ACORD 329 (2014/12) - Aviation Products Liability

ACORD 329 (2014/12) - Aviation Products Liability
ACORD 329, Aviation Products Liability, is used in conjunction with ACORD 325, Aviation Insurance Application - Applicant Information Section, to
apply for aviation products liability coverage.
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.
COVERAGES
Products Liability Incl Comp
Ops
Check the box (if applicable): Indicates completed operations are included in the products
liability coverage.
COVERAGES
Products Liability Excl
Comp Ops
Check the box (if applicable): Indicates completed operations are excluded from the products
liability coverage.
COVERAGES
Products Liability Incl
Spacecraft
Check the box (if applicable): Indicates spacecraft are included in the products liability coverage.
COVERAGES
Products Liability Excl
Spacecraft
Check the box (if applicable): Indicates spacecraft are excluded from the products liability
coverage.
COVERAGES
Products Liability Limit Ea
Occ
Enter limit: The each occurrence limit for products liability coverage.
COVERAGES
Products Liability Limit Aggr
Enter limit: The aggregate limit for products liability coverage.
ACORD 329 (2014/12) rev. 04-29-2014
Page 1 of 27
COVERAGES
Products Liability
Deductible Ea Occ
Enter deductible: The each occurrence deductible amount for products liability coverage.
COVERAGES
Products Liability
Deductible Aggr
Enter deductible: The aggregate deductible amount for products liability coverage.
COVERAGES
Products Liability Premium
Enter amount: The premium amount for products liability coverage.
COVERAGES
Grounding Liability Limit Ea
Occ
Enter limit: The each occurrence limit amount for grounding liability coverage.
COVERAGES
Grounding Liability Limit
Aggr
Enter limit: The aggregate limit amount for grounding liability coverage.
COVERAGES
Grounding Liability
Deductible Amount
Enter deductible: The deductible amount for grounding liability coverage.
COVERAGES
Grounding Liability
Deductible Percent Each
Ground
Enter percentage: The percentage deductible for each ground for grounding liability coverage.
COVERAGES
Grounding Liability
Premium
Enter amount: The premium amount for grounding liability coverage.
COVERAGES
Foreign Military Aircraft
Products Included
Check the box (if applicable): Indicates foreign military aircraft products coverage is included in
the policy.
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
Options
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Describe Other Options
Enter text: The description of the option being requested.
COVERAGES
Options
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Describe Other Options
Enter text: The description of the option being requested.
COVERAGES
Limit
Enter limit: The limit amount for the coverage.
COVERAGES
Limit 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
Limit 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
Deductible Applies to
Enter code: The code identifying what the deductible applies to.
ACORD 329 (2014/12) rev. 04-29-2014
Page 2 of 27
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
COVERAGES
Deductible 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.
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
Options
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Describe Other Options
Enter text: The description of the option being requested.
COVERAGES
Options
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Describe Other Options
Enter text: The description of the option being requested.
COVERAGES
Limit
Enter limit: The limit amount for the coverage.
COVERAGES
Limit 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
Limit 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
Deductible Applies to
Enter code: The code identifying what the deductible applies to.
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
COVERAGES
Deductible 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.
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
Options
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Describe Other Options
Enter text: The description of the option being requested.
COVERAGES
Options
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Describe Other Options
Enter text: The description of the option being requested.
COVERAGES
Limit
Enter limit: The limit amount for the coverage.
COVERAGES
Limit Applies to
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
ACORD 329 (2014/12) rev. 04-29-2014
Page 3 of 27
COVERAGES
Limit
Enter limit: The limit amount for the coverage.
COVERAGES
Limit 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
Deductible Applies to
Enter code: The code identifying what the deductible applies to.
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
COVERAGES
Deductible Applies to
Enter code: The code identifying what the deductible applies to.
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
EXCESS COVERAGE
Will you be purchasing
excess coverage over this
insurance?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Will you be purchasing excess coverage over this insurance?.
EXCESS COVERAGE
Excess Carrier
Enter text: The insurer name on any other applicable insurance. As used here, this is for the
excess carrier.
EXCESS COVERAGE
Policy Number
Enter identifier: The policy number on any other applicable insurance. As used here, this is for
the excess policy.
EXCESS COVERAGE
Expiration Date
Enter date: The date on which the terms and conditions of the other policy expires. As used
here, this is for the excess policy.
EXCESS COVERAGE
Describe Excess Coverage
Enter text: The description of the other policy not listed on the form. As used here, this is for the
excess policy.
PRINCIPAL CUSTOMERS
Customer Name
Enter text: The full name of the principal customer.
PRINCIPAL CUSTOMERS
% of Sales
Enter percentage: The percentage of total sales this principal customer is responsible for.
PRINCIPAL CUSTOMERS
Description of
Product/Service
Enter text: The description of the products and / or services purchased by the principal
customer.
PRINCIPAL CUSTOMERS
Aircraft Models Utilizing the
Product
Enter text: The description of the aircraft models using the products and / or services purchased
by the principal customer.
PRINCIPAL CUSTOMERS
Aircraft Systems Utilizing
the Product
Enter text: The description of the aircraft systems using the products and / or services
purchased the by the principal customer.
PRINCIPAL CUSTOMERS
Customer Name
Enter text: The full name of the principal customer.
PRINCIPAL CUSTOMERS
% of Sales
Enter percentage: The percentage of total sales this principal customer is responsible for.
PRINCIPAL CUSTOMERS
Description of
Product/Service
Enter text: The description of the products and / or services purchased by the principal
customer.
ACORD 329 (2014/12) rev. 04-29-2014
Page 4 of 27
PRINCIPAL CUSTOMERS
Aircraft Models Utilizing the
Product
Enter text: The description of the aircraft models using the products and / or services purchased
by the principal customer.
PRINCIPAL CUSTOMERS
Aircraft Systems Utilizing
the Product
Enter text: The description of the aircraft systems using the products and / or services
purchased the by the principal customer.
PRINCIPAL CUSTOMERS
Customer Name
Enter text: The full name of the principal customer.
PRINCIPAL CUSTOMERS
% of Sales
Enter percentage: The percentage of total sales this principal customer is responsible for.
PRINCIPAL CUSTOMERS
Description of
Product/Service
Enter text: The description of the products and / or services purchased by the principal
customer.
