Insurance Questionnaire 2021_0001.xlsx
XLSX spreadsheet 18 KB Posted
- Attached to
- -AIRCRAFT LIABILITY INSURANCE Federal contract opportunity
- Solicitation number
- 140F0621Q0041
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| SOW Updated_0002.docx | DOCX document | |
| Sol_140F0621Q0041_Amd_0002.pdf | ||
| Sol_140F0621Q0041_Amd_0001.pdf | ||
| Sol_140F0621Q0041.pdf |
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Text version
PILOT INFO
| PILOT INFO | RESPONSE HERE |
| Name of Pilot | |
| Date of Birth | |
| Address | |
| Present Employer | |
| Date Employed | |
| Position Held | |
| Address | |
| Previous Employer 1 | |
| Previous Employer 1 Dates Employed | |
| Previous Employer 1 Position Held | |
| Previous Employer 2 | |
| Previous Employer 2 Dates Employed | |
| Previous Employer 2 Position Held | |
| Previous Employer 3 | |
| Previous Employer 3 Dates Employed | |
| Previous Employer 3 Position Held | |
| Have you ever been discharged or asked to resign? | |
| PILOT CERTIFICATE AND RATINIGS CURRENTLY HELD | |
| Student [S], Private [P], Commercial [C], ATP [A], Instructor [I], SEL, SES, MEL, MES, Helo, Instrument [IR] | |
| FAA Certificate Number | |
| Date first Certificated | |
| Medical certificate number | |
| Medical certificate type | |
| Medical certificate date | |
| Physical Impairments | |
| Waivers and Limitations | |
| Date of last biennial flight review | |
| Make and Model of primary aircraft | |
| Have you attended manufacturers ground and flight training course? | |
| If yes above, Date, Facility and Location |
FLIGHT EXPERIENCE
| MAKE AND MODEL | YRS FLOWN | PIC | SIC | DUAL | TOTAL TIME | LAST 90 DAYS | LAST 12 MONTHS | |
| C172 | ||||||||
| C182 | ||||||||
| Single | KODI | |||||||
| Engine | PA28 | |||||||
| C206 |
| BE30 | |
| BE58 | |
| Multi | BE20 |
| Engine & | PA44 |
| Jet |
| C172L | |
| TH67 | |
| Seaplanes | UH-60A/L |
| & Helos | OH58C |
GRAND TOTALS 0 0 0
EDUCATION
| Highest Year Completed? | Level and # Years | ||
| Code as a) High School 1-4 yrs, b) College 1-4 yrs, c ) Graduate School 1-4 yrs | |||
| Name of College(s) | Years Attended | Did you graduate? |
AIRCRAFT ACCIDENTS
| Have you ever been involved in an accident? If yes, explain below | ||||
| NO | ||||
| Accident Location | Date | Make/Model | Registration Number | Probable Cause |
| Explain circumstances if you have any: | Explanation | |||
| a) Physical impairments | ||||
| b) waivers or limitations on your medical | ||||
| c) An FAA, Transport Canada, or Military pilot certificate held by you has been revoked or suspended | ||||
| d) you have been cited for violation of an aviation regulation in any country | ||||
| e) you have ever been convicted or pleaded guilty to a felony or DUI |
File details come from the government source that posted it. Updated .