Drone Sprayer Applicator Program Supplemental Questionnaire
Before getting started, please be prepared to upload or enter key documentation such as your current policy details, VIN(s), and driver’s license(s). Having these ready will help you complete the form more efficiently.
Full Name
*
Drone Business Name
*
Year Business Established
*
ex. 2023
Years of Drone Spraying Experience
*
FEIN (if applicable)
*
Email
*
Phone
*
Website
Mailing Address
Address
Street Address
City
State
Postal Code
Do you have multiple business locations or franchisees
*
Yes
No
Do you currently have business locations or operations in multiple States?
*
Yes
No
Do you currently OR do you plan to operate or provide services outside of the United States, its territories or possessions, or Canada?
*
Yes
No
Do You Have Current Coverage
*
Yes
No
What is the effective date of current coverage? 85ft
*
Please upload current policy documentation:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Current Coverage Policy Documentation
Coverage of Interest
*
General Liability
Misapplication
Pollution
Inland Marine/Drone Physical Damage
Property
Commercial Auto
Excess Liability
Cyber
Workers Compensation
*Select at least two options.
Underwriting Information
Describe your aerial operations or business exposures
*
Agriculture / Farming / Ranching (Non-Spraying)
Chemical / Fertilizer / Seed Dealer
Spraying of Row Crops
Spraying of Orchards / Vineyards
Spraying of Forestry
Spraying of Invasive Vegetation
Seed / Cover Crop Application
Spraying of Livestock
Application on or around Bodies of Water
Application for Insect or Rodent Control
Training / Consultation
Washing Buildings, Property, or Hard Surfaces
Painting
Sand Blasting or Other Blast Media
Product Delivery using UAS
Material Transport using UAS
Animal Recovery
Environmental Monitoring
Inspection / Maintenance
Mapping / Surveying
Security / Search and Rescue / Firefighting
Municipal or Educational
Photography / Videography
Advertising / Media / Entertainment
Describe “other” aerial operations or business exposures
How many drones do you own?
Do you lease ANY drones for use in your operation?
*
Yes
No
Do you EVER rent drones for use in your operation?
*
Yes
No
How many auto power units are in operation? (Number of vehicles… excluding trailers)
*
Auto power units - Permanently attached equipment
*
How many trailers used in the operation?
*
How many acres do you apply herbicides and pesticides (chemicals) to?
*
What types of crops do you apply herbicides or pesticides to?
*
How many acres do you apply fertilizer on?
*
What types of crops do you apply fertilizer on?
*
How many acres do you apply seed to via drone?
*
Do you practice the following:
Monitor the wind/guidelines in place:
*
Yes
No
Use Maps:
*
Yes
No
Use GPS:
*
Yes
No
PPE Worn:
*
Yes
No
Formalized Training:
*
Yes
No
Do you have written procedures in place for the operation of the UAS(s)/Drone?
*
Yes
No
Is line of sight maintained with the UAS/Drone at all times during flight?
*
Yes
No
Do you keep a copy of the customer information that is collected?
*
Yes
No
Are the UAS(s)/Drones equipped with return home and GEO-fencing technology?
*
Yes
No
Have you ever been named in a lawsuit in regard to your UAS/Drone operations?
*
Yes
No
Have you ever reported a claim that resulted in a covered loss?
*
Yes
No
If yes, please provide the loss details including the amount paid for all damages:
The undersigned is an authorized representative of the applicant and certifies that reasonable inquiry has been made to obtain the answers to questions on this application. He/She certifies that the answers are true, correct and complete to the best of his/her knowledge.
Applicant's First Name
*
Applicant's Last Name
*
Applicant’s Signature:
*
Clear
Date:
*
*Coverage options and program eligibility may vary by state. Certain risks may be ineligible or subject to underwriting approval. Submission of this form does not constitute a complete application. Additional information regarding your business may be requested as part of the underwriting process.