PRINCIPAL CUSTOMERS
Aircraft Models Utilizing the
Product
Enter text: The description of the aircraft models using the products and / or services purchased
by the principal customer.
PRINCIPAL CUSTOMERS
Aircraft Systems Utilizing
the Product
Enter text: The description of the aircraft systems using the products and / or services
purchased the by the principal customer.
PRINCIPAL CUSTOMERS
Customer Name
Enter text: The full name of the principal customer.
PRINCIPAL CUSTOMERS
% of Sales
Enter percentage: The percentage of total sales this principal customer is responsible for.
PRINCIPAL CUSTOMERS
Description of
Product/Service
Enter text: The description of the products and / or services purchased by the principal
customer.
PRINCIPAL CUSTOMERS
Aircraft Models Utilizing the
Product
Enter text: The description of the aircraft models using the products and / or services purchased
by the principal customer.
PRINCIPAL CUSTOMERS
Aircraft Systems Utilizing
the Product
Enter text: The description of the aircraft systems using the products and / or services
purchased the by the principal customer.
PRINCIPAL CUSTOMERS
Customer Name
Enter text: The full name of the principal customer.
PRINCIPAL CUSTOMERS
% of Sales
Enter percentage: The percentage of total sales this principal customer is responsible for.
PRINCIPAL CUSTOMERS
Description of
Product/Service
Enter text: The description of the products and / or services purchased by the principal
customer.
PRINCIPAL CUSTOMERS
Aircraft Models Utilizing the
Product
Enter text: The description of the aircraft models using the products and / or services purchased
by the principal customer.
PRINCIPAL CUSTOMERS
Aircraft Systems Utilizing
the Product
Enter text: The description of the aircraft systems using the products and / or services
purchased the by the principal customer.
PRINCIPAL CUSTOMERS
Customer Name
Enter text: The full name of the principal customer.
PRINCIPAL CUSTOMERS
% of Sales
Enter percentage: The percentage of total sales this principal customer is responsible for.
ACORD 329 (2014/12) rev. 04-29-2014
Page 5 of 27
PRINCIPAL CUSTOMERS
Description of
Product/Service
Enter text: The description of the products and / or services purchased by the principal
customer.
PRINCIPAL CUSTOMERS
Aircraft Models Utilizing the
Product
Enter text: The description of the aircraft models using the products and / or services purchased
by the principal customer.
PRINCIPAL CUSTOMERS
Aircraft Systems Utilizing
the Product
Enter text: The description of the aircraft systems using the products and / or services
purchased the by the principal customer.
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).
AIRCRAFT PRODUCT
SALES
Year One
Enter year: The year the sales took place.
AIRCRAFT PRODUCT
SALES
Year Two
Enter year: The year the sales took place.
AIRCRAFT PRODUCT
SALES
Year Three
Enter year: The year the sales took place.
AIRCRAFT PRODUCT
SALES
Year Four
Enter year: The year the sales took place.
AIRCRAFT PRODUCT
SALES
Year Five
Enter year: The year the sales took place.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Airframe Year One
Enter amount: The annual gross receipts amount for fixed wing piston airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Airframe Year Two
Enter amount: The annual gross receipts amount for fixed wing piston airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Airframe Year Three
Enter amount: The annual gross receipts amount for fixed wing piston airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Airframe Year Four
Enter amount: The annual gross receipts amount for fixed wing piston airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Airframe Year Five
Enter amount: The annual gross receipts amount for fixed wing piston airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Engine Year One
Enter amount: The annual gross receipts amount for fixed wing piston engines.
ACORD 329 (2014/12) rev. 04-29-2014
Page 6 of 27
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Engine Year Two
Enter amount: The annual gross receipts amount for fixed wing piston engines.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Engine Year Three
Enter amount: The annual gross receipts amount for fixed wing piston engines.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Engine Year Four
Enter amount: The annual gross receipts amount for fixed wing piston engines.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Engine Year Five
Enter amount: The annual gross receipts amount for fixed wing piston engines.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Propeller Year One
Enter amount: The annual gross receipts amount for fixed wing piston propellers.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Propeller Year Two
Enter amount: The annual gross receipts amount for fixed wing piston propellers.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Propeller Year Three
Enter amount: The annual gross receipts amount for fixed wing piston propellers.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Propeller Year Four
Enter amount: The annual gross receipts amount for fixed wing piston propellers.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Piston Propeller Year Five
Enter amount: The annual gross receipts amount for fixed wing piston propellers.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Airframe Year One
Enter amount: The annual gross receipts amount for fixed wing turbine airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Airframe Year Two
Enter amount: The annual gross receipts amount for fixed wing turbine airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Airframe Year Three
Enter amount: The annual gross receipts amount for fixed wing turbine airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Airframe Year Four
Enter amount: The annual gross receipts amount for fixed wing turbine airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Airframe Year Five
Enter amount: The annual gross receipts amount for fixed wing turbine airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Engine Year One
Enter amount: The annual gross receipts amount for fixed wing turbine engines.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Engine Year Two
Enter amount: The annual gross receipts amount for fixed wing turbine engines.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Engine Year Three
Enter amount: The annual gross receipts amount for fixed wing turbine engines.
ACORD 329 (2014/12) rev. 04-29-2014
Page 7 of 27
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Engine Year Four
Enter amount: The annual gross receipts amount for fixed wing turbine engines.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Engine Year Five
Enter amount: The annual gross receipts amount for fixed wing turbine engines.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Propeller Year One
Enter amount: The annual gross receipts amount for fixed wing turbine propellers.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Propeller Year Two
Enter amount: The annual gross receipts amount for fixed wing turbine propellers.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Propeller Year
Three
Enter amount: The annual gross receipts amount for fixed wing turbine propellers.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Propeller Year Four
Enter amount: The annual gross receipts amount for fixed wing turbine propellers.
AIRCRAFT PRODUCT
SALES
Non Military - Fixed Wing
Turbine Propeller Year Five
Enter amount: The annual gross receipts amount for fixed wing turbine propellers.
