Atch_7_-_Indemnification_request.pdf

HTC711-15-R-C001

Attachment 7

SAMPLE FORMAT

10 December 2014

To: Contracting Officer

1. XXX Air Carrier, Inc., requests that it be indemnified pursuant to Public Law 85-804 for loss or damage caused by unusually hazardous risks as described in, and under the conditions prescribed by Solicitation Number HTC711-15-R-C001.

2. XXX Air Carrier may be exposed to unusually hazardous risks while performing missions and related services for the DoD due to cancellation, prohibitive price escalations and/or coverage limitations of its commercial or government-provided insurance, to include war risk insurance. XXX Air Carrier’s hull and liability policies exclude coverage for enumerated war risks. For its ordinary operations, it purchases war risk coverage that satisfies this need.

However, this coverage may not be available for operations in support of the DoD because it is subject to cancellation by the insurer on X days notice and such cancellation is likely in time or regions of crisis or during CRAF activation [and/or] [the coverage excludes all operations as part of the CRAF when it is activated] [and/or] [the coverage does not include flights to or over

[Iraq], [Burundi], [Libya], [etc] unless the insurer expressly consents in advance.] In addition, the commercial or FAA war risk coverage available may not be precisely coextensive with the unusually hazardous risks described in the solicitation. (e.g. damage caused by hostile detonation of nuclear weapons).

3. A summary of all insurance coverage carried by XXX Air Carrier applicable to the specified unusually hazardous risks is attached.

4. The controlling or limiting factors that determine the amount of financial protection XXX Air

Carrier provides and maintains include the risks to which it is exposed in the regular course of operations; the value of its assets; the availability, cost, and terms of insurance coverage; and its obligations to secure type and amounts of insurance required by regulatory agencies and third parties such as lessors. The amounts and types of insurance maintained are consistent with prevailing industry practices for commercial air carriers. (Tailor as necessary to describe carrier’s insurance practices).

5. XXX Air Carrier’s insurance programs in general or aggregate are not subject to approval and have not been approved by any government agency. (This is normally the case. Carrier should verify and change as necessary.) It has no indemnification agreement covering similar risks under any other government program. It has applied for or obtained FAA 443 Non-Premium

Insurance coverage as required or appropriate.

6. [XXX Air Carrier is not a division or subsidiary of a parent corporation.] [ XXX Air Carrier is a {division} {subsidiary} {other} of ___________ {which provides/carries no insurance coverage bearing on the risks for which indemnification is sought} {other}].

Signature of Official Authorized to Bind Offeror Date

Attachment A: Insurance Table:

TYPE OF

INSURANCE

INSURER’S

NAME AND

ADDRESS

POLICY

#S

POLICY

DATES

DEDUCTIBLES EXCLUSIONS DOLLAR LIMITS

PER OCCURRENCE,

ANNUALLY &

OTHER

HULL

{Hull All Risks (ground

& flight)}

See Exhibit A See

Exhibit A

January 1, 2011 to

September 30, See Exhibit B See Exhibit C $xx,xxx,xxx per occurrence &

$xxx,xxx,xxx annually or

{$x,xxx,xxx per aircraft (12

B747-100 aircraft)}

{Spares}

See Exhibit A See

Exhibit A

January 1, 2011 to

September 30, See Exhibit B See Exhibit C $xx,xxx,xxx per occurrence &

$xxx,xxx,xxx annually or

{$x,xxx,xxx per aircraft (12

B747-100 aircraft)}

{Other} See Exhibit A See

Exhibit A

January 1, 2011 to

September 30, See Exhibit B See Exhibit C $xx,xxx,xxx per occurrence &

$xxx,xxx,xxx annually or

{$x,xxx,xxx per aircraft (12

B747-100 aircraft)}

*Link to FAR website http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/50.htm#P171_26249

FAR 50.104-3 (a) (1) (iii) (A)* FAR 50.104-3 (a) (1)

