ACORD 328 (2014/12) - Private Hangar Liability Section

ACORD 328 (2014/12) - Private Hangar Liability Section
ACORD 328, Private Hangar Liability Section, is used in conjunction with ACORD 325, Aviation Insurance Application - Applicant Information
Section, for hangar liability insurance. Attach ACORD 332, Hangar Schedule, if necessary.
Form Page 1
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
IDENTIFICATION SECTION
Date (MM/DD/YYYY)
Enter date: The date on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION
Agency
Enter text: The full name of the producer / agency.
IDENTIFICATION SECTION
Policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for
self-insurance, the self-insured license or contract number.
IDENTIFICATION SECTION
Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the policy
commence. (MM/DD/YYYY)
IDENTIFICATION SECTION
Carrier
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use
the actual name of the company within the group to which the policy has been issued. This is
not the insurer's group name or trade name.
IDENTIFICATION SECTION
NAIC Code
Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION
Named Insured
Enter text: The named insured(s) as it / they will appear on the policy declarations page.
IDENTIFICATION SECTION
Estimated Annual Premium
Enter amount: The estimated annual premium amount for the Aircraft line of business.
HANGAR INFORMATION
Location #
Enter number: The location number for the premises.
HANGAR INFORMATION
Building #
Enter number: The building number for the premises. Used when more than one building exists
at an individual location.
HANGAR INFORMATION
Airport ID
Enter identifier: The Federal Aviation Administration's designator for the airport (e.g. ORD -
O'Hare International Airport).
HANGAR INFORMATION
Airport Name
Enter text: The full name of the location.
HANGAR INFORMATION
Number of Hangars Insured
Enter number: The number of hangars insured.
HANGAR INFORMATION
Number of Aircraft Owners
Stores in the Insured
Hangar.
Enter number: The number of aircraft the owner stores in the insured hangar.
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HANGAR INFORMATION
Maximum Value of all
Aircraft Stored in the
Hangar.
Enter amount: The maximum value of all aircraft stored in the hangar.
HANGAR INFORMATION
Number of Hangar Spaces
you Lease.
Enter number: The number of hangar spaces leased by the insured.
HANGAR INFORMATION
Make One
Enter text: The manufacturer of the aircraft.
HANGAR INFORMATION
Model One
Enter text: The model of the aircraft.
HANGAR INFORMATION
Make Two
Enter text: The manufacturer of the aircraft.
HANGAR INFORMATION
Model Two
Enter text: The model of the aircraft.
HANGAR INFORMATION
Make Three
Enter text: The manufacturer of the aircraft.
HANGAR INFORMATION
Model Three
Enter text: The model of the aircraft.
HANGAR INFORMATION
Who has access to Leased
Hangars?
Enter text: The description of all parties that have access to leased hangars.
HANGAR INFORMATION
Liability and Physical
Damage Insurance
Company.
Enter text: The insurer name on any other applicable insurance. As used here, this is the liability
and physical damage insurance company.
HANGAR INFORMATION
Description of Hangar.
Enter text: The description of the hangar.
HANGAR INFORMATION
Describe other items in
storage.
Enter text: The description of items other than aircraft that are stored in the hangar.
HANGAR INFORMATION
Describe any Commercial
Operations you or your
tenant carry out in the
hangar.
Enter text: The description of any commercial operations you or your tenant carry out in the
hangar.
HANGAR INFORMATION
If you are required to sign
airport hangar agreements
with your city, with whom
are the agreements signed?
Enter text: The person and / or position of the person within the city with whom you are required
to sign airport hangar agreements.
GENERAL INFORMATION
Do you require hangar
tenants to carry insurance?
Yes
Check the box (if applicable): Indicates a Yes response to the question, Do you require
hangar tenants to carry insurance?.
GENERAL INFORMATION
Do you require hangar
tenants to carry insurance?
No
Check the box (if applicable): Indicates a No response to the question, Do you require hangar
tenants to carry insurance?.
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GENERAL INFORMATION
If yes, does their insurance
policy name the owner as an
additional insured? Yes
Check the box (if applicable): Indicates a Yes response to the question, If you require hangar
tenants to carry insurance, does their insurance policy name the owner as an additional
insured?.
GENERAL INFORMATION
If yes, does their insurance
policy name the owner as an
additional insured? No
Check the box (if applicable): Indicates a No response to the question, If you require hangar
tenants to carry insurance, does their insurance policy name the owner as an additional
insured?.
GENERAL INFORMATION
Do you require tenants to
sign a hangar agreement
holding you harmless for
losses not caused by you?
Yes
Check the box (if applicable): Indicates a Yes response to the question, Do you require
tenants to sign hangar agreement holding you harmless for losses not caused by you?.
GENERAL INFORMATION
Do you require tenants to
sign a hangar agreement
holding you harmless for
losses not caused by you?
No
Check the box (if applicable): Indicates a No response to the question, Do you require tenants
to sign hangar agreement holding you harmless for losses not caused by you?.
GENERAL INFORMATION
Are any aircraft of others
taxied, towed or moved by
applicant? Yes
Check the box (if applicable): Indicates a Yes response to the question, Are any aircraft of
others taxied, towed or moved by applicant?.
GENERAL INFORMATION
Are any aircraft of others
taxied, towed or moved by
applicant? No
Check the box (if applicable): Indicates a No response to the question, Are any aircraft of
others taxied, towed or moved by applicant?.
ADDITIONAL INSUREDS
Name And Address
Enter text: The additional interest's full name.
ADDITIONAL INSUREDS
Enter text: The additional interest's mailing address line one.
ADDITIONAL INSUREDS
Enter text: The additional interest's mailing address line two.
ADDITIONAL INSUREDS
Enter text: The additional interest's mailing address city name.