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Airframe Year One
Enter amount: The annual gross receipts amount for helicopter airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Airframe Year Two
Enter amount: The annual gross receipts amount for helicopter airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Airframe Year Three
Enter amount: The annual gross receipts amount for helicopter airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Airframe Year Four
Enter amount: The annual gross receipts amount for helicopter airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Airframe Year Five
Enter amount: The annual gross receipts amount for helicopter airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Engine Year One
Enter amount: The annual gross receipts amount for helicopter engines.
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Engine Year Two
Enter amount: The annual gross receipts amount for helicopter engines.
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Engine Year Three
Enter amount: The annual gross receipts amount for helicopter engines.
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Engine Year Four
Enter amount: The annual gross receipts amount for helicopter engines.
ACORD 329 (2014/12) rev. 04-29-2014
Page 8 of 27
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Engine Year Five
Enter amount: The annual gross receipts amount for helicopter engines.
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Rotors Year One
Enter amount: The annual gross receipts amount for helicopter rotors.
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Rotors Year Two
Enter amount: The annual gross receipts amount for helicopter rotors.
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Rotors Year Three
Enter amount: The annual gross receipts amount for helicopter rotors.
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Rotors Year Four
Enter amount: The annual gross receipts amount for helicopter rotors.
AIRCRAFT PRODUCT
SALES
Non Military - Helicopter
Rotors Year Five
Enter amount: The annual gross receipts amount for helicopter rotors.
AIRCRAFT PRODUCT
SALES
Non Military - Remote
Piloted Vehicles Airframe
Enter number: The average number of remote piloted vehicle airframes sold per year.
AIRCRAFT PRODUCT
SALES
Non Military - Remote
Piloted Vehicles Airframe
Year One
Enter amount: The annual gross receipts amount for remote piloted vehicle airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Remote
Piloted Vehicles Airframe
Year Two
Enter amount: The annual gross receipts amount for remote piloted vehicle airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Remote
Piloted Vehicles Airframe
Year Three
Enter amount: The annual gross receipts amount for remote piloted vehicle airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Remote
Piloted Vehicles Airframe
Year Four
Enter amount: The annual gross receipts amount for remote piloted vehicle airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Remote
Piloted Vehicles Airframe
Year Five
Enter amount: The annual gross receipts amount for remote piloted vehicle airframes.
AIRCRAFT PRODUCT
SALES
Non Military - Remote
Piloted Vehicles Engine
Enter number: The average number of remote piloted vehicle engines sold per year.
AIRCRAFT PRODUCT
SALES
Non Military - Remote
Piloted Vehicles Engine
Year One
Enter amount: The annual gross receipts amount for remote piloted vehicle engines.
ACORD 329 (2014/12) rev. 04-29-2014
Page 9 of 27
AIRCRAFT PRODUCT
SALES
Non Military - Remote
Piloted Vehicles Engine
Year Two
Enter amount: The annual gross receipts amount for remote piloted vehicle engines.
AIRCRAFT PRODUCT
SALES
Non Military - Remote
Piloted Vehicles Engine
Year Three
Enter amount: The annual gross receipts amount for remote piloted vehicle engines.
AIRCRAFT PRODUCT
SALES
Non Military - Remote
Piloted Vehicles Engine
Year Four
Enter amount: The annual gross receipts amount for remote piloted vehicle engines.
AIRCRAFT PRODUCT
SALES
Non Military - Remote
Piloted Vehicles Engine
Year Five
Enter amount: The annual gross receipts amount for remote piloted vehicle engines.
AIRCRAFT PRODUCT
SALES
Non Military - Commercial
Spacecraft Satellite Year
One
Enter amount: The annual gross receipts amount for commercial spacecraft satellites.
AIRCRAFT PRODUCT
SALES
Non Military - Commercial
Spacecraft Satellite Year
Two
Enter amount: The annual gross receipts amount for commercial spacecraft satellites.
AIRCRAFT PRODUCT
SALES
Non Military - Commercial
Spacecraft Satellite Year
Three
Enter amount: The annual gross receipts amount for commercial spacecraft satellites.
AIRCRAFT PRODUCT
SALES
Non Military - Commercial
Spacecraft Satellite Year
Four
Enter amount: The annual gross receipts amount for commercial spacecraft satellites.
AIRCRAFT PRODUCT
SALES
Non Military - Commercial
Spacecraft Satellite Year
Five
Enter amount: The annual gross receipts amount for commercial spacecraft satellites.
AIRCRAFT PRODUCT
SALES
Non Military - Commercial
Spacecraft Other Type
Enter text: The description of the commercial spacecraft sold.
AIRCRAFT PRODUCT
SALES
Non Military - Commercial
Spacecraft Other Type Year
One
Enter amount: The annual gross receipts amount for other commercial spacecraft.
AIRCRAFT PRODUCT
SALES
Non Military - Commercial
Spacecraft Other Type Year
Two
Enter amount: The annual gross receipts amount for other commercial spacecraft.
ACORD 329 (2014/12) rev. 04-29-2014
Page 10 of 27
AIRCRAFT PRODUCT
SALES
Non Military - Commercial
Spacecraft Other Type Year
Three
Enter amount: The annual gross receipts amount for other commercial spacecraft.
AIRCRAFT PRODUCT
SALES
Non Military - Commercial
Spacecraft Other Type Year
Four
Enter amount: The annual gross receipts amount for other commercial spacecraft.
AIRCRAFT PRODUCT
SALES
Non Military - Commercial
Spacecraft Other Type Year
Five
Enter amount: The annual gross receipts amount for other commercial spacecraft.
AIRCRAFT PRODUCT
SALES
Non Military - Hot Air
Balloons Year One
Enter amount: The annual gross receipts amount for hot air balloons.
AIRCRAFT PRODUCT
SALES
Non Military - Hot Air
Balloons Year Two
Enter amount: The annual gross receipts amount for hot air balloons.
AIRCRAFT PRODUCT
SALES
Non Military - Hot Air
Balloons Year Three
Enter amount: The annual gross receipts amount for hot air balloons.
AIRCRAFT PRODUCT
SALES
Non Military - Hot Air
Balloons Year Four
Enter amount: The annual gross receipts amount for hot air balloons.
AIRCRAFT PRODUCT
SALES
Non Military - Hot Air
Balloons Year Five
Enter amount: The annual gross receipts amount for hot air balloons.
AIRCRAFT PRODUCT
SALES
Non Military - Blimps Year
One
Enter amount: The annual gross receipts amount for blimps.
