(1) You (are) (are not) (strike phrase not applicable) insured under a policy or policies of insurance provided by the undersigned and providing liability coverage to renters of aircraft. If coverage is provided, it is in the following amount or amounts: $________________________.

(a) The above insurance is subject to a deductible amount of $____________________.

(2) You (are) (are not) (strike phrase not applicable) insured for hull damage to the aircraft. If hull insurance is provided, it is in the amount of $________________.

(a) The above insurance is subject to a deductible amount of $________________.

(3) Although insurance may be provided for liability and/or hull coverage, the undersigned's insurance carrier has full rights to subrogate against you for any payments it may be required to make on account of any damage or loss arising out of your operation of the aircraft. It is suggested that you carry insurance to protect you to partially or fully cover this possibility. _____________________________

(Day)

(Year) 2. The notice delivered pursuant to subdivision one of this section shall constitute a material part of any rental agreement, and each renter shall give written acknowledgement of receipt of such notice. 3. Delivery of the above notice to a renter shall cover all future rentals, unless the insurance coverage set forth in the original notice has been reduced or eliminated. 4. Copies of the notices provided for in subdivision one of this section shall be maintained by the owner for a period of three years from the last date that the renter has rented an aircraft from such owner. 5. Whoever fails to deliver the notice in accordance with the provisions of subdivision one of this section shall be fined not less than one hundred dollars nor more than five hundred dollars for a first offense, and not less than five hundred dollars nor more than one thousand dollars for a second or subsequent offense.