(iii) (B)*

FAR 50.104-3 (a)

(1) (iii) (D)*

FAR 50.104-3 (a)

(1) (iii) (E)*

FAR 50.104-3 (a) (1) (iii) (C)* http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/50.htm#P171_26249

INSURER’S

NAME AND

ADDRESS

POLICY

#S

POLICY

DATES

DEDUCTIBLES EXCLUSIONS DOLLAR LIMITS

PER OCCURRENCE,

ANNUALLY &

OTHER

LIABILITY

{Bodily Injury

Excluding Passengers}

January 1, 2011 to

September 30, {See Exhibit B}

{None}

See Exhibit C $x,xxx,xxx per occurrence, $x,xxx,xxx per person &

$xx,xxx,xxx annually

{Passenger Bodily

Injury}

January 1, 2011 to

September 30, {See Exhibit B}

{None}

See Exhibit C $x,xxx,xxx per occurrence, {Property Damage}

January 1, 2011 to

September 30, {See Exhibit B}

{None}

See Exhibit C $x,xxx,xxx per occurrence, {Passenger Crew and

Property Liability}

January 1, 2011 to

September 30, {See Exhibit B}

{None}

See Exhibit C $x,xxx,xxx per occurrence, {Other} See Exhibit A See

January 1, 2011 to

September 30, {See Exhibit B}

{None}

See Exhibit C $x,xxx,xxx per occurrence, *Link to FAR website http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/50.htm#P171_26249

FAR 50.104-3 (a) (1)

(iii) (B)* FAR 50.104-3 (a) (1) (iii) (A)*

FAR 50.104-3 (a)

(1) (iii) (D)*

FAR 50.104-3

(a) (1) (iii) (E)*

ADDRESS

POLICY

#’S

POLICY

DATES

DEDUCTIBLES

EXCLUSIONS

DOLLAR LIMITS

PER OCCURRENCE,

{WAR RISK

INSURANCE} OR

{THIRD PARTY WAR

RISK LIABILITY} OR

{FAA 443 PREMIUM

WAR RISK

INSURANCE}

{Federal Aviation

Administration

800 Independence

Avenue SW

Washington DC

20591}

{other}

{PX-XXX-

XX-XX}

{other}

January 1, 2011 to

September

30, 2011

None See Exhibit C $x,xxx,xxx per occurrence, FAA 443 NON-

PREMIUM

Federal Aviation

Administration

800 Independence

Avenue SW

Washington DC

20591

NP-XXX-

XXX-XXX

January 1, 2011 to

September

30, 2011 until cancelled or terminated

None None {Same as Commercial Hull and

Liability Policies} {Hull loss payments are limited to the commercially insured value of the aircraft or its fair and reasonable value, whichever is less }

WORKER’S

COMPENSATION

& EMPLOYER’S

LIABILITY

INSURANCE

INCLUDING

DEFENSE BASE ACT

(DBA) INSURANCE**

{AIG} or {see attached certificate}

#xxx-xx-xx-xxxxx-xxx

January 1, 2011 to

September

30, 2011

{See Exhibit B}

{None}

See Exhibit C $x,xxx,xxx each accident

$x,xxx,xxx disease limit

$x,xxx,xxx policy limit

*Link to FAR website http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/50.htm#P171_26249

** DBA not subject to Indemnification but required per Contract Clauses FAR 52.228-3, 52-228-4, and 52-228-5 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/52_227.htm#P594_136140

(iii) (B) and (F)* FAR 50.104-3 (a) (1) (iii) (A)*

(a) (1) (iii) (D)*

FAR 50.104-3 (a) (1) (iii) (C)*

And (F) http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/52_227.htm#P594_136140

ADDRESS

POLICY

#S

POLICY

DATES

EXCLUSIONS DOLLAR LIMITS

PER OCCURRENCE,

ANY OTHER

APPLICABLE

COVERAGE:

Defense Base Act {$x,xxx,xxx amount of self-insurance after which reinsurance by AIG appli Self-Insured n/a n/a n/a n/a $x,xxx,xxx annual dollar limit after which reinsurance DBA policy from AIG applies

Any type of self-insurance and what you self-insure for

Any other insurance which extends to air operations

*Link to FAR website http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/50.htm#P171_26249

(iii) (B)*

FAR 50.104-3 (a) (1) (iii) (A)*

(a) (1) (iii) (D)*

Exhibit A (for multiple insurers).