AIRCRAFT PRODUCT
SALES
Non Military - Blimps Year
Two
Enter amount: The annual gross receipts amount for blimps.
AIRCRAFT PRODUCT
SALES
Non Military - Blimps Year
Three
Enter amount: The annual gross receipts amount for blimps.
AIRCRAFT PRODUCT
SALES
Non Military - Blimps Year
Four
Enter amount: The annual gross receipts amount for blimps.
AIRCRAFT PRODUCT
SALES
Non Military - Blimps Year
Five
Enter amount: The annual gross receipts amount for blimps.
AIRCRAFT PRODUCT
SALES
Non Military - Hang Gliders
Year One
Enter amount: The annual gross receipts amount for hang gliders.
AIRCRAFT PRODUCT
SALES
Non Military - Hang Gliders
Year Two
Enter amount: The annual gross receipts amount for hang gliders.
ACORD 329 (2014/12) rev. 04-29-2014
Page 11 of 27
AIRCRAFT PRODUCT
SALES
Non Military - Hang Gliders
Year Three
Enter amount: The annual gross receipts amount for hang gliders.
AIRCRAFT PRODUCT
SALES
Non Military - Hang Gliders
Year Four
Enter amount: The annual gross receipts amount for hang gliders.
AIRCRAFT PRODUCT
SALES
Non Military - Hang Gliders
Year Five
Enter amount: The annual gross receipts amount for hang gliders.
AIRCRAFT PRODUCT
SALES
Non Military - Ultralights
Year One
Enter amount: The annual gross receipts amount for ultralights.
AIRCRAFT PRODUCT
SALES
Non Military - Ultralights
Year Two
Enter amount: The annual gross receipts amount for ultralights.
AIRCRAFT PRODUCT
SALES
Non Military - Ultralights
Year Three
Enter amount: The annual gross receipts amount for ultralights.
AIRCRAFT PRODUCT
SALES
Non Military - Ultralights
Year Four
Enter amount: The annual gross receipts amount for ultralights.
AIRCRAFT PRODUCT
SALES
Non Military - Ultralights
Year Five
Enter amount: The annual gross receipts amount for ultralights.
AIRCRAFT PRODUCT
SALES
Non Military - Home Built
Aircraft Year One
Enter amount: The annual gross receipts amount for home built aircraft.
AIRCRAFT PRODUCT
SALES
Non Military - Home Built
Aircraft Year Two
Enter amount: The annual gross receipts amount for home built aircraft.
AIRCRAFT PRODUCT
SALES
Non Military - Home Built
Aircraft Year Three
Enter amount: The annual gross receipts amount for home built aircraft.
AIRCRAFT PRODUCT
SALES
Non Military - Home Built
Aircraft Year Four
Enter amount: The annual gross receipts amount for home built aircraft.
AIRCRAFT PRODUCT
SALES
Non Military - Home Built
Aircraft Year Five
Enter amount: The annual gross receipts amount for home built aircraft.
AIRCRAFT PRODUCT
SALES
Non Military - Repair &
Servicing Year One
Enter amount: The annual gross receipts amount for repair and servicing of aircraft and aviation
products.
AIRCRAFT PRODUCT
SALES
Non Military - Repair &
Servicing Year Two
Enter amount: The annual gross receipts amount for repair and servicing of aircraft and aviation
products.
AIRCRAFT PRODUCT
SALES
Non Military - Repair &
Servicing Year Three
Enter amount: The annual gross receipts amount for repair and servicing of aircraft and aviation
products.
AIRCRAFT PRODUCT
SALES
Non Military - Repair &
Servicing Year Four
Enter amount: The annual gross receipts amount for repair and servicing of aircraft and aviation
products.
ACORD 329 (2014/12) rev. 04-29-2014
Page 12 of 27
AIRCRAFT PRODUCT
SALES
Non Military - Repair &
Servicing Year Five
Enter amount: The annual gross receipts amount for repair and servicing of aircraft and aviation
products.
AIRCRAFT PRODUCT
SALES
Military - Missiles Year One
Enter amount: The annual gross receipts amount for military missiles.
AIRCRAFT PRODUCT
SALES
Military - Missiles Year Two
Enter amount: The annual gross receipts amount for military missiles.
AIRCRAFT PRODUCT
SALES
Military - Missiles Year
Three
Enter amount: The annual gross receipts amount for military missiles.
AIRCRAFT PRODUCT
SALES
Military - Missiles Year Four
Enter amount: The annual gross receipts amount for military missiles.
AIRCRAFT PRODUCT
SALES
Military - Missiles Year Five
Enter amount: The annual gross receipts amount for military missiles.
AIRCRAFT PRODUCT
SALES
Military - Spacecraft Year
One
Enter amount: The annual gross receipts amount for military spacecraft.
AIRCRAFT PRODUCT
SALES
Military - Spacecraft Year
Two
Enter amount: The annual gross receipts amount for military spacecraft.
AIRCRAFT PRODUCT
SALES
Military - Spacecraft Year
Three
Enter amount: The annual gross receipts amount for military spacecraft.
AIRCRAFT PRODUCT
SALES
Military - Spacecraft Year
Four
Enter amount: The annual gross receipts amount for military spacecraft.
AIRCRAFT PRODUCT
SALES
Military - Spacecraft Year
Five
Enter amount: The annual gross receipts amount for military spacecraft.
AIRCRAFT PRODUCT
SALES
Military - U.S. Aircraft Year
One
Enter amount: The annual gross receipts amount for United States military aircraft.
AIRCRAFT PRODUCT
SALES
Military - U.S. Aircraft Year
Two
Enter amount: The annual gross receipts amount for United States military aircraft.
AIRCRAFT PRODUCT
SALES
Military - U.S. Aircraft Year
Three
Enter amount: The annual gross receipts amount for United States military aircraft.
AIRCRAFT PRODUCT
SALES
Military - U.S. Aircraft Year
Four
Enter amount: The annual gross receipts amount for United States military aircraft.
AIRCRAFT PRODUCT
SALES
Military - U.S. Aircraft Year
Five
Enter amount: The annual gross receipts amount for United States military aircraft.
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing
Airframe Year One
Enter amount: The annual gross receipts amount for military fixed wing airframes.
