Links for Vaughn Add New Partner Add New Testimonial UAS Agriculture Submission Contact InformationBusiness Name(Required) Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Policy InformationNew or RenewalNewRenewalif Renewal, last carrier Policy Period Part 137 Status HiddenFarm-i-Tude Status Custom or Personal Work Ground Spraying Experience Anticipated Acres Flown AircraftAircraft(Required)MakeModelManufacture YearRegistration/Serial #Insured ValuePhysical Damanage Coverage Required? Add RemoveFor Registration/Serial #, please put "TBD" if unknownLienholder or Additional Insured, If ApplicableLienholder or Additional Insured, If ApplicableLienholder NameAddress Add RemoveSpare PartsSpare PartsEquipmentInsured ValueQuantityTotal ValuePhysical Damage Coverage Required? Add RemoveTotal Spare Parts Value HiddenChemical Liability CoverageHiddenBodily Injury (each person) : Limits HiddenBodily Injury (each person) : Alternate Limits HiddenBodily Injury (each person) : Coverage Type HiddenBodily Injury (each occurrence) : Limits HiddenBodily Injury (each occurrence) : Alternate Limits HiddenBodily Injury (each occurrence) : Coverage Type HiddenProperty Damage : Limits HiddenProperty Damage : Alternate Limits HiddenProperty Damage : Coverage Type HiddenAggregate Limit : Limits HiddenAggregate Limit : Alternate Limits HiddenAggregate Limit : Coverage Type Chemical UsageSeedingYesNoSeeding Percentage FertilizingYesNoFertilizing Percentage FungicideYesNoFungicide Percentage InsecticideYesNoInsecticide Percentage Cover CropYesNoCover Crop Percentage HerbicideYesNoHerbicide Percentage HiddenNon-Chemical LiabilityHiddenNon-Chemical Liability : Limit HiddenNon-Chemical Liability : Aggregate Limit PilotsPilotsNameDate of BirthPilot CertificationTotal UAS Flight HoursTotal UAS Make & Model Flight Hours Add RemoveInsurance & Claims HistoryDo any of the operators have any medical waivers other than corrective lenses or color blindness?If Yes, please provide detailsIn the last 5 years, have any of the operators (a) been cited for violation of any aviation regulation, or (b) had their pilot’s or driver’s license suspended or (c) been convicted of driving while intoxicated or (d) been convicted of any felony charge?If Yes, please provide detailsIn the last 5 years, have you been involved in any aircraft or UAS accidents or incidents?If Yes, please provide detailsAny additional notes or comments
