ACORD 337 (2009/06)

Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 337 (2009/06)
Airport and FBO Liability Change
Request
ACORD 337, Airport and FBO Liability Change Request, is used to
submit requested changes to an airport / fixed based operator policy. This form may
stand on its own or be attached to the ACORD 335, Aviation Policy Change Request
Applicant Information Section.
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 month/day/year 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.
IDENTIFICATION SECTION Effective Date of Change
Enter date: The date on which the change should take effect.
IDENTIFICATION SECTION Effective Time of Change
Enter time: The effective time of the policy change.
IDENTIFICATION SECTION Effective Time AM
Check the box (if applicable): Indicates the effective time of the policy change is in the
morning (AM).
IDENTIFICATION SECTION Effective Time PM
Check the box (if applicable): Indicates the effective time of the policy change is in the
afternoon or evening (PM).
IDENTIFICATION SECTION Named Insured
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
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.
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Section Name
Field Name
Field and/or Section Description
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Loc #
Enter number: The location number for the premises.
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Airport ID
Enter identifier: The Federal Aviation Administration's designator for the airport (e.g. ORD -
O'Hare International Airport).
AIRPORT INFORMATION
Airport Name (On Current Policy)
Enter text: The full name of the location. As used here, this is the name of the airport as it
appears on the current policy.
AIRPORT INFORMATION
Airport Name (If Changed)
Enter text: The full name of the location. As used here, this is the name of the airport if it
has changed.
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Section Name
Field Name
Field and/or Section Description
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Elevation
Enter number: The approximate distance, in feet, of the airport above or below sea level.
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Describe any sea lanes
Enter text: The description of any sea lanes at the airport.
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Applicant's Interest in Airport -
Tenant
Check the box (if applicable): Indicates the applicant's / insured's interest in the airport is
as a tenant.
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Section Name
Field Name
Field and/or Section Description
AIRPORT INFORMATION
Applicant's Interest in Airport -
General Lessee
Check the box (if applicable): Indicates the applicant's / insured's interest in the airport is
as a general lessee.
AIRPORT INFORMATION
Applicant's Interest in Airport -
Airport Owner
Check the box (if applicable): Indicates the applicant's / insured's interest in the airport is
as an owner.
AIRPORT INFORMATION
Applicant's Interest in Airport -
Sub-Tenant
Check the box (if applicable): Indicates the applicant's / insured's interest in the airport is
as a sub-tenant.
AIRPORT INFORMATION
Applicant's Interest in Airport -
Other
Check the box (if applicable): Indicates the applicant's / insured's interest in the airport is
other than those listed.
AIRPORT INFORMATION
Applicant's Interest in Airport -
Other Description
Enter text: The description of the applicant's / insured's interest in the airport.
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Airport Occupancy - Entire Airport
Check the box (if applicable): Indicates the applicant / insured occupies the entire airport.
AIRPORT INFORMATION
Airport Occupancy - Portion
Check the box (if applicable): Indicates the applicant / insured occupies a portion of the
airport.
AIRPORT INFORMATION
Airport Occupancy - Portion
Description
Enter text: The description of the applicant's / insured's occupancy of the airport. As used
here, this describes the portion of the airport the applicant / insured occupies if they do not
occupy the entire airport.
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Section Name
Field Name
Field and/or Section Description
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Fire Station on Prem?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is there a Fire Station on premises?.
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Distance to Fire Station
Enter number: The distance in miles from the nearest fire station that supports the
protection class used.
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Airline Aircraft - Based at the
Airport
Enter number: The number of airline aircraft based at the airport.
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Section Name
Field Name
Field and/or Section Description
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Airline Aircraft - Estimated Arrivals
/ Departures this Year
Enter number: The estimated number of airline aircraft arrivals / departures at the airport
for the current year.
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
General Aviation Aircraft - Based
at the Airport
Enter number: The number of general aviation aircraft based at the airport.
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
AIRPORT INFORMATION
General Aviation Aircraft -
Estimated Arrivals / Departures
this Year
Enter number: The estimated number of general aviation aircraft arrivals / departures at
the airport for the current year.
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Military Aircraft - Based at the
Airport
Enter number: The number of military aircraft based at the airport.
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Military Aircraft - Estimated
Arrivals / Departures this Year
Enter number: The estimated number of military aircraft arrivals / departures at the airport
for the current year.