This list is coverage for our {Hull All Risks (ground & flight)} {Spares} {Leased Engines}

{Bodily Injury Excluding Passengers} {Passenger Bodily Injury} {Property Damage}

{Passenger Crew and Property Liability} {other}

Insurer Policy Number % share of policy

Global Aviation

51 John F. Kennedy Parkway

Short Hills NJ 07078 xxxxxxxx 25%

The Underwriters at Lloyd’s of London

Aviation and Aerospace Practice

Tower Place

London EC3R 5BU

United Kingdom xxxxxxx 25%

AIG Aviation

100 Colony Square

PO Box 448

Atlanta GA 30361 xxxxxxx 25%

The XL Specialty Insurance Company through XL

1111 Chapala Street, Suite 300

Santa Barbara, CA 93101 xxxxxxx 25%

Total 100%

Exhibit B

HULL POLICIES: DEDUCTIBLE

{Wide Body Aircraft} $x,xxx,xxx

{Narrow Body Aircraft} $xxx,xxx

{B747-100} $xxx,xxx

{While the aircraft is in motion} $x,xxx,xxx

{While the aircraft is not in motion} $xxx,xxx

{other} $xx,xxx,xxx

Spares $xx,xxx

Leased Engines $xxx,xxx

LIABILITY POLICIES: DEDUCTIBLE

{None } {None}

{other} $x,xxx

PREMIUM WAR RISK INSURANCE DEDUCTIBLE

None None

CHAPTER 443 NON-PREMIUM DEDUCTIBLE

None None

WORKER’S COMPENSATION DEDUCTIBLE

& EMPLOYER’S LIABILITY INS {None} {Other}

OTHER TYPES OF INSURANCE DEDUCTIBLE

xxxxxx $xx,xxx

Exhibit C - Exclusions:

List exclusions here and/or attach the page(s) out of your insurance policy that talks about the exclusions to your policy or pull all exclusionary clauses and attach them as an Exhibit.

HULL POLICIES:

See attached pages from our policy including the, {War, Hi-Jacking and Other Perils Exclusion

Clause}, {Nuclear Risks Exclusion Clause}, {Geographical Exclusions Clause}, {other}

LIABILITY POLICIES:

See attached pages from our policy including the {Bodily Injury Exclusion} {Personal Injury

Exclusion} {Property Damage Exclusion} {Physical Damage Exclusion} {Terrorism

Exclusion} {War, Hi-Jacking and Other Perils Exclusion Clause}, {Nuclear Risks Exclusion

Clause}, {Geographical Exclusions Clause}, {other}

{THIRD PARTY WAR RISK} OR {PREMIUM WAR RISK INSURANCE}:

Exclusions include: Civil air missions awarded individually to those specified operators pursuant to USTRANSCOM Solicitation HTC711-15-R-C001 or CRAF activation missions covered by FAA 443 Non Premium Insurance Program.

FAA NON-PREMIUM INSURANCE:

Exclusions include: None

WORKER’S COMPENSATION INSURANCE:

Exclusions include: {Intoxication of the worker by the influence of narcotic drugs, barbiturates or stimulates not prescribed by a physician}; {willful intention of the worker to injure or kill him/herself or another}; {willful disregard of safety rules and regulations}, {other}

OTHER APPLICABLE INSURANCE:

Exclusions include: