Vehicle/Insurance Update Form for Access Credential Holders

Vehicle & Insurance Update Form for Access Credential Holders

Please kindly take this opportunity to update your vehicle(s) information and vehicle insurance since you were originally credentialled. This information is required to maintain access control privileges with Chicago Executive Airport. Please have your current vehicle insurance certificate available prior to starting this form.
Credential Type*

Permitted Tenant/Aircraft Partner/Authorized PilotFlight School/Club ClientAirport Based Employee
Full Name (if you do not have a middle name, type NMN in the appropriate field)*

First NameMiddle NameLast NameSuffix
Hangar or Tiedown Spot # as assigned (for Permitted Tenants)*
Select Your Employer*
Select Your Flight School/Club*

Vehicle and Insurance Information
List ALL of your personal vehicle(s) that may be parked within the Airport property.*
Please upload copy of you current/unexpired vehicle insurance certificate*

Valid vehicle insurance is a required to park within the airport perimeter per the Rules & Regulations of Chicago Executive Airport.
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Safety Video & Acknowledgements Review

Safety is everyone's responsibility. To ensure we are all utilizing the access gates correctly, please carefully watch the Youtube safety video and re-review the below safety rules regarding gate access procedures at Chicago Executive Airport. Please email Ops@chiexec.com if you have any specific questions.
I understand that Chicago Executive Airport access credentials must be kept in my personal possession for the safety of the Airport. I acknowledge full responsibility for damages that may result from the improper use of the access credentials. I also may not loan my access credentials to any other person or knowingly permit the use there of by another.*
Initial if you accept/agree
I understand that Aircraft always have the right of way over personnel and vehicles. I will use caution around aircraft as the engines may be started at any time.*
Initial if you accept/agree
I understand that failure to not wait for a gate to close whether entering or exiting the Airport may result in fines, revocation of access privileges', and/or revocation of any movement area privileges (if applicable) without notice or warning.*
Initial if you accept/agree
I understand that allowing anyone to tailgate or piggyback me through the gate may result in fines, loss of access privileges, and/or revocation of movement area privileges (if applicable), without prior notice or warning.*
Initial if you accept/agree
I agree to comply with the Chicago Executive Airport Rules & Regulations in which can be found at https://www.chiexec.com/documents/.*
Initial if you accept/agree
I understand that I am responsible for immediately notifying Chicago Executive Airport Operations to ops@chiexec.com when the access credential is no longer required and/or will no longer be used.*
Initial if you accept/agree
I understand that my access credential is valid for two (2) calendar years and may be subject to renewal fees. I also am responsible for application of renewal.*
Initial if you accept/agree
I understand that Chicago Executive Airport may tow, remove, or cause to be removed from the Airport if my vehicle is disabled, abandoned, creates a safety risk, and/or parked in violation of the Rules and Regulations at the vehicle operator’s risk and expense and without liability for damage that may result from such removal.*
Initial if you accept/agree
I understand that my vehicles shall not be parked or stopped in such a manner to obstruct an Airport access gate, taxiway, taxilane, and/or obstruct access to hangars, parked aircraft, and/or parked vehicles. Vehicles must be parking in designated parking areas per the access control map.*
Initial if you accept/agree
I understand that these access credentials is NOT an authorization to operate a vehicle on the Aircraft Movement Area. I understand that if I am to operate a vehicle on the Aircraft Movement Area requires explicit permission, training, testing, and certification administered by PWK Airport Operations. *
Initial if you accept/agree
I understand that Chicago Executive Airport reserves the right to deny my application and and/or revoke my access credentials at any time.*
Initial if you accept/agree
Access Control Map Review
Please read and review the below document in its entirety.
*

Signature
Signature to acknowledge this application, the safety rules regarding gate access procedures, and the Rules & Regulations of Chicago Executive Airport *

Clear
Print Full Name*
Date*

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Date
Please verify that you are human*
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Vehicle & Insurance Update Form for Access Credential Holders

Vehicle and Insurance Information

Safety Video & Acknowledgements Review

Access Control Map Review

Signature