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Section Name
Field Name
Field and/or Section Description
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Runways Construction - Blacktop
Check the box (if applicable): Indicates the runways are constructed using blacktop.
AIRPORT INFORMATION
Runways Construction - Concrete
Check the box (if applicable): Indicates the runways are constructed using concrete.
AIRPORT INFORMATION
Runways Construction - Gravel
Check the box (if applicable): Indicates the runways are constructed using gravel.
AIRPORT INFORMATION
Runways Construction - Turf
Check the box (if applicable): Indicates the runways are constructed using turf.
AIRPORT INFORMATION
Runways Construction - Other
Check the box (if applicable): Indicates the runways are constructed using a material other
than those listed.
AIRPORT INFORMATION
Runways Construction -
Description
Enter text: The construction material used for runways.
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Runways Lighted?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Are runways lighted?.
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Section Name
Field Name
Field and/or Section Description
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Longest Runway
Enter number: The length of the longest runway in feet.
AIRPORT INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT INFORMATION
Who maintains taxiways and
runways?
Enter text: The description of who maintains runways and taxiways.
AIRPORT GENERAL
INFORMATION
Are there any obstructions to the
approach?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Are there any obstructions to the approach?.
AIRPORT GENERAL
INFORMATION
Explanation
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
AIRPORT GENERAL
INFORMATION
Does the airport maintain an air
crash emergency plan?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the airport maintain an air crash emergency plan?.
AIRPORT GENERAL
INFORMATION
Explanation
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
AIRPORT GENERAL
INFORMATION
Does the airport maintain an anti-
terrorist plan?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the airport maintain an anti-terrorist plan?.
AIRPORT GENERAL
INFORMATION
Explanation
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
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Section Name
Field Name
Field and/or Section Description
AIRPORT GENERAL
INFORMATION
Does the airport employ medical
personnel?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the airport employ medical personnel?.
AIRPORT GENERAL
INFORMATION
Explanation
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
AIRPORT GENERAL
INFORMATION
Does the airport maintain a bird
strike prevention program?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the airport maintain a bird strike prevention program?.
AIRPORT GENERAL
INFORMATION
Explanation
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
AIRPORT GENERAL
INFORMATION
Is the airport fenced?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is the airport fenced?.
AIRPORT GENERAL
INFORMATION
Explanation
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
AIRPORT GENERAL
INFORMATION
Is there a control tower on the
airport?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is there an Air Traffic Control Tower?.
AIRPORT GENERAL
INFORMATION
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT GENERAL
INFORMATION
Name of Operator
Enter text: The full name of the air traffic control tower operator.
AIRPORT GENERAL
INFORMATION
Full Time
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
AIRPORT GENERAL
INFORMATION
Part Time
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
AIRPORT GENERAL
INFORMATION
Start Time
Enter time: The start time for part time air traffic control tower operations.
AIRPORT GENERAL
INFORMATION
Close Time
Enter time: The close time for part time air traffic control tower operations.
GENERAL LESSEE /
AIRPORT OWNER
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GENERAL LESSEE /
AIRPORT OWNER
# Bldgs
Enter number: The number of buildings at the airport.
GENERAL LESSEE /
AIRPORT OWNER
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
GENERAL LESSEE /
AIRPORT OWNER
Brief Description of Premises
Enter text: The brief description of the premises.
GENERAL LESSEE /
AIRPORT OWNER
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GENERAL LESSEE /
AIRPORT OWNER
Describe any ultralight,
parachuting or agriculture
activities allowed.
Enter text: The description of the activities allowed at the airport that include ultralights,
parachuting, or agriculture.
GENERAL LESSEE /
AIRPORT OWNER
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GENERAL LESSEE /
AIRPORT OWNER
Describe any recreational or non-
aviation use of the airport.
Enter text: The description of recreational or non-aviation use of airport.
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Section Name
Field Name
Field and/or Section Description
GENERAL LESSEE /
AIRPORT OWNER
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GENERAL LESSEE /
AIRPORT OWNER
Describe any air shows,
exhibitions, or other aviation
special events scheduled or
anticipated at the airport.
Enter text: The description of any air shows, exhibitions, or other aviation special events
scheduled or anticipated at the airport.