ACORD 329 (2014/12) rev. 04-29-2014
Page 13 of 27
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing
Airframe Year Two
Enter amount: The annual gross receipts amount for military fixed wing airframes.
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing
Airframe Year Three
Enter amount: The annual gross receipts amount for military fixed wing airframes.
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing
Airframe Year Four
Enter amount: The annual gross receipts amount for military fixed wing airframes.
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing
Airframe Year Five
Enter amount: The annual gross receipts amount for military fixed wing airframes.
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing Engine
Year One
Enter amount: The annual gross receipts amount for military fixed wing engines.
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing Engine
Year Two
Enter amount: The annual gross receipts amount for military fixed wing engines.
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing Engine
Year Three
Enter amount: The annual gross receipts amount for military fixed wing engines.
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing Engine
Year Four
Enter amount: The annual gross receipts amount for military fixed wing engines.
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing Engine
Year Five
Enter amount: The annual gross receipts amount for military fixed wing engines.
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing
Propeller Year One
Enter amount: The annual gross receipts amount for military fixed wing propellers.
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing
Propeller Year Two
Enter amount: The annual gross receipts amount for military fixed wing propellers.
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing
Propeller Year Three
Enter amount: The annual gross receipts amount for military fixed wing propellers.
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing
Propeller Year Four
Enter amount: The annual gross receipts amount for military fixed wing propellers.
AIRCRAFT PRODUCT
SALES
Military - Fixed Wing
Propeller Year Five
Enter amount: The annual gross receipts amount for military fixed wing propellers.
AIRCRAFT PRODUCT
SALES
Military - Helicopter Airframe
Year One
Enter amount: The annual gross receipts amount for military helicopter airframes.
AIRCRAFT PRODUCT
SALES
Military - Helicopter Airframe
Year Two
Enter amount: The annual gross receipts amount for military helicopter airframes.
AIRCRAFT PRODUCT
SALES
Military - Helicopter Airframe
Year Three
Enter amount: The annual gross receipts amount for military helicopter airframes.
ACORD 329 (2014/12) rev. 04-29-2014
Page 14 of 27
AIRCRAFT PRODUCT
SALES
Military - Helicopter Airframe
Year Four
Enter amount: The annual gross receipts amount for military helicopter airframes.
AIRCRAFT PRODUCT
SALES
Military - Helicopter Airframe
Year Five
Enter amount: The annual gross receipts amount for military helicopter airframes.
AIRCRAFT PRODUCT
SALES
Military - Helicopter Engine
Year One
Enter amount: The annual gross receipts amount for military helicopter engines.
AIRCRAFT PRODUCT
SALES
Military - Helicopter Engine
Year Two
Enter amount: The annual gross receipts amount for military helicopter engines.
AIRCRAFT PRODUCT
SALES
Military - Helicopter Engine
Year Three
Enter amount: The annual gross receipts amount for military helicopter engines.
AIRCRAFT PRODUCT
SALES
Military - Helicopter Engine
Year Four
Enter amount: The annual gross receipts amount for military helicopter engines.
AIRCRAFT PRODUCT
SALES
Military - Helicopter Engine
Year Five
Enter amount: The annual gross receipts amount for military helicopter engines.
AIRCRAFT PRODUCT
SALES
Military - Helicopter Rotors
Year One
Enter amount: The annual gross receipts amount for military helicopter rotors.
AIRCRAFT PRODUCT
SALES
Military - Helicopter Rotors
Year Two
Enter amount: The annual gross receipts amount for military helicopter rotors.
AIRCRAFT PRODUCT
SALES
Military - Helicopter Rotors
Year Three
Enter amount: The annual gross receipts amount for military helicopter rotors.
AIRCRAFT PRODUCT
SALES
Military - Helicopter Rotors
Year Four
Enter amount: The annual gross receipts amount for military helicopter rotors.
AIRCRAFT PRODUCT
SALES
Military - Helicopter Rotors
Year Five
Enter amount: The annual gross receipts amount for military helicopter rotors.
AIRCRAFT PRODUCT
SALES
Military - Remote Piloted
Vehicles Airframe
Enter number: The average number of military remote piloted vehicle airframes sold per year.
AIRCRAFT PRODUCT
SALES
Military - Remote Piloted
Vehicles Airframe Year One
Enter amount: The annual gross receipts amount for military remote piloted vehicles airframes.
AIRCRAFT PRODUCT
SALES
Military - Remote Piloted
Vehicles Airframe Year Two
Enter amount: The annual gross receipts amount for military remote piloted vehicles airframes.
AIRCRAFT PRODUCT
SALES
Military - Remote Piloted
Vehicles Airframe Year
Three
Enter amount: The annual gross receipts amount for military remote piloted vehicles airframes.
ACORD 329 (2014/12) rev. 04-29-2014
Page 15 of 27
AIRCRAFT PRODUCT
SALES
Military - Remote Piloted
Vehicles Airframe Year Four
Enter amount: The annual gross receipts amount for military remote piloted vehicles airframes.
AIRCRAFT PRODUCT
SALES
Military - Remote Piloted
Vehicles Airframe Year Five
Enter amount: The annual gross receipts amount for military remote piloted vehicles airframes.
AIRCRAFT PRODUCT
SALES
Military - Remote Piloted
Vehicles Engine
Enter number: The average number of military remote piloted vehicle engines sold per year.
AIRCRAFT PRODUCT
SALES
Military - Remote Piloted
Vehicles Engine Year One
Enter amount: The annual gross receipts amount for military remote piloted vehicles engines.
AIRCRAFT PRODUCT
SALES
Military - Remote Piloted
Vehicles Engine Year Two
Enter amount: The annual gross receipts amount for military remote piloted vehicles engines.
AIRCRAFT PRODUCT
SALES
Military - Remote Piloted
Vehicles Engine Year Three
Enter amount: The annual gross receipts amount for military remote piloted vehicles engines.
AIRCRAFT PRODUCT
SALES
Military - Remote Piloted
Vehicles Engine Year Four
Enter amount: The annual gross receipts amount for military remote piloted vehicles engines.
AIRCRAFT PRODUCT
SALES
Military - Remote Piloted
Vehicles Engine Year Five
Enter amount: The annual gross receipts amount for military remote piloted vehicles engines.
