6411 Foreign Air Carriers Certificate of Insurance

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Department of Transportation, Office of Aviation Analysis, X-56, 400 7 St., SW,., Washington, D.C. 20590. According to the
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control number.

Office of the Secretary
of Transportation

NOTE: For information on where to file completed copies of this form, see FILING INSTRUCTIONS below.
OMB No. 2106-0030 Expires 9-30-2007

FOREIGN AIR CARRIERS - CERTIFICATE OF INSURANCE
POLICIES OF INSURANCE FOR AIRCRAFT ACCIDENT BODILY INJURY
AND PROPERTY DAMAGE LIABILITY
FILING INSTRUCTIONS: File a signed original of this form with the Federal Aviation Administration, Air Transportation Div., AFS-260, 800 Independence
Ave., SW., Washington, DC 20591. (See EXCEPTION below.)
EXCEPTION: If Section 2.A. is filled in because the insured is a Canadian Charter Air Taxi Operator, file an original of this form with the U.S. Department
th
of Transportation, Special Authorities Division (X-46), 400 7 Street, SW, Washington, D.C. 20590

(Please type information, except signatures.)

THIS CERTIFIES THAT:
_________________________________________________________________________________
(Name of Insurer)

has issued a policy or policies of Aircraft Liability Insurance to
____________________________________________________
__________________________________________________________________FAA Certificate
Number________________
(Name, address and FAA Certificate number of Insured Foreign Air Carrier)

effective from __________________________ until ten (10) days after written notice from the insurer or carrier of the intent
to terminate coverage is received by the Department of Transportation.
NOTE: Part 205 of the Department’s Regulations does not allow for a predetermined termination date, and a certificate showing such a date
is unacceptable.
_______________________________________________________________________________________________________________1.
The Insurer (Check One):

is licensed to issue aircraft insurance policies in the United States;
is licensed or approved by the government of _______________________ to issue aircraft insurance policies; or
is an approved surplus line insurer in the State(s) of _________________________

_______________________________________________________________________________________________________________2.
The insurer assumes, under the policy or policies listed below, aircraft accident liability insured to minimums at least equal to the
following during operation, maintenance, or use of aircraft in “foreign air transportation” as that term is defined in 49 U.S.C. 40102.
(Complete applicable section A, B, or C below):
A.

CANADIAN CHARTER AIR TAXI OPERATORS WITH PART 294 AUTHORITY ONLY
The aircraft covered by this policy have: (1) 30 or fewer passenger seats and a maximum payload capacity of 7,500 pounds or less;
and/or (2) a maximum authorized takeoff weight on wheels of no more than 35,000 pounds. (Complete separate or combined
coverage as appropriate):

Separate Coverages:
Policy No.
__________________
__________________

Minimum Limit
Type of Liability

Each person

Combined Bodily Injury (Excluding Passengers other
than cargo attendants) and Property Damage Liability

$75,000

$2,000,000*(See note)

Passenger Bodily Injury

$75,000

$75,000 x 75% of
total number of
passenger seats
installed in aircraft

Combined Coverage: This combined coverage is a single limit of liability for each occurrence at least equal to the required minimums
stated above for bodily injury (excluding passengers), property damage, and passenger bodily injury.
Policy No.__________________________________

Each Occurrence

Amount of Coverage_____________________U.S. Dollars

This policy covers CARGO operations only and excludes passenger liability insurance.

___________________________________________________________________________________________________________
NOTE: If the aircraft covered by this policy have more than 30 passenger seats or more than a maximum payload capacity of 7,500 pounds, the
minimum limit per occurrence shall be $20,000,000.

OST Form 6411

B.

FOREIGN AIR CARRIERS OPERATING SMALL AIRCRAFT
The aircraft covered by this policy are SMALL AIRCRAFT (i.e., with 60 or fewer passenger seats or with a maximum payload
capacity of 18,000 pounds or less). (Complete separate or combined coverage as appropriate):

Separate Coverages:
Policy No.

Type of Liability

__________________

Combined Bodily Injury (Excluding Passengers other
than cargo attendants) and Property Damage Liability

$300,000

$2,000,000

Passenger Bodily Injury

$300,000

$300,000 x 75% of
total number of
passenger seats
installed in aircraft

__________________

Minimum Limit
Each Occurrence

Combined Coverage: This combined coverage is a single limit of liability for each occurrence at least equal to the required
minimums stated above for bodily injury (excluding passengers), property damaged, and passenger bodily injury.
Policy No.__________________________________

Each person

Amount of Coverage_____________________U.S. Dollars

This policy covers CARGO operations only and excludes passenger liability insurance.

______________________________________________________________________________________________________________________________

C.

FOREIGN AIR CARRIERS OPERATING LARGE AIRCRAFT
The aircraft covered by this policy are LARGE AIRCRAFT (i.e., with more than 60 passenger seats or with a maximum payload
capacity of more than 18,000 pounds). (Complete separate or combined coverage as appropriate):

Separate Coverages:
Policy No.

Type of Liability

__________________

Combined Bodily Injury (Excluding Passengers other
than cargo attendants) and Property Damage Liability

$300,000

$20,000,000

Passenger Bodily Injury

$300,000

$300,000 x 75% of
total number of
passenger seats
installed in aircraft

__________________

Minimum Limit
Each Occurrence

Combined Coverage: This combined coverage is a single limit of liability for each occurrence at least equal to the required
minimums stated above for bodily injury (excluding passengers), property damaged, and passenger bodily injury.
Policy No.__________________________________

Each person

Amount of Coverage_____________________U.S. Dollars

This policy covers CARGO operations only and excludes passenger liability insurance.

______________________________________________________________________________________________________________________________

3.

The policy or policies listed in this certificate insure(s) (Check One):

Make and Model

FAA or Foreign Flag
Registration No.

Operations conducted with all aircraft operated by the insured

Operations conducted with the following types of aircraft:

Operations with the following aircraft: (Use additional page if necessary)
______________________________________________________________________________________________________________________________

4.

Each policy listed in this certificate meets or exceeds the requirements in 14 CFR Part 205.

_______________________________________________________________
(Name of Insurer)

___________________________________________________________
(Name of Broker, if applicable)

_______________________________________________________________
(Address)

___________________________________________________________
(Address)

_______________________________________________________________
(City, State, Zip Code)

___________________________________________________________
(City, State, Zip Code)

_______________________________________________________________
Contact (person who can verify the effectiveness of the coverage)

___________________________________________________________
(Officer or authorized representative)

________________________________/_______________________________
(Area Code, Phone Number)
(Area Code, Fax Number)

________________________________/__________________________
(Area Code, Phone Number)
(Area Code, Fax Number)

________________________________________________________________
(Signature, if applicable)

__________________________________________________________
(Signature)

____________________________________________
(Date)

___________________________________________
(Date)