GENERAL LESSEE /
AIRPORT OWNER
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GENERAL LESSEE /
AIRPORT OWNER
List airlines and scheduled air
taxis that will serve this airport
during the next year.
Enter text: The name of an airline or scheduled air taxis that will serve this airport during
the next year.
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Section Name
Field Name
Field and/or Section Description
GENERAL LESSEE /
AIRPORT OWNER
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GENERAL LESSEE /
AIRPORT OWNER
List airlines and scheduled air
taxis that will serve this airport
during the next year.
Enter text: The name of an airline or scheduled air taxis that will serve this airport during
the next year.
GENERAL LESSEE /
AIRPORT OWNER
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GENERAL LESSEE /
AIRPORT OWNER
List airlines and scheduled air
taxis that will serve this airport
during the next year.
Enter text: The name of an airline or scheduled air taxis that will serve this airport during
the next year.
GENERAL LESSEE /
AIRPORT OWNER
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
GENERAL LESSEE /
AIRPORT OWNER
List airlines and scheduled air
taxis that will serve this airport
during the next year.
Enter text: The name of an airline or scheduled air taxis that will serve this airport during
the next year.
GENERAL LESSEE /
AIRPORT OWNER
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GENERAL LESSEE /
AIRPORT OWNER
List the type of airline/commuter
equipment
Enter text: The description of the type of airline / commuter equipment used at the airport.
GENERAL LESSEE /
AIRPORT OWNER
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GENERAL LESSEE /
AIRPORT OWNER
List the type of airline/commuter
equipment
Enter text: The description of the type of airline / commuter equipment used at the airport.
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Section Name
Field Name
Field and/or Section Description
GENERAL LESSEE /
AIRPORT OWNER
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GENERAL LESSEE /
AIRPORT OWNER
List the type of airline/commuter
equipment
Enter text: The description of the type of airline / commuter equipment used at the airport.
GENERAL LESSEE /
AIRPORT OWNER
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GENERAL LESSEE /
AIRPORT OWNER
List the type of airline/commuter
equipment
Enter text: The description of the type of airline / commuter equipment used at the airport.
BUSINESS OWNER /
MANAGEMENT
Is there an airport manager?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is there an airport manager?.
BUSINESS OWNER /
MANAGEMENT
Is the airport manager an
employee of the insured?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is the airport manager an employee of the insured?.
BUSINESS OWNER /
MANAGEMENT
Is there a manager on premises
during operation?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is there a manager on premises during operation?.
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Section Name
Field Name
Field and/or Section Description
BUSINESS OWNER /
MANAGEMENT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BUSINESS OWNER /
MANAGEMENT
Manager of Flight Operations
Name
Enter text: The name or description of the flight operations manager.
BUSINESS OWNER /
MANAGEMENT
Manager of Flight Operations
Experience
Enter text: The description of the flight operations manager experience.
BUSINESS OWNER /
MANAGEMENT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BUSINESS OWNER /
MANAGEMENT
Business Owner - Name
Enter text: The airport business owner's full name.
BUSINESS OWNER /
MANAGEMENT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
BUSINESS OWNER /
MANAGEMENT
Business Owner - Status Absentee
Check the box (if applicable): Indicates the business owner is absent.
BUSINESS OWNER /
MANAGEMENT
Business Owner - Active Owner
Check the box (if applicable): Indicates the business owner is active in the business.
BUSINESS OWNER /
MANAGEMENT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BUSINESS OWNER /
MANAGEMENT
Business Owner - Employee
Status - Contracted
Check the box (if applicable): Indicates the business owner is a contracted employee.
BUSINESS OWNER /
MANAGEMENT
Business Owner - Employee
Status - Full Time
Check the box (if applicable): Indicates the business owner is a full time employee.
BUSINESS OWNER /
MANAGEMENT
Business Owner - Employee
Status - Part Time
Check the box (if applicable): Indicates the business owner is a part time employee.
BUSINESS OWNER /
MANAGEMENT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
BUSINESS OWNER /
MANAGEMENT
Business Manager Name
Enter text: The name or description of who manages the business when the owner is
absent..
BUSINESS OWNER /
MANAGEMENT
Business Manager Experience
Enter text: The description of the experience of the business manager.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
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Section Name
Field Name
Field and/or Section Description
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Fuel & Lubricants
Enter amount: The annual gross receipts amount for fuel and lubricants.