AIRCRAFT PRODUCT
SALES
Other - Foreign Aircraft
Parts Year One
Enter amount: The annual gross receipts amount for foreign aircraft parts.
AIRCRAFT PRODUCT
SALES
Other - Foreign Aircraft
Parts Year Two
Enter amount: The annual gross receipts amount for foreign aircraft parts.
AIRCRAFT PRODUCT
SALES
Other - Foreign Aircraft
Parts Year Three
Enter amount: The annual gross receipts amount for foreign aircraft parts.
AIRCRAFT PRODUCT
SALES
Other - Foreign Aircraft
Parts Year Four
Enter amount: The annual gross receipts amount for foreign aircraft parts.
AIRCRAFT PRODUCT
SALES
Other - Foreign Aircraft
Parts Year Five
Enter amount: The annual gross receipts amount for foreign aircraft parts.
AIRCRAFT PRODUCT
SALES
Other - Avionics Year One
Enter amount: The annual gross receipts amount for avionics.
AIRCRAFT PRODUCT
SALES
Other - Avionics Year Two
Enter amount: The annual gross receipts amount for avionics.
AIRCRAFT PRODUCT
SALES
Other - Avionics Year Three
Enter amount: The annual gross receipts amount for avionics.
AIRCRAFT PRODUCT
SALES
Other - Avionics Year Four
Enter amount: The annual gross receipts amount for avionics.
ACORD 329 (2014/12) rev. 04-29-2014
Page 16 of 27
AIRCRAFT PRODUCT
SALES
Other - Avionics Year Five
Enter amount: The annual gross receipts amount for avionics.
AIRCRAFT PRODUCT
SALES
Other - Petrol Fuel
Lubricants Year One
Enter amount: The annual gross receipts amount for petroleum fuel lubricants.
AIRCRAFT PRODUCT
SALES
Other - Petrol Fuel
Lubricants Year Two
Enter amount: The annual gross receipts amount for petroleum fuel lubricants.
AIRCRAFT PRODUCT
SALES
Other - Petrol Fuel
Lubricants Year Three
Enter amount: The annual gross receipts amount for petroleum fuel lubricants.
AIRCRAFT PRODUCT
SALES
Other - Petrol Fuel
Lubricants Year Four
Enter amount: The annual gross receipts amount for petroleum fuel lubricants.
AIRCRAFT PRODUCT
SALES
Other - Petrol Fuel
Lubricants Year Five
Enter amount: The annual gross receipts amount for petroleum fuel lubricants.
AIRCRAFT PRODUCT
SALES
Other Description
Enter text: The description of other products or services.
AIRCRAFT PRODUCT
SALES
Other Year One
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Two
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Three
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Four
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Five
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Description
Enter text: The description of other products or services.
AIRCRAFT PRODUCT
SALES
Other Year One
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Two
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Three
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Four
Enter amount: The annual gross receipts amount for other products or services.
ACORD 329 (2014/12) rev. 04-29-2014
Page 17 of 27
AIRCRAFT PRODUCT
SALES
Other Year Five
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Description
Enter text: The description of other products or services.
AIRCRAFT PRODUCT
SALES
Other Year One
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Two
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Three
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Four
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Five
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Description
Enter text: The description of other products or services.
AIRCRAFT PRODUCT
SALES
Other Year One
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Two
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Three
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Four
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Five
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Description
Enter text: The description of other products or services.
AIRCRAFT PRODUCT
SALES
Other Year One
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Two
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Three
Enter amount: The annual gross receipts amount for other products or services.
ACORD 329 (2014/12) rev. 04-29-2014
Page 18 of 27
AIRCRAFT PRODUCT
SALES
Other Year Four
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Other Year Five
Enter amount: The annual gross receipts amount for other products or services.
AIRCRAFT PRODUCT
SALES
Grand Total Year One
Enter amount: The annual gross receipts grand total amount.
AIRCRAFT PRODUCT
SALES
Grand Total Year Two
Enter amount: The annual gross receipts grand total amount.
AIRCRAFT PRODUCT
SALES
Grand Total Year Three
Enter amount: The annual gross receipts grand total amount.
AIRCRAFT PRODUCT
SALES
Grand Total Year Four
Enter amount: The annual gross receipts grand total amount.
AIRCRAFT PRODUCT
SALES
Grand Total Year Five
Enter amount: The annual gross receipts grand total amount.
WARRANTIES AND
CONTROLS
Describe all aircraft
warranties to be attached
Enter text: The description of all aircraft warranties to be attached.
WARRANTIES AND
CONTROLS
Describe all product
engineering and testing
controls involved in quality
control
Enter text: The description of all product engineering and testing controls involved in quality
control.
Form Page 3
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).
PRODUCTS INFORMATION
Describe all aircraft
products, including
containers, designed by the
applicant
Enter text: The description of products designed by the insured. As used here, describe all
aircraft products, including containers, designed by the applicant.
PRODUCTS INFORMATION
Describe all aircraft
products manufactured,
assembled, or distributed by
the applicant
Enter text: The description of products manufactured by the insured. As used here, describe all
aircraft products manufactured, assembled, or distributed by the applicant.
ACORD 329 (2014/12) rev. 04-29-2014
Page 19 of 27
PRODUCTS INFORMATION
List all products
discontinued and
companies sold/terminated
for which coverage is
required
Enter text: The description of all products discontinued and companies sold / terminated for
which coverage is required.
PRODUCTS INFORMATION
Describe modifications to
current products and
describe all new aircraft
products for the next 12
months
Enter text: The description of modifications to current products and all new products for next 12
months.
PRODUCTS INFORMATION
Describe why modifications
were necessary
Enter text: The reason modifications were necessary.
PRODUCTS INFORMATION
List all liquid chemical
aircraft products
Enter text: The description of all liquid chemical aircraft products.
PRODUCTS INFORMATION
Describe potential hazards
of all aircraft products
including if they are
flammable, explosive,
corrosive, poisonous or
toxic in any chemical state.
Enter text: The description of potential hazards.
PRODUCTS INFORMATION
Describe repair and service
operations.
Enter text: The description of repair and/or service operations.
PRODUCTS INFORMATION
Make One
Enter text: The name of the manufacturer of the aircraft. As used here, describes an aircraft in
which the insured specializes for repair and service operations.
