Costello Insurance Associates Drone - UAV Insurance

 Costello Insurance
 Associates, Inc.
 Tel: 800.528.6483
 Tel: 480.968.7746
 Fax: 480.967.3828
 insure@aviationi.com

Aircraft above clouds
Free Quote for Drone - UAV Insurance

Need a Quote for the Operation of a UAV or Drone?
Please Complete this Form and Someone will Contact You.

Sorry, we are unable to assist if the UAV is used only for pleasure. The insurance company will quote only if there is some business use.


Policyholder's Information
If the UAV will be owned & operated by a Corporation, LLC or DBA enter that name below. If it will be owned and operated by an individual(s) reflect those names below.
Name(s)
      Is this a: Corporation  LLC  DBA  Individual
Occupation
Street Address
City State      Zip  

Contact Information for Person Handling Insurance
First Name Last Name   
Work Phone Home Phone  
Cell Phone Email  
What is the address (URL) of your website?
How did you hear about us?
Is this a new purchase?
If not provide current insurance company data (if any) below:
Yes No
Present Insurance Company (not broker)
Policy Expiration Date

Aircraft Data
UAV/Drone #1
Will the aircraft be a: UAV (ground pilot operated aircraft)
Drone (No ground pilot. Entirely pre-programmed.)
Year Built
Make/Model/Include model number i.e. DJI Phantom 2 Vision Plus

Fixed Wing
Rotorwing
Who manufactured the aircraft?
Value of aircraft with attached instrumentation (except removable cameras)?

How is the aircraft launched? Mark all that apply.

Airport Runway
Roads
Fields
Rail
Catapult
Vertical takeoff
Other (describe):

Describe how aircraft is retrieved:
How is aircraft controlled? I.E. No pilot (just pre-programmed). With a ground based pilot.

Aircraft Data
UAV/Drone #2
(if only 1 aircraft skip questions pertaining to additional aircraft by clicking here.)
Will the aircraft be a: UAV (ground pilot operated aircraft)
Drone (No ground pilot. Entirely pre-programmed.)
Year Built
Make/Model/Include model number i.e. DJI Phantom 2 Vision Plus
***List additional UAVs to be quoted in the Comments section at the bottom of this survey. Be sure to give the year, make, and model.

Fixed Wing
Rotorwing
Who manufactured the aircraft?
Value of aircraft with attached instrumentation (except removable cameras)?

How is the aircraft launched? Mark all that apply.

Airport Runway
Roads
Fields
Rail
Catapult
Vertical takeoff
Other (describe):

Describe how aircraft is retrieved:
How is aircraft controlled? I.E. No pilot (just pre-programmed). With a ground based pilot.

Proposed Use of Aircraft
Business. I.e. Real Estate Aerial Photography. No charge to others.
Commercial. A charge will be made to others for the operation of the aircraft.
Pleasure. No business or commercial uses at all. Just pleasure flying.
Will the aircraft be flown “line of sight” only? Yes
No

Describe intended business use of the aircraft in detail:

Area of Operations
In what states will the aircraft generally be operated?
Will the aircraft be operated in other countries? If yes, please list.


Insurance desired
$500,000 Combined Single Limit of bodily and property damage
$1,000,000 Combined Single Limit of bodily and property damage
Other (please list):

If hull coverage is desired, what value do you place on the aircraft without detachable cameras?


During the last 3 years have you had any aviation accidents or FAR violations?
If yes, please provide details.


Pilots/Operators
  Pilot 1 Pilot 2 Pilot 3
First Name
Last Name
Age
FAA Pilot Certificates, if any
Total hours piloting general aviation
aircraft (not UAVs)
Total hours piloting UAVs
Total hours piloting this make and model aircraft
Any accidents in the last 3 years while piloting aircraft or UAVs?
If yes, please provide details.
Yes No Yes No Yes No

Comments
Please list the year, make, & model of any additional UAVs to be quoted as well as any questions or comments below:

Thank you for taking the time to complete this form.