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Aircraft Repair / Servicing
Enter amount: The annual gross receipts amount for aircraft repair and / or servicing.
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Aircraft Parts (not installed)
Enter amount: The annual gross receipts amount for aircraft parts (not installed).
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Section Name
Field Name
Field and/or Section Description
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Sale of New Aircraft
Enter amount: The annual gross receipts amount for the sale of new aircraft.
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Sale of Used Aircraft
Enter amount: The annual gross receipts amount for the sale of used aircraft.
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Restaurant
Enter amount: The annual gross receipts amount for restaurants.
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Section Name
Field Name
Field and/or Section Description
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Aircraft Painting
Enter amount: The annual gross receipts amount for aircraft painting.
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Engine Overhaul
Enter amount: The annual gross receipts amount for engine overhaul operations.
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Tie-Down/Hangaring
Enter amount: The annual gross receipts amount for tie-downs and hangaring.
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Section Name
Field Name
Field and/or Section Description
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Propeller Repair
Enter amount: The annual gross receipts amount for propeller repair operations.
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Aircraft Charter
Enter amount: The annual gross receipts amount for aircraft charter operations.
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Rental - Instruction
Enter amount: The annual gross receipts amount for rental / instruction operations.
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Section Name
Field Name
Field and/or Section Description
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Helicopter Repairs
Enter amount: The annual gross receipts amount for helicopter repair operations.
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Auto Parking
Enter amount: The annual gross receipts amount for auto parking operations.
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Other Description
Enter text: The annual gross receipts amount for the operation.
GROSS RECEIPTS
Other Amount
Enter amount: The annual gross receipts amount for the operation.
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Section Name
Field Name
Field and/or Section Description
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Other Description
Enter text: The annual gross receipts amount for the operation.
GROSS RECEIPTS
Other Amount
Enter amount: The annual gross receipts amount for the operation.
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Other Description
Enter text: The annual gross receipts amount for the operation.
GROSS RECEIPTS
Other Amount
Enter amount: The annual gross receipts amount for the operation.
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Other Description
Enter text: The annual gross receipts amount for the operation.
GROSS RECEIPTS
Other Amount
Enter amount: The annual gross receipts amount for the operation.
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Section Name
Field Name
Field and/or Section Description
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Other Description
Enter text: The annual gross receipts amount for the operation.
GROSS RECEIPTS
Other Amount
Enter amount: The annual gross receipts amount for the operation.
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Other Description
Enter text: The annual gross receipts amount for the operation.
GROSS RECEIPTS
Other Amount
Enter amount: The annual gross receipts amount for the operation.
GROSS RECEIPTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
GROSS RECEIPTS
Other Description
Enter text: The annual gross receipts amount for the operation.
GROSS RECEIPTS
Other Amount
Enter amount: The annual gross receipts amount for the operation.
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Section Name
Field Name
Field and/or Section Description
FUELING
Is Fueling Done - By Self Serve
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
FUELING
Is Fueling Done - By Truck
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
FUELING
Is Fueling Done - On Premises
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
FUELING
Is Fueling Done - By Applicant
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
FUELING
Is Fueling Done - By Gas Pump
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
FUELING
If not by applicant, by whom?
Enter text: Describes who does the fueling if not the applicant / insured.
FUELING
Applicant Sells - AV Gas
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
FUELING
Applicant Sells - Jet Fuel
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
FUELING
Applicant Sells - Auto Fuel
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
FUELING
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
FUELING
Annual Gallonage - Airline
Enter number: The number of gallons of fuel annually used for airlines.
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Section Name
Field Name
Field and/or Section Description
FUELING
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
FUELING
Annual Gallonage - General
Aviation
Enter number: The number of gallons of fuel annually used for general aviation.
FUELING
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
FUELING
Annual Gallonage - Military
Enter number: The number of gallons of fuel annually used for military aviation.
FUELING
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
FUELING
Annual Gallonage - Fuel Stored
Underground
Enter number: The number of gallons of fuel stored underground.
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Section Name
Field Name
Field and/or Section Description
FUELING
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
FUELING
Annual Gallonage - Fuel Stored
Above Ground
Enter number: The number of gallons of fuel stored above ground.