PRODUCTS INFORMATION
Model One
Enter text: The model name of the aircraft. As used here, describes an aircraft in which the
insured specializes for repair and service operations.
PRODUCTS INFORMATION
Make Two
Enter text: The name of the manufacturer of the aircraft. As used here, describes an aircraft in
which the insured specializes for repair and service operations.
PRODUCTS INFORMATION
Model Two
Enter text: The model name of the aircraft. As used here, describes an aircraft in which the
insured specializes for repair and service operations.
PRODUCTS INFORMATION
Make Three
Enter text: The name of the manufacturer of the aircraft. As used here, describes an aircraft in
which the insured specializes for repair and service operations.
PRODUCTS INFORMATION
Model Three
Enter text: The model name of the aircraft. As used here, describes an aircraft in which the
insured specializes for repair and service operations.
PRODUCTS INFORMATION
Make Four
Enter text: The name of the manufacturer of the aircraft. As used here, describes an aircraft in
which the insured specializes for repair and service operations.
ACORD 329 (2014/12) rev. 04-29-2014
Page 20 of 27
PRODUCTS INFORMATION
Model Four
Enter text: The model name of the aircraft. As used here, describes an aircraft in which the
insured specializes for repair and service operations.
PRODUCTS INFORMATION
Make Five
Enter text: The name of the manufacturer of the aircraft. As used here, describes an aircraft in
which the insured specializes for repair and service operations.
PRODUCTS INFORMATION
Model Five
Enter text: The model name of the aircraft. As used here, describes an aircraft in which the
insured specializes for repair and service operations.
PRODUCTS INFORMATION
Make Six
Enter text: The name of the manufacturer of the aircraft. As used here, describes an aircraft in
which the insured specializes for repair and service operations.
PRODUCTS INFORMATION
Model Six
Enter text: The model name of the aircraft. As used here, describes an aircraft in which the
insured specializes for repair and service operations.
PRODUCTS INFORMATION
Describe Service Contracts
to be attached to the
application.
Enter text: The description of service contracts to be attached to the application.
PRODUCTS INFORMATION
Describe all contracts
involving aircraft products
in which the application
hold harmless or
indemnification others to be
attached to the application.
Enter text: The description of all contracts involving products in which the insured hold harmless
or indemnification others to be attached to the application.
SPACECRAFT PRODUCTS
Spacecraft Make
Enter text: The manufacturer of the spacecraft.
SPACECRAFT PRODUCTS
Model
Enter text: The model of the spacecraft.
SPACECRAFT PRODUCTS
Launch Vehicle
Enter text: The description of the launch vehicle(s) for the item.
SPACECRAFT PRODUCTS
Start Date
Enter date: The anticipated start date of the launch window for the spacecraft in which your
products are used.
SPACECRAFT PRODUCTS
End Date
Enter date: The anticipated end date of the launch window for the spacecraft in which your
products are used.
SPACECRAFT PRODUCTS
Spacecraft Make
Enter text: The manufacturer of the spacecraft.
SPACECRAFT PRODUCTS
Model
Enter text: The model of the spacecraft.
SPACECRAFT PRODUCTS
Launch Vehicle
Enter text: The description of the launch vehicle(s) for the item.
SPACECRAFT PRODUCTS
Start Date
Enter date: The anticipated start date of the launch window for the spacecraft in which your
products are used.
SPACECRAFT PRODUCTS
End Date
Enter date: The anticipated end date of the launch window for the spacecraft in which your
products are used.
SPACECRAFT PRODUCTS
Spacecraft Make
Enter text: The manufacturer of the spacecraft.
ACORD 329 (2014/12) rev. 04-29-2014
Page 21 of 27
SPACECRAFT PRODUCTS
Model
Enter text: The model of the spacecraft.
SPACECRAFT PRODUCTS
Launch Vehicle
Enter text: The description of the launch vehicle(s) for the item.
SPACECRAFT PRODUCTS
Start Date
Enter date: The anticipated start date of the launch window for the spacecraft in which your
products are used.
SPACECRAFT PRODUCTS
End Date
Enter date: The anticipated end date of the launch window for the spacecraft in which your
products are used.
OUTSIDE FIRMS
Describe the product or
portion of product that are
manufactured or assembled
by outside firms.
Enter text: The description of a product, or portion of a product, that is manufactured or
assembled by an outside firm.
OUTSIDE FIRMS
Firm Name
Enter text: The description of the manufacturing, assembly, or specification design firm involved
with a product the insured creates, sells or distributes.
OUTSIDE FIRMS
Describe the product or
portion of product that are
manufactured or assembled
by outside firms.
Enter text: The description of a product, or portion of a product, that is manufactured or
assembled by an outside firm.
OUTSIDE FIRMS
Firm Name
Enter text: The description of the manufacturing, assembly, or specification design firm involved
with a product the insured creates, sells or distributes.
OUTSIDE FIRMS
Describe the product or
portion of product that are
manufactured or assembled
by outside firms.
Enter text: The description of a product, or portion of a product, that is manufactured or
assembled by an outside firm.
OUTSIDE FIRMS
Firm Name
Enter text: The description of the manufacturing, assembly, or specification design firm involved
with a product the insured creates, sells or distributes.
OUTSIDE FIRMS
Describe the product or
portion of product that are
manufactured or assembled
by outside firms.
Enter text: The description of a product, or portion of a product, that is manufactured or
assembled by an outside firm.
OUTSIDE FIRMS
Firm Name
Enter text: The description of the manufacturing, assembly, or specification design firm involved
with a product the insured creates, sells or distributes.
OUTSIDE FIRMS
Enter products that are
manufactured to the
specifications of other firms
by the applicant or any
subsidiary.
Enter text: The description of a product that is manufactured by the insured or any subsidiary to
the specifications of an outside firm.
ACORD 329 (2014/12) rev. 04-29-2014
Page 22 of 27
OUTSIDE FIRMS
Firm Name
Enter text: The description of the manufacturing, assembly, or specification design firm involved
with a product the insured creates, sells or distributes.
OUTSIDE FIRMS
Enter products that are
manufactured to the
specifications of other firms
by the applicant or any
subsidiary.
Enter text: The description of a product that is manufactured by the insured or any subsidiary to
the specifications of an outside firm.
