Aircraft Information Form (Personally Owned or Privately Leased)

If you need any assistance completing this form, please contact Risk Management at risk-management@uiowa.edu or (319) 335-0010. 

 

If you would like a printable PDF to complete by hand, please contact Risk Management at risk-management@uiowa.edu.  

Aircraft Owner Information 
Pilot Information 
Insurance Information 

Please Attach the Following Documents:

  1. Copy of the Pilot License
  2. Copy of the FAA Certification
  3. Certificate of Insurance
  • Minimum Liability Limits Required 

    5 seat capacity or less - $1,000,000/occurrence with no per-seat limit 

    6-8 seat capacity - $2,000,000/occurrence with a minimum of $300,000 per-seat limit 

    9 seat capacity or greater - $3,000,000/occurrence, with minimum of $300,000 per-seat limit

  • Additional Insured to be listed as follows:

    The University of Iowa; Iowa Board of Regents, and the State of Iowa 

    c/o Risk Management, 

    202 Plaza Centre One, Iowa City, IA 52242

  • Waiver of Subrogation
One file only.
50 MB limit.
Allowed types: jpg, png, tif, pict, rtf, pdf, doc, docx, .
One file only.
50 MB limit.
Allowed types: jpg, png, tif, pict, rtf, pdf, doc, docx, .
One file only.
50 MB limit.
Allowed types: jpg, png, tif, pict, rtf, pdf, doc, docx, .