ACORD 275 Instructions


ACORD 275 (2009/05)

Section Name Field Name Field and/or Section Description
TITLE ACORD 275 (2009/05) Aviation Insurance Binder The title of the form. ACORD 275, Aviation Insurance Binder, addresses both Personal Lines and Commercial Lines Aviation risks. Before issuing any binder, the following important considerations should be reviewed and considered carefully: * A Binder (Cover Note in some states) is a temporary insurance contract which provides coverage in advance of the issuance of an insurance policy. * The improper use of binders has become a major cause of producer’s Errors and Omissions claims. It is imperative that only authorized people prepare them. Preparation must be complete and accurate. * All binders must conform to thestate insurance code for the state in which the subject of insurance in located. * The maximum and/or minimum term of a binder may be governed by state statute and/or company underwriting instructions. * At the end of the binder’s specified term, all coverage expires unless a new binder has been issued or the expired binder has been replaced with a policy .
TITLE * The language in the binder must be precise. Do not use vague or all-encompassing terms which may imply coverages not intended, such as “All Risk.” If possible, use the same language and terminology that will appear on policy. * An agent may only issue binders which comply with the company’s underwriting instructions (per company manual, agency agreement, correspondence and/or company underwriter). If the authority is not in writing, the agent should obtain written authority. Most agency agreements contain stated “time frames” within which the company must be notified of any risk bound. * Generally, a broker cannot bind insurance. A broker may only exercise the authority extended by the company. It is recommended that individual binders be issued for each company affording coverage. * Most agency agreements dealing with surplus lines and specialty market contracts do not allow the agent or broker to bind coverage. Authorization must be secured prior to binding.
 

Section Name Field Name Field and/or Section Description
TITLE * A binder provides coverage for a specified period. In most jurisdictions, a premium must be charged for this period unless the binder is replaced by a policy. A deposit should be obtained when issuing a binder. A deposit premium may be required by some companies. * Most companies prohibit issuing or extending binders where coverage has been refused or cancelled by any carrier.
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 Enter text: The mailing address line one of the producer/agency.
IDENTIFICATION SECTION Enter text: The mailing address line two of the producer/agency.
IDENTIFICATION SECTION Enter text: The mailing address city name of the producer/agency.
IDENTIFICATION SECTION Enter code: The mailing address state or province code of the producer/agency.
IDENTIFICATION SECTION Enter code: The mailing address postal code of the producer/agency.
IDENTIFICATION SECTION Contact Name Enter text: The name of the individual at the producer’s establishment that is the primary contact.
IDENTIFICATION SECTION Phone (A/C, No, Ext) Enter number: The producer’s contact person’s phone number. If applicable, include the area code and extension.
IDENTIFICATION SECTION Fax No. (A/C, No) Enter number: The fax number of the producer/agency.
IDENTIFICATION SECTION Code Enter code: The identification code assigned to the producer (e.g. agency or brokerage firm) by the insurer.
IDENTIFICATION SECTION Sub Code Enter code: The identification code assigned by the insurer to the sub-producer (e.g. person) within a producer’s office (e.g. agency or brokerage).
IDENTIFICATION SECTION Agency Customer Id Enter identifier: The customer’s identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION Name & Mailing Address Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION Enter text: The named insured’s mailing address line one.
 