TIE-DOWNS / HANGARING Location #
Enter number: The location number for the premises.
TIE-DOWNS / HANGARING Building #
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
TIE-DOWNS / HANGARING Airport ID
Enter identifier: The Federal Aviation Administration's designator for the airport (e.g. ORD -
O'Hare International Airport).
TIE-DOWNS / HANGARING Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TIE-DOWNS / HANGARING Tie-Down Provider
Enter text: The description of the tie-down provider.
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Section Name
Field Name
Field and/or Section Description
TIE-DOWNS / HANGARING Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TIE-DOWNS / HANGARING Type of Tie-Downs
Enter text: The description of the type of tie-downs.
TIE-DOWNS / HANGARING Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TIE-DOWNS / HANGARING Number Tie-Down Spaces
Enter number: The number of tie-down spaces.
TIE-DOWNS / HANGARING Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TIE-DOWNS / HANGARING Describe Storage Hangars
Enter text: The description of storage hangars.
ACORD 337 (2009/06)
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Section Name
Field Name
Field and/or Section Description
TIE-DOWNS / HANGARING Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TIE-DOWNS / HANGARING one aircraft
Maximum Value Of Aircraft - Any
Enter amount: The maximum value of any one aircraft in care and custody of applicant.
TIE-DOWNS / HANGARING Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TIE-DOWNS / HANGARING Aircraft
Maximum Value Of Aircraft - All
Enter amount: The maximum value of all aircraft in care and custody of applicant.
TIE-DOWNS / HANGARING Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TIE-DOWNS / HANGARING Type
Storage Hangars Construction
Enter code: The construction type of the storage hangars.
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Section Name
Field Name
Field and/or Section Description
TIE-DOWNS / HANGARING Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
TIE-DOWNS / HANGARING Storage Hangars Area
Enter number: The total area of this building, in square feet, counting both stories above
ground and basements.
HANGAR INFORMATION
Do You Require Hangar Tenants
To Carry Insurance?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Do you require hangar tenants to carry insurance?.
HANGAR INFORMATION
If Yes, Does Their Insurance Policy
Name The Owner As An Additional
Insured?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, If you require hangar tenants to carry insurance, does their insurance policy
name the owner as an additional insured?.
HANGAR INFORMATION
Do You Require Tenants To Sign A
Hangar Agreement Holding You
Harmless For Losses Not Caused
By You?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Do you require tenants to sign hangar agreement holding you harmless for
losses not caused by you?.
HANGAR INFORMATION
Are Any Aircraft Of Others Taxied,
Towed Or Moved By The
Applicant?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Are any aircraft of others taxied, towed or moved by applicant?.
CONTRACTS AND
CONSTRUCTION
Has Applicant Entered Into Any
Agreements Assuming Liability Of
Others Such As Lease Of
Premises, Fuel Supplier,
Equipment Leases, Etc.??
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Has applicant entered into any agreements assuming liability of others such as
lease of premises, fuel supplier, equipment leases, etc.?.
CONTRACTS AND
CONSTRUCTION
Does Applicant Use Contracts For
Hangaring And Tie-Down Service,
Etc.?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does applicant use contracts for hangaring and tie down service, etc.?.
CONTRACTS AND
CONSTRUCTION
Estimated Cost Of Construction
For Runways And Taxiways:
Enter amount: The estimated cost of construction for runways and taxiways.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Fuel Trucks
Enter number: The number of fuel trucks.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Snow Removal
Enter number: The number of snow removal trucks.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Fire Engines
Enter number: The number of fire engines.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Tugs
Enter number: The number of tugs.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Mowers
Enter number: The number of mowers.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Pickup Trucks
Enter number: The number of pickup trucks.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Passenger Cars
Enter number: The number of passenger cars.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Sweepers
Enter number: The number of sweepers.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Elevators
Enter number: The number of elevators.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Escalators
Enter number: The number of escalators.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Moving Sidewalks
Enter number: The number of moving sidewalks.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Aircraft Owned and Operated by
Applicant
Enter number: The number of aircraft owned and operated by the applicant / insured.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Helicopters Owned and Operated
by Applicant
Enter number: The number of helicopters owned and operated by applicant / insured.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Other
Enter number: The number of vehicles.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
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Section Name
Field Name
Field and/or Section Description
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Other Description
Enter text: The description of the type of vehicle.