OUTSIDE FIRMS
Firm Name
Enter text: The description of the manufacturing, assembly, or specification design firm involved
with a product the insured creates, sells or distributes.
OUTSIDE FIRMS
Enter products that are
manufactured to the
specifications of other firms
by the applicant or any
subsidiary.
Enter text: The description of a product that is manufactured by the insured or any subsidiary to
the specifications of an outside firm.
OUTSIDE FIRMS
Firm Name
Enter text: The description of the manufacturing, assembly, or specification design firm involved
with a product the insured creates, sells or distributes.
OUTSIDE FIRMS
Enter products that are
manufactured to the
specifications of other firms
by the applicant or any
subsidiary.
Enter text: The description of a product that is manufactured by the insured or any subsidiary to
the specifications of an outside firm.
OUTSIDE FIRMS
Firm Name
Enter text: The description of the manufacturing, assembly, or specification design firm involved
with a product the insured creates, sells or distributes.
OUTSIDE FIRMS
Enter products of others
that are sold or distributed
by the applicant or any
subsidiary.
Enter text: The description of a product of an outside firm that is sold or distributed by the
insured or any subsidiary.
OUTSIDE FIRMS
Firm Name
Enter text: The description of the manufacturing, assembly, or specification design firm involved
with a product the insured creates, sells or distributes.
OUTSIDE FIRMS
Enter products of others
that are sold or distributed
by the applicant or any
subsidiary.
Enter text: The description of a product of an outside firm that is sold or distributed by the
insured or any subsidiary.
OUTSIDE FIRMS
Firm Name
Enter text: The description of the manufacturing, assembly, or specification design firm involved
with a product the insured creates, sells or distributes.
ACORD 329 (2014/12) rev. 04-29-2014
Page 23 of 27
OUTSIDE FIRMS
Enter products of others
that are sold or distributed
by the applicant or any
subsidiary.
Enter text: The description of a product of an outside firm that is sold or distributed by the
insured or any subsidiary.
OUTSIDE FIRMS
Firm Name
Enter text: The description of the manufacturing, assembly, or specification design firm involved
with a product the insured creates, sells or distributes.
OUTSIDE FIRMS
Enter products of others
that are sold or distributed
by the applicant or any
subsidiary.
Enter text: The description of a product of an outside firm that is sold or distributed by the
insured or any subsidiary.
OUTSIDE FIRMS
Firm Name
Enter text: The description of the manufacturing, assembly, or specification design firm involved
with a product the insured creates, sells or distributes.
Form Page 4
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).
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.
ADDITIONAL INSUREDS
Name and Address
Enter text: The additional interest's full name.
ACORD 329 (2014/12) rev. 04-29-2014
Page 24 of 27
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.
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.
GENERAL INFORMATION
Does applicant use airport
premises? If yes, name
airport and describe uses.
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Does applicant use airport premises?.
ACORD 329 (2014/12) rev. 04-29-2014
Page 25 of 27
GENERAL INFORMATION
Explain
Enter text: An explanation as to whether the applicant uses airport premises.
GENERAL INFORMATION
Have there been any
incidents in the past which
could result in a claim?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Have there been any incidents in past which could result in a claim?.
GENERAL INFORMATION
Explain
Enter text: An explanation as to whether there are any past incidents which could result in a
claim.
GENERAL INFORMATION
Has any subsidiary,
affiliated, owned or
managed firm, or applicants
products liability ever been
self-insured or not insured?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Has any subsidiary, affiliated, owned or managed firm, or applicant's products liability ever been
self-insured or not insured?.
GENERAL INFORMATION
Explain
Enter text: An explanation as to whether any subsidiary, affiliated, owned or managed firm, or
applicant's products liability has ever been self-insured or not insured.
GENERAL INFORMATION
Have any aircraft products
ever been subject to a
manufacturers factory
service bulletin or advisory?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Have any aircraft products ever been subject to a manufacturers factory service bulletin or
advisory?.
GENERAL INFORMATION
Explain
Enter text: An explanation as to whether any aircraft products have ever been subject to a
manufacturer's factory service bulletin or advisory.
GENERAL INFORMATION
Have any aircraft products
ever been subject to an
airworthiness directive?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Have any aircraft products ever been subject to an airworthiness directive?.
GENERAL INFORMATION
Explain
Enter text: An explanation as to whether any aircraft products have ever been subject to an
airworthiness directive.
GENERAL INFORMATION
Have any aircraft products
ever been subjected to an
emergency airworthiness
directive?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Have any aircraft products ever been subject to an emergency airworthiness directive?.
GENERAL INFORMATION
Explain
Enter text: An explanation as to whether any aircraft products have ever been subject to an
emergency airworthiness directive.
GENERAL INFORMATION
Have any aircraft products
ever been subject to a recall
by any applicant?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Have any aircraft products ever been subject to a recall by any applicant?.
GENERAL INFORMATION
Explain
Enter text: An explanation as to whether any aircraft products have ever been subject to a recall
by any applicant.
ACORD 329 (2014/12) rev. 04-29-2014
Page 26 of 27
GENERAL INFORMATION
Have any aircraft products
ever been subject to a recall
by any other firm?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Have any aircraft products ever been subject to a recall by any other firm?.
GENERAL INFORMATION
Explain
Enter text: An explanation as to whether any aircraft products have ever been subject to a recall
by any other firm.
GENERAL INFORMATION
Have any aircraft products
ever been subject to a recall
by a governmental agency?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Have any aircraft products ever been subject to a recall by a governmental agency?.
GENERAL INFORMATION
Explain
Enter text: An explanation as to whether any aircraft products have ever been subject to a recall
by a governmental agency.
GENERAL INFORMATION
Do you allow
subcontractors to work
without providing a
certificate of insurance?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Do you allow subcontractors to work without providing a certificate of insurance?.
GENERAL INFORMATION
Explain
Enter text: An explanation as to whether you allow subcontractors to work without providing a
certificate of insurance.
REMARKS
Remarks
Enter text: The general remarks associated with the products liability line of business. Use this
section to provide any additional information required for underwriting or rating. ACORD 101,
Additional Remarks Schedule, may be attached if more space is required.
Form Page 5
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)
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.
ACORD 329 (2014/12) rev. 04-29-2014
Page 27 of 27