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
FEIN (if applicable)
*
Email
*
Phone
*
Website
Mailing Address
*
Address
*
Street Address
State
City
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, Puerto Rico or Canada?
*
Yes
No
Do you currently OR do you anticipate entering into a contract(s) to secure work in your operation?
*
Yes
No
Do You Have Current Coverage
*
Yes
No
Is this business a new venture?
Yes
No
What is the effective date of current coverage
Please upload current policy documentation:
Click to upload
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 ALL that apply
Association Membership
Farm-i-Tude
American Drone Network
N/A
common.other_option
Select all that apply
Underwriting Information
Select ALL that apply
Describe your aerial operations or business exposures
*
Agriculture / Farming / Ranching (Non-Spraying)
Chemical Dealer / Fertilizer Dealer / 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
Estimated Acres sprayed with UAS annually:
Herbicides and Pesticides:
Fertilizer:
Estimated annual flight hours Spraying of Row Crops:
Estimated gross annual sales Spraying Row Crops:
$
Estimated annual flight hours spraying Orchards/Vineyards:
Estimated gross annual sales spraying Orchards/Vineyards:
$
Estimated annual acres applying Seed/Cover Crop:
Estimated annual flight hours applying Seed/Cover Crop:
Estimated gross annual sales applying Seed/Cover Crop:
$
Estimated annual acres for Spraying of Forestry
Estimated annual flight hours for Spraying of Forestry
Estimated gross annual sales for Spraying of Forestry
$
Estimated annual acres for Spraying of Invasive Vegetation
Estimated annual flight hours for Spraying of Invasive Vegetation
Estimated gross annual sales for Spraying of Invasive Vegetation
$
Estimated annual flight hours for Spraying of Livestock
Estimated gross annual sales for Spraying of Livestock
$
Estimated annual flight hours for Application for Insect or Rodent Control
Estimated gross annual sales for Application for Insect or Rodent Control
$
Estimated annual flight hours for Washing Buildings, Property, or Hard Surfaces
Estimated gross annual sales for Washing Buildings, Property, or Hard Surfaces
$
Estimated annual flight hours for Painting
Estimated gross annual sales for Painting
$
Estimated annual flight hours for Sand Blasting or Other Blast Media
Estimated gross annual sales for Sand Blasting or Other Blast Media
$
Estimated annual flight hours for Product Delivery using UAS
Estimated gross annual sales for Product Delivery using UAS
$
Estimated annual flight hours for Material Transport using UAS
Estimated gross annual sales for Material Transport using UAS
$
Estimated annual flight hours for Animal Recovery
Estimated gross annual sales for Animal Recovery
$
Estimated annual acres for Environmental Monitoring
Estimated annual flight hours for Environmental Monitoring
Estimated gross annual sales for Environmental Monitoring
$
Estimated annual flight hours for Inspection / Maintenance
Estimated gross annual sales for Inspection / Maintenance
$
Estimated annual acres for Mapping / Surveying
Estimated annual flight hours for Mapping / Surveying
Estimated gross annual sales for Mapping / Surveying
$
Estimated annual flight hours for Security / Search and Rescue / Firefighting
Estimated gross annual sales for Security / Search and Rescue / Firefighting
$
Estimated annual acres for Municipal or Educational
Estimated annual flight hours for Municipal or Educational
Estimated gross annual sales for Municipal or Educational
$
Estimated annual flight hours for Photography / Videography
Estimated gross annual sales for Photography / Videography
$
Estimated annual flight hours for Advertising / Media / Entertainment
Estimated gross annual sales for Advertising / Media / Entertainment
$
Do you sell drones and/or provide service/repair for others
*
Yes
No
Regarding the sale of drones
Do you sell new drones?
Yes
No
Estimated annual sales for new drones:
Do you sell used/rebuilt drones?
Yes
No
Estimated annual sales for used/rebuilt drones:
Regarding service or repair work on drones
What type/kind of work is performed on drones?
What level of service/repair work is performed on drones?
Level 1: Field or User-Level Maintenance (Basic)
Level 2: Component Replacement (Intermediate)
Level 3: Avionics and Deep Internal Repair (Advanced)
Level 4: Depot-Level and Board Level (Complex)
Describe "other" aerial operations or business exposures
How many drones do you own?
*
Complete UAS schedule or attach current policy documentation
Click to upload
UAS Schedule - Application
Do you EVER lease or rent drones for use in your operation?
*
Yes
No
Do you currently OR do you anticipate using boats, barges, or any other type of watercraft in your operation?
*
Yes
No
Pilot Schedule - Application
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(s)/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:
Auto Schedule - Application
Driver Schedule - Application
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.