ADDITIONAL INSUREDS
Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INSUREDS
Enter code: The additional interest's mailing address postal code.
ADDITIONAL INSUREDS
Enter code: The additional interest's country code.
ADDITIONAL INSUREDS
Certificate Required
Check the box (if applicable): Indicates if the additional interest requires a Certificate of
Insurance.
ADDITIONAL INSUREDS
Reason For Interest
Enter text: The description for the interest in the item.
ADDITIONAL INSUREDS
Phone
Enter number: The primary phone number of the additional interest.
ADDITIONAL INSUREDS
Fax
Enter number: The primary fax number of the additional interest.
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ADDITIONAL INSUREDS
E-Mail
Enter text: The primary e-mail address for the additional interest.
ADDITIONAL INSUREDS
Name And Address
Enter text: The additional interest's full name.
ADDITIONAL INSUREDS
Enter text: The additional interest's mailing address line one.
ADDITIONAL INSUREDS
Enter text: The additional interest's mailing address line two.
ADDITIONAL INSUREDS
Enter text: The additional interest's mailing address city name.
ADDITIONAL INSUREDS
Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INSUREDS
Enter code: The additional interest's mailing address postal code.
ADDITIONAL INSUREDS
Enter code: The additional interest's country code.
ADDITIONAL INSUREDS
Certificate Required
Check the box (if applicable): Indicates if the additional interest requires a Certificate of
Insurance.
ADDITIONAL INSUREDS
Reason For Interest
Enter text: The description for the interest in the item.
ADDITIONAL INSUREDS
Phone
Enter number: The primary phone number of the additional interest.
ADDITIONAL INSUREDS
Fax
Enter number: The primary fax number of the additional interest.
ADDITIONAL INSUREDS
E-Mail
Enter text: The primary e-mail address for the additional interest.
COVERAGES
Hangarkeepers Legal
Liability Including Taxi
Check the box (if applicable): Indicates the including taxi option applies to the coverage.
COVERAGES
Hangarkeepers Legal
Liability In Flight
Check the box (if applicable): Indicates the in flight option applies to the coverage.
COVERAGES
Hangarkeepers Legal
Liability Other Option
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Hangarkeepers Legal
Liability Describe Other
Option
Enter text: The description of the option being requested. Example: Ground Only.
COVERAGES
Hangarkeepers Legal
Liability Limit Each Aircraft
Enter limit: The each aircraft limit amount for hangarkeepers legal liability coverage.
COVERAGES
Hangarkeepers Legal
Liability Limit Each
Occurrence
Enter limit: The each occurrence limit amount for hangarkeepers legal liability coverage.
COVERAGES
Hangarkeepers Legal
Liability Deductible
Enter deductible: The deductible amount for hangarkeepers legal liability coverage.
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COVERAGES
Hangarkeepers Legal
Liability Applies To
Enter code: The code identifying what the deductible applies to. Examples: Each and Every
Loss, Turbine Aircraft, Airline, Property Damage, Each Occurrence
COVERAGES
Hangarkeepers Legal
Liability Deductible
Enter deductible: The deductible amount for hangarkeepers legal liability coverage.
COVERAGES
Hangarkeepers Legal
Liability Applies To
Enter code: The code identifying what the deductible applies to. Examples: Each and Every
Loss, Turbine Aircraft, Airline, Property Damage, Each Occurrence
COVERAGES
Hangarkeepers Legal
Liability Deductible
Enter deductible: The deductible amount for hangarkeepers legal liability coverage.
COVERAGES
Hangarkeepers Legal
Liability Applies To
Enter code: The code identifying what the deductible applies to. Examples: Each and Every
Loss, Turbine Aircraft, Airline, Property Damage, Each Occurrence
COVERAGES
Hangarkeepers Legal
Liability Premium
Enter amount: The premium amount for hangarkeepers legal liability coverage.
COVERAGES
Coverage Code
Enter code: The code for the coverage.
COVERAGES
Coverage Description
Enter text: The description of other coverage (not the limit) on the policy. Any questions about
appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
COVERAGES
Option
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Option Description
Enter text: The description of the option being requested.
COVERAGES
Option
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Option Description
Enter text: The description of the option being requested.
COVERAGES
Limit
Enter limit: The limit amount for the coverage.
COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
COVERAGES
Limit
Enter limit: The limit amount for the coverage.
COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
COVERAGES
Coverage Code
Enter code: The code for the coverage.
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COVERAGES
Coverage Description
Enter text: The description of other coverage (not the limit) on the policy. Any questions about
appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s)
COVERAGES
Option
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Option Description
Enter text: The description of the option being requested.
COVERAGES
Option
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Option Description
Enter text: The description of the option being requested.
COVERAGES
Limit
Enter limit: The limit amount for the coverage.
COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
COVERAGES
Limit
Enter limit: The limit amount for the coverage.
COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
COVERAGES
Applies To
Enter code: The code identifying what the deductible applies to.
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
Form Page 2
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
SIGNATURE
Producer's Signature
Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent,
broker, etc.) of the company(ies) listed on the document. This is required in most states.
SIGNATURE
Producer's Name (Please
Print)
Enter text: The name of the authorized representative of the producer, agency and/or broker
that signed the form.
SIGNATURE
State Producer License No
(Required in FL)
Enter identifier: The State License Number of the producer.
SIGNATURE
Applicant's Signature
Sign here: Accommodates the signature of the applicant or named insured.
SIGNATURE
Date
Enter date: The date the form was signed by the named insured. (MM/DD/YYYY)
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SIGNATURE
National Producer Number
Enter identifier: The National Producer Number (NPN) as defined in the National Insurance
Producer Registry (NIPR). Note: The NPN is not the same as the producer state license
number.
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