venture Applicant Name:(Required)Applicant's Name:(Required) First Last Applicant's Company Name:(Required)(N/A if you don't have one)Applicant Owner's Name:(Required) First Last What is the corporate name of the applicant? (This is the name that goes on the company’s tax returns)(Required)Owner's DOB:(Required) MM slash DD slash YYYY Owner's Position:(Required)Business Address:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is your mailing address the same as your business address?(Required) Yes No Mailing Address:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:(Required)Fax:Email:(Required) Website:FEIN (Tax ID #):(Required)Contact Person:(Required)Does the applicant have a DBA (Doing Business As) name:Do you operate at multiple locations:(Required) Yes No If yes, list all locations:(Required)In what year did the applicant start operations?(Required)Is this entity a franchise?(Required)Applicant pays for the right to operate under the franchisor's brand and system, the franchisor being the one that owns the brand, products, and business model Yes No Please describe what type of service(s) does the applicant provide:(Required)Please describe in detail.Years in business:(Required)Annual Revenue:(Required)Number of Employees:(Required)Full Time:Part Time:Contractors:What are your standard operating hours?(Required)Do you have any government or military contracts?(Required) Yes No Do You Operate Under an Airport Lease Agreement?(Required) Yes No If so, please explain:(Required)Services Provided (Check All That Apply)Services(Required) Aircraft Fueling Aircraft Maintenance & Repair Flight Training Hangar Rental De-Icing Services Concierge Services Aircraft Rental Aircraft Sales Charter Services Tie-Down Services Ground Handling Other Select AllAircraft Fueling: Avg. Gallons Pumped Per Year:(Required)Other Services(Required)FacilitiesDescribe all buildings and structures owned or leased by the applicant (e.g., main terminal, hangars, maintenance shops, fuel farms, offices, retail spaces):(Required)For Each Building:(Required)Year BuiltConstruction Type (e.g., steel, concrete block, frame)Square FootageRoof TypeFire Protection Systems (sprinklers, alarms, fire extinguishers) Add RemoveWhat is the replacement cost value of all buildings and contents?(Required)Are there any tenants or sub-lessees within the applicant’s premises? If so, what are their operations and what are the terms of their lease agreements, particularly regarding insurance requirements?(Required)What security measures are in place for the premises (e.g., fencing, gates, surveillance cameras, security personnel, lighting)?(Required)EquipmentList all major ground support equipment (GSE) owned or leased:(Required)(e.g., tugs, baggage carts, de-icing trucks, lavatory service trucks)What is the maintenance schedule for all GSE?(Required)Are all operators of GSE trained and certified?(Required)Property & EquipmentDo you own or lease your buildings and facilities?(Required) Own Lease Both Do you own or lease hangars?(Required) Own Lease Both Total square footage of hangar space:(Required)Estimated total value of buildings and facilities:(Required)Do you have a fire suppression system installed?(Required) Yes No Do you have security measures in place? (Check all that apply)(Required) 24/7 security personnel Surveillance cameras Access control system Fencing and restricted entry What is the average daily aircraft traffic?(Required)Are there any special events or airshows hosted or participated in by the applicant? If so, what are the dates, nature of the event, and attendance figures?(Required)Does the applicant own any mobile fueling or maintenance services off-airport?(Required) Yes No What products does the applicant sell (e.g., aircraft parts, pilot supplies, fuel, lubricants)?(Required)Does the applicant perform any maintenance or repair services on aircraft not owned by the applicant? If so, describe the scope of services (e.g., minor repairs, major overhauls, engine work, avionics).(Required)What is the maximum value of any single product sold or service completed?(Required)What is the applicant’s quality control program for products and services?(Required)Are parts tracked (e.g., serial numbers, shelf life)?(Required)Are all maintenance personnel FAA-certified (e.g., A&P, IA)? What is their experience level?(Required)What are the warranty terms, if any, for products sold or services rendered?(Required)Does the applicant operate or utilize any non-owned aircraft for business purposes?(Required)(e.g., ferry flights, parts pickups, customer transport) Yes No If so, what type of aircraft, who pilots them, and what are the typical uses?(Required)Are certificates of insurance obtained from all third-party aircraft operators?(Required)Security & Safety Management System (SMS)Does the applicant have a formal Safety Management System (SMS) in place?(Required) Yes No If yes, describe:(Required)Who is responsible for safety oversight and compliance?(Required)How are hazards identified, assessed, and mitigated?(Required)What is the incident/accident reporting and investigation process?(Required)What are the emergency response plans for various scenarios?(Required)(e.g., fuel spill, aircraft fire, medical emergency)Are regular safety audits or inspections conducted?(Required)Please note whether they are internal or external.Aircraft Exposure & LiabilityDo you own or operate any aircraft?(Required) Yes No If yes, please list:(Required)Do you offer aircraft rental or leasing?(Required) Yes No Do you provide flight instruction services?(Required) Yes No Do you require customers to sign liability waivers before services?(Required) Yes No Do you maintain detailed maintenance and safety records?(Required) Yes No Employees & Workers' CompensationHow many employees do you have?(Required)Full-Time:Part-Time:Do your employees receive safety training?(Required) Yes No Do you conduct background checks and drug screening?(Required) Yes No Do you have a workers’ compensation policy in place?(Required) Yes No Insurance History & ClaimsDo you currently have business insurance coverage?(Required) Yes No Current Insurer(Required)Policy Expiration Date(Required) MM slash DD slash YYYY Policy Limits(Required)Have you had any claims in the past five years?(Required) Yes No If yes, please provide details (date, type of claim, amount paid):(Required)Has your insurance ever been canceled or non-renewed?(Required) Yes No If yes, please explain:(Required)Coverage Needs & Additional ProtectionWhich types of insurance coverage are you interested in? (Check all that apply)(Required) Select All Hangarkeepers Liability Commercial General Liability Workers’ Compensation Professional Liability (For Flight Instructors) Business Interruption Insurance Cyber Liability (Data Breaches, Online Transactions) Pollution Liability (For Fuel Spills) Other Other (Please specify):(Required)Additional Comments or Special Considerations(Please provide any other relevant information that may impact your insurance coverage needs.) Δ