VEHICLES, ELEVATORS
AND AIRCRAFT
Number of
Enter number: The number of vehicles.
VEHICLES, ELEVATORS
AND AIRCRAFT
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
VEHICLES, ELEVATORS
AND AIRCRAFT
Are Any Vehicles Operated Off
Airport?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Are any vehicles operated off airport?.
VEHICLES, ELEVATORS
AND AIRCRAFT
Explanation
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Interest - Additional Insured
Check the box (if applicable): Indicates the additional interest type is an additional insured.
ADDITIONAL INTERESTS
Interest - Breach of Warranty
Check the box (if applicable): Indicates the additional interest type is a breach of warranty.
ADDITIONAL INTERESTS
Interest - Co-Owner
Check the box (if applicable): Indicates the additional interest type is a co-owner.
ADDITIONAL INTERESTS
Interest - Leaseback Owner
Check the box (if applicable): Indicates the additional interest type is a leaseback owner.
ADDITIONAL INTERESTS
Interest - Lienholder
Check the box (if applicable): Indicates the additional interest type is a lien holder.
ADDITIONAL INTERESTS
Interest - Loss Payee
Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL INTERESTS
Interest - Mortgagee
Check the box (if applicable): Indicates the additional interest type is a mortgagee.
ADDITIONAL INTERESTS
Interest - Other
Check the box (if applicable): Indicates the additional interest is not any of the types listed
on the form.
ADDITIONAL INTERESTS
Interest - Other Description
Enter text: The description of the type of interest in the item.
ADDITIONAL INTERESTS
Reason For Interest
Enter text: The description for the interest in the item.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Rank
Enter number: The ranking of 'this' additional interest when multiple additional interests
are associated with the same item.
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTERESTS
Certificate Required
Check the box (if applicable): Indicates if the additional interest requires a Certificate of
Insurance,
ADDITIONAL INTERESTS
Name
Enter text: The additional interest's full name.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Name
Enter text: The additional interest's full name.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Street
Enter text: The additional interest's mailing address line one.
ADDITIONAL INTERESTS
Street
Enter text: The additional interest's mailing address line two.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTERESTS
City
Enter text: The additional interest's mailing address city name.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
State
Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Zip
Enter code: The additional interest's mailing address postal code.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Country
Enter code: The additional interest's country code.
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Reference #
Enter identifier: The loan number, account number or other controlling number that the
additional interest may have assigned the insured.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Interest End Date
Enter date: The date the interest holder's interest terminates.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Lien Amount
Enter amount: The amount of the loan.
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Phone
Enter number: The primary phone number of the additional interest.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
Fax
Enter number: The primary fax number of the additional interest.
ADDITIONAL INTERESTS
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
ADDITIONAL INTERESTS
E-Mail
Enter text: The primary e-mail address for the additional interest.
ADDITIONAL INTERESTS
Interest In Item Location
Enter number: The producer assigned number of the location which has an additional
interest.
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTERESTS
Interest In Item Building
Enter number: The producer assigned number of the building which has an additional
interest.
ADDITIONAL INTERESTS
Interest In Item Airport
Enter identifier: The Federal Aviation Administration's designator for the airport (e.g. ORD -
O'Hare International Airport).
ADDITIONAL INTERESTS
Interest In Item Aircraft
Enter number: The producer assigned number of the aircraft which has an additional
interest.
ADDITIONAL INTERESTS
Item Class
Enter text: The description of the property class of the scheduled item (i.e. Jewelry, Furs,
Contractors Equipment, etc.).
ADDITIONAL INTERESTS
Item
Enter number: The producer assigned number of the scheduled item which has an
additional interest.
ADDITIONAL INTERESTS
Item Description
Enter text: The description of the item of interest if needed to further clarify. For a vehicle,
list the make, model and VIN number. For a scheduled item, list the description, such as
three carat diamond in six point setting.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
COVERAGES
Premises Liability Option
Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Premises Liability Option
Description
Enter text: The description of the option being requested.
COVERAGES
Premises Liability Option
Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Premises Liability Option
Description
Enter text: The description of the option being requested.
COVERAGES
Premises Liability Option
Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Premises Liability Option
Description
Enter text: The description of the option being requested.
COVERAGES
Premises Liability BI Ea Pers
Enter limit: The bodily injury each person limit amount for premises liability coverage.