Section Name Field Name Field and/or Section Description
IDENTIFICATION SECTION Enter text: The named insured’s mailing address line two.
IDENTIFICATION SECTION Enter text: The named insured’s mailing address city name.
IDENTIFICATION SECTION Enter code: The named insured’s mailing address state or province code.
IDENTIFICATION SECTION Enter code: The named insured’s mailing address postal code.
IDENTIFICATION SECTION Carrier Enter text: The insurer’s full legal company name(s) as found in thefile copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer’s group name or trade name.
IDENTIFICATION SECTION NAIC Code Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION Binder # Enter identifier: The number assigned to uniquely identify the binder.
IDENTIFICATION SECTION Effective Date Enter date: The date on which the terms and conditions of the binder commenced. This date normally coincides with the effective date of the policy or of an endorsement to the policy.
IDENTIFICATION SECTION Effective Time Enter time: The time of the binder effective date that the binder becomes effective.
IDENTIFICATION SECTION Effective Time AM Check the box (if applicable): Indicates the binder effective time is in the morning (AM).
IDENTIFICATION SECTION Effective Time PM Check the box (if applicable): Indicates the binder effective time is in the afternoon or evening (PM).
IDENTIFICATION SECTION Expiration Date Enter date: The date on which the terms and conditions of the policy will or have expired. Certain state laws limit the terms of a binder, so this date may not coincide with the policy expiration date.
IDENTIFICATION SECTION Expiration Time 12:01 AM Check the box (if applicable): Indicates the binder expires at 12:01 AM on the expiration date.
IDENTIFICATION SECTION Expiration Time Noon Check the box (if applicable): Indicates the binder expires at 12:00 noon on the expiration date.
IDENTIFICATION SECTION This binder is issued to extend coverage Checkbox Check the box (if applicable): Indicates the binder is issued to extend coverage on a policy where renewal is not yet available.
IDENTIFICATION SECTION Expiring Policy # Enter identifier: The policy number of the policy that is expiring.
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability BI Each Person Enter limit: The bodily injury each person limit amount for premises liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Each Occurrence Enter limit: The each occurrence limit amount for premises liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Property Damage Enter limit: The property damage limit amount for premises liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Deductible Enter deductible: The deductible amount for premises liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Liability Deductible Applies To Enter code: The code identifying what the deductible applies to.
AIRPORT & FBO LIABILITY COVERAGES Premises Medical Payments Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Medical Payments Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Premises Medical Payments Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Medical Payments Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Premises Medical Payments Each Person Enter limit: The each person limit amount for premises medical payments coverage.
AIRPORT & FBO LIABILITY COVERAGES Premises Medical Payments Each Occurrence Enter limit: The each occurrence limit amount for premises medical payments coverage.
AIRPORT & FBO LIABILITY COVERAGES Products Liability Sale of Fuel & Oil Check the box (if applicable): Indicates the sale of fuel and oil option applies to the products liability coverage.
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Products Liability Extended Check the box (if applicable): Indicates the extended option applies to the products liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Products Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY 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.
AIRPORT & FBO LIABILITY COVERAGES Products Liability BI Each Person Enter limit: The bodily injury each person limit amount for products liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Products Liability Each Occurrence Enter limit: The each occurrence limit amount for products liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Products Liability Aggregate Enter limit: The aggregate limit amount for products liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Completed Operations Extended Check the box (if applicable): Indicates the extended option applies to the completed operations liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Completed Operations Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY 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.
AIRPORT & FBO LIABILITY COVERAGES Completed Operations Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY 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.
AIRPORT & FBO LIABILITY COVERAGES Completed Operations Liability BI Each Person Enter limit: The bodily injury each person limit amount for completed operations liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Completed Operations Liability Each Occurrence Enter limit: The each occurrence limit amount for completed operations liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Completed Operations Liability Aggregate Enter limit: The aggregate limit amount for completed operations liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Hangarkeepers Legal Liability Including Taxi Check the box (if applicable): Indicates the including taxi option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Hangarkeepers Legal Liability In Flight Check the box (if applicable): Indicates the in flight option applies to the coverage.
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Hangarkeepers Legal Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Hangarkeepers Legal Liability Option Description Enter text: The description of the option being requested. Example: Ground Only.
AIRPORT & FBO LIABILITY COVERAGES Hangarkeepers Legal Liability Each Aircraft Enter limit: The each aircraft limit amount for hangarkeepers legal liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Hangarkeepers Legal Liability Each Occurrence Enter limit: The each occurrence limit amount for hangarkeepers legal liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Hangarkeepers Legal Liability Deductible Amount Enter deductible: The deductible amount for hangarkeepers legal liability coverage.
AIRPORT & FBO LIABILITY 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
AIRPORT & FBO LIABILITY COVERAGES Hangarkeepers Legal Liability Deductible Amount Enter deductible: The deductible amount for hangarkeepers legal liability coverage.
AIRPORT & FBO LIABILITY 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
AIRPORT & FBO LIABILITY COVERAGES Fire Legal Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Fire Legal Liability Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Fire Legal Liability Any One Fire Enter limit: The any one fire limit amount for fire legal liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Personal Injury Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Personal Injury Liability Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Personal Injury Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Personal Injury Liability Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Personal Injury Liability Each Occurrence Enter limit: The each occurrence limit amount for personal injury liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Personal Injury Liability Aggregate Enter limit: The aggregate limit amount for personal injury liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Advertising Liability Option Checkbox Check the box (if applicable): The description of the option being requested.
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Advertising Liability Option Description Enter text: The any one fire limit amount for fire legal liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Advertising Liability Option Checkbox Check the box (if applicable): The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Advertising Liability Option Description Enter text: The any one fire limit amount for fire legal liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Advertising Liability Each Occurrence Enter limit: The each occurrence limit amount for advertising liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Advertising Liability Aggregate Enter limit: The aggregate limit amount for advertising liability coverage.
AIRPORT & FBO LIABILITY COVERAGES Contractual Liability Included Check the box (if applicable): Indicates contractual liability coverage is included in the policy.
AIRPORT & FBO LIABILITY COVERAGES Contractual Liability Excluded Check the box (if applicable): Indicates contractual liability coverage is excluded from the policy.
AIRPORT & FBO LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AIRPORT & FBO LIABILITY 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)
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AIRPORT & FBO LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AIRPORT & FBO LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AIRPORT & FBO LIABILITY 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)
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AIRPORT & FBO LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AIRPORT & FBO LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AIRPORT & FBO LIABILITY 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)
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AIRPORT & FBO LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AIRPORT & FBO LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AIRPORT & FBO LIABILITY 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)
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AIRPORT & FBO LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AIRPORT & FBO LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AIRPORT & FBO LIABILITY 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)
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
 

Section Name Field Name Field and/or Section Description
AIRPORT & FBO LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRPORT & FBO LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AIRPORT & FBO LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AIRPORT & FBO LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
NAME & ADDRESS Name & Address Enter text: The additional interest’s full name.
NAME & ADDRESS Enter text: The additional interest’s mailing address line one.
NAME & ADDRESS Enter text: The additional interest’s mailing address line two.
NAME & ADDRESS Enter text: The additional interest’s mailing address city name.
NAME & ADDRESS Enter code: The additional interest’s mailing address state or province code.
NAME & ADDRESS Enter code: The additional interest’s mailing address postal code.
NAME & ADDRESS Mortgagee Check the box (if applicable): Indicates the additional interest type is a mortgagee.
NAME & ADDRESS Additional Insured Check the box (if applicable): Indicates the additional interest type is an additional insured.
NAME & ADDRESS Loss Payee Check the box (if applicable): Indicates the additional interest type is a loss payee.
NAME & ADDRESS Other Check the box (if applicable): Indicates the additional interest is not any of the types listed on the form.
NAME & ADDRESS Other Description Enter text: The description of the type of interest in the item.
NAME & ADDRESS Loan Number Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured.
 

Section Name Field Name Field and/or Section Description
NAME & ADDRESS Authorized Representative Sign here: Accommodates the signature of the authorized representative (e.g. producer, agent, broker, etc.). by all companies to issue Certificates. This is required in most states. As used here, binders must be signed by authorized representatives of the issuing company.
IDENTIFICATION SECTION Agency Customer Id Enter identifier: The customer’s identification number assigned by the producer (e.g. agency or brokerage).
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Including Taxi Check the box (if applicable): Indicates the including taxi option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability In Flight Check the box (if applicable): Indicates the in flight option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Option Description Enter text: The description of the option being requested. Example: Ground Only.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Each Aircraft Enter limit: The each aircraft limit amount for hangarkeepers legal liability coverage.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Each Occurrence Enter limit: The each occurrence limit amount for hangarkeepers legal liability coverage.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Deductible Enter deductible: The deductible amount for hangarkeepers legal liability coverage.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Applies To Enter code: The code identifying what the deductible applies to. Examples: Each and Every Loss, Turbine Aircraft, Airline, Property Damage, Each Occurrence
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Deductible Enter deductible: The deductible amount for hangarkeepers legal liability coverage.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Applies To Enter code: The code identifying what the deductible applies to. Examples: Each and Every Loss, Turbine Aircraft, Airline, Property Damage, Each Occurrence
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Deductible Enter deductible: The deductible amount for hangarkeepers legal liability coverage.
PRIVATE HANGAR LIABILITY COVERAGES Hangarkeepers Legal Liability Applies To Enter code: The code identifying what the deductible applies to. Examples: Each and Every Loss, Turbine Aircraft, Airline, Property Damage, Each Occurrence
PRIVATE HANGAR LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
PRIVATE HANGAR LIABILITY 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)
 

Section Name Field Name Field and/or Section Description
PRIVATE HANGAR LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
PRIVATE HANGAR LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
PRIVATE HANGAR LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
PRIVATE HANGAR LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
PRIVATE HANGAR LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
PRIVATE HANGAR LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
PRIVATE HANGAR LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
PRIVATE HANGAR LIABILITY 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)
PRIVATE HANGAR LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
PRIVATE HANGAR LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
 