COVERAGES
Premises Liability Ea Occ
Enter limit: The each occurrence limit amount for premises liability coverage.
COVERAGES
Premises Liability PD
Enter limit: The property damage limit amount for premises liability coverage.
COVERAGES
Premises Liability Deductible
Enter deductible: The deductible amount for premises liability coverage.
COVERAGES
Premises Liability Deductible
Applies to
Enter code: The code identifying what the deductible applies to.
COVERAGES
Premises Liability Premium
Enter amount: The premium amount for premises liability coverage.
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
COVERAGES
Premises Medical Payments
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Premises Medical Payments
Option Description
Enter text: The description of the option being requested.
COVERAGES
Premises Medical Payments
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Premises Medical Payments
Option Description
Enter text: The description of the option being requested.
COVERAGES
Premises Medical Payments Ea
Pers
Enter limit: The each person limit amount for premises medical payments coverage.
COVERAGES
Premises Medical Payments Ea
Occ
Enter limit: The each occurrence limit amount for premises medical payments coverage.
COVERAGES
Premises Medical Payments
Premium
Enter amount: The premium amount for premises medical payments coverage.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
COVERAGES
Products Liability Sales of Fuel &
Oil
Check the box (if applicable): Indicates the sale of fuel and oil option applies to the
products liability coverage.
COVERAGES
Products Liability Extended
Check the box (if applicable): Indicates the extended option applies to the products liability
coverage.
COVERAGES
Products Liability Option
Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Products Liability Option
Description
Enter text: The description of the option being requested. Examples: Sale of Used
Aircraft, Sale of New Aircraft, Parts Installed, Parts Not Installed, Food and Beverage,
Pilot Supplies.
COVERAGES
Products Liability BI Ea Pers
Enter limit: The bodily injury each person limit amount for products liability coverage.
COVERAGES
Products Liability Ea Occ
Enter limit: The each occurrence limit amount for products liability coverage.
COVERAGES
Products Liability Aggr
Enter limit: The aggregate limit amount for products liability coverage.
COVERAGES
Products Liability Premium
Enter amount: The premium amount for products liability coverage.
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
COVERAGES
Completed Operations Liability
Extended
Check the box (if applicable): Indicates the extended option applies to the completed
operations liability coverage.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Completed Operations Liability
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Completed Operations Liability
Option Description
Enter text: The description of the option being requested. Examples: Sale of Fuel and Oil,
Parts Not Installed, Sale of New Aircraft, Sale of Used Aircraft, Restaurant Liability, Repair
and Services.
COVERAGES
Completed Operations Liability
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Completed Operations Liability
Option Description
Enter text: The description of the option being requested. Examples: Sale of Fuel and Oil,
Parts Not Installed, Sale of New Aircraft, Sale of Used Aircraft, Restaurant Liability, Repair
and Services.
COVERAGES
Completed Operations Liability BI
Ea Pers
Enter limit: The bodily injury each person limit amount for completed operations liability
coverage.
COVERAGES
Completed Operations Liability Ea
Occ
Enter limit: The each occurrence limit amount for completed operations liability coverage.
COVERAGES
Completed Operations Liability
Aggr
Enter limit: The aggregate limit amount for completed operations liability coverage.
COVERAGES
Completed Operations Liability
Premium
Enter amount: The premium amount for completed operations liability coverage.
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Hangarkeepers Legal Liability
Option Description
Enter text: The description of the option being requested. Example: Ground Only.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Hangarkeepers Legal Liability Ea
Aircraft
Enter limit: The each aircraft limit amount for hangarkeepers legal liability coverage.
COVERAGES
Hangarkeepers Legal Liability Ea
Occ
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.
COVERAGES
Hangarkeepers Legal Liability
Deductible 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
Deductible 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
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
COVERAGES
Fire Legal Liability Option
Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Fire Legal Liability Option
Description
Enter text: The description of the option being requested.
COVERAGES
Fire Legal Liability Any One Fire
Enter limit: The any one fire limit amount for fire legal liability coverage.
COVERAGES
Fire Legal Liability Premium
Enter amount: The premium amount for fire legal liability coverage.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
COVERAGES
Personal Injury Liability Option
Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Personal Injury Liability Option
Description
Enter text: The description of the option being requested.