Section Name Field Name Field and/or Section Description
PRIVATE HANGAR LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
PRIVATE HANGAR LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
PRIVATE HANGAR LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
PRIVATE HANGAR LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
PRIVATE HANGAR LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
PRIVATE HANGAR LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
PRIVATE HANGAR LIABILITY 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)
PRIVATE HANGAR LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
PRIVATE HANGAR LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
PRIVATE HANGAR LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
 

Section Name Field Name Field and/or Section Description
PRIVATE HANGAR LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
PRIVATE HANGAR LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
PRIVATE HANGAR LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PRIVATE HANGAR LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AVIATION PRODUCTS LIABILITY COVERAGES Products Liability Incl Completed Operations Check the box (if applicable): Indicates completed operations are included in the products liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Products Liability Excl Completed Operations Check the box (if applicable): Indicates completed operations are excluded from the products liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Products Liability Includes Spacecraft Check the box (if applicable): Indicates spacecraft are included in the products liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Products Liability Excludes Spacecraft Check the box (if applicable): Indicates spacecraft are excluded from the products liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Products Liability Each Occurrence Limit Enter limit: The each occurrence limit for products liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Products Liability Aggregate Limit Enter limit: The aggregate limit for products liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Products Liability Each Occurrence Deductible Enter deductible: The each occurrence deductible amount for products liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Products Liability Aggregate Deductible Enter deductible: The aggregate deductible amount for products liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Grounding Liability Each Occurrence Enter limit: The each occurrence limit amount for grounding liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Grounding Liability Aggregate Enter limit: The aggregate limit amount for grounding liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Grounding Liability Deductible Amount Enter deductible: The deductible amount for grounding liability coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Grounding Liability Deductible Percent Enter percentage: The percentage deductible for each ground for grounding liability coverage.
 

Section Name Field Name Field and/or Section Description
AVIATION PRODUCTS LIABILITY COVERAGES Foreign Military Aircraft Products Included Check the box (if applicable): Indicates foreign military aircraft products coverage is included in the policy.
AVIATION PRODUCTS LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AVIATION PRODUCTS LIABILITY 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)
AVIATION PRODUCTS LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AVIATION PRODUCTS LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AVIATION PRODUCTS LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AVIATION PRODUCTS LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AVIATION PRODUCTS LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AVIATION PRODUCTS LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AVIATION PRODUCTS LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AVIATION PRODUCTS LIABILITY 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)
 

Section Name Field Name Field and/or Section Description
AVIATION PRODUCTS LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AVIATION PRODUCTS LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AVIATION PRODUCTS LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AVIATION PRODUCTS LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AVIATION PRODUCTS LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AVIATION PRODUCTS LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AVIATION PRODUCTS LIABILITY COVERAGES Coverage Code Enter code: The code for the coverage.
AVIATION PRODUCTS LIABILITY 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)
AVIATION PRODUCTS LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AVIATION PRODUCTS LIABILITY COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
 

Section Name Field Name Field and/or Section Description
AVIATION PRODUCTS LIABILITY COVERAGES Option Description Enter text: The description of the option being requested.
AVIATION PRODUCTS LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AVIATION PRODUCTS LIABILITY COVERAGES Limit Enter limit: The limit amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AVIATION PRODUCTS LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
AVIATION PRODUCTS LIABILITY COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
AVIATION PRODUCTS LIABILITY COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
OTHER COVERAGES Line of Business Enter text: The description of the line of business classification.
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
OTHER 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)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
OTHER COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
 

Section Name Field Name Field and/or Section Description
OTHER 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)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
OTHER COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
OTHER 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)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
OTHER COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
OTHER COVERAGES Coverage Code Enter code: The code for the coverage.
OTHER 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)
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
Section Name Field Name Field and/or Section Description
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Option Checkbox Check the box (if applicable): Indicates a coverage option applies to the coverage.
OTHER COVERAGES Option Description Enter text: The description of the option being requested.
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Limit Enter limit: The limit amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
OTHER COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
OTHER COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
OTHER COVERAGES Applies To Enter code: The code identifying what the deductible applies to.
DESCRIPTION OF OPERATIONS / REMARKS (Attach ACORD 101, Additional Remarks Schedule if more space is required) Description of Operations Enter text: The Aviation Insurance Binder general remarks including the description of operations. Attach ACORD 101, Additional Remarks Schedule, if more space is required.
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).