COVERAGES
Personal Injury Liability Option
Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
COVERAGES
Personal Injury Liability Option
Description
Enter text: The description of the option being requested.
COVERAGES
Personal Injury Liability Ea Occ
Enter limit: The each occurrence limit amount for personal injury liability coverage.
COVERAGES
Personal Injury Liability Aggr
Enter limit: The aggregate limit amount for personal injury liability coverage.
COVERAGES
Personal Injury Liability Premium
Enter amount: The premium amount for personal injury liability coverage.
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
COVERAGES
Advertising Liability Option
Checkbox
Check the box (if applicable): Indicates there is an option on advertising liability coverage.
COVERAGES
Advertising Liability Option
Description
Enter text: The description of the option being requested.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Advertising Liability Option
Checkbox
Check the box (if applicable): Indicates there is an option on advertising liability coverage.
COVERAGES
Advertising Liability Option
Description
Enter text: The description of the option being requested.
COVERAGES
Advertising Liability Ea Occ
Enter limit: The each occurrence limit amount for advertising liability coverage.
COVERAGES
Advertising Liability Aggr
Enter limit: The aggregate limit amount for advertising liability coverage.
COVERAGES
Advertising Liability Premium
Enter amount: The premium amount for advertising liability coverage.
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
COVERAGES
Contractual Liability Included
Check the box (if applicable): Indicates contractual liability coverage is included in the
policy.
COVERAGES
Contractual Liability Excluded
Check the box (if applicable): Indicates contractual liability coverage is excluded from the
policy.
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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 Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Option Description
Enter text: The description of the option being requested.
COVERAGES
Option Checkbox
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
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
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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 Checkbox
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 Checkbox
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
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.
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Section Name
Field Name
Field and/or Section Description
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
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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 Checkbox
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 Checkbox
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
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.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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 Checkbox
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 Checkbox
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
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.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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 Checkbox
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 Checkbox
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
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.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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 Checkbox
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 Checkbox
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
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.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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 Checkbox
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 Checkbox
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
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.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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 Checkbox
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 Checkbox
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
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.
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Type of Change
Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-
Delete or I - Informational Only No Change. Various combinations of changes are
permitted in one submission. Use A to add an item that was not previously in the policy
(e.g., add a vehicle, add a coverage). Use D to delete an item (e.g., delete a vehicle,
delete a driver). Use C to change an item in the policy (e.g., change a deductible,
change coverage limits). Use I to identify a risk or other item that is not being changed
but is related to another change on the form. Example: When adding collision coverage to
a vehicle, enter A in the type of change for Collision. Enter I in the type of change for
the Vehicle. Enter enough information to identify the vehicle that is having coverage
changed (e.g. year, make, model, body, VIN).
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 Checkbox
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 Checkbox
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
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.
GENERAL INFORMATION
Any aircraft other than single
engine or multi-engine maintained,
serviced, or repaired by applicant?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any aircraft other than single engine or multi-engine maintained, serviced or
repaired by applicant?. As used here, If yes, enter number and type(s) of other aircraft.
GENERAL INFORMATION
Explanation
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
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Section Name
Field Name
Field and/or Section Description
GENERAL INFORMATION
Are aircraft owners permitted to
perform any repair service or
inspection of aircraft under
supervision?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Aircraft owners permitted to perform any repair service of inspection of Aircraft
under supervision?.
GENERAL INFORMATION
Explanation
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
Highest value of aircraft
maintained, serviced, or repaired:
Enter amount: The highest value of aircraft maintained, serviced, or repaired.
GENERAL INFORMATION
Does the applicant perform engine
overhauls?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the applicant perform engine overhauls?.
GENERAL INFORMATION
Explanation
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
Does the applicant perform
propeller overhauls?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the applicant perform propeller overhauls?.
GENERAL INFORMATION
Explanation
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
Does the applicant perform major
airframe structural repairs?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the applicant perform major airframe structural repairs?.
GENERAL INFORMATION
Explanation
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
Does the applicant perform aircraft
painting?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the applicant perform aircraft painting?.
GENERAL INFORMATION
Explanation
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
Does the applicant participate in
the National Air Transportation
Association (NATA) Safety First
program?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the applicant participate in the National Air Transportation Association
(NATA) Safety First program?.
GENERAL INFORMATION
Explanation
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
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