Professional Forester's General Liability Application
click here to download a PDF application that can be mailed or faxed.
If you have any questions, problems, or concerns
please contact Outdoor Underwriters at 1-866-961-4101.
Company Information |
|||
| Name of Company* | Email Address* | ||
| Representative* | Main Number* | ||
| Mailing Address* | Mobile | ||
| Fax | |||
| City* | |||
| State* | How did you find us?* | ||
| Zip* | Please describe | ||
| Location Address | |||
| Business Form* | |||
| Desired Effective Date* | |||
Commercial General Liability (Occurrence Form)
Deductible $500.00 Property Damage & Bodily Injury per claim
| General Aggregate | $ |
| Products & Completed Operations Aggregate | $ |
| Personal & Advertising Injury | $ |
| Each Occurrence | $ |
| Damage to Rented Premises (each occurrence) | $ |
| Medical Expense (any one person) | $ |
| Foresters Special Liability | $ |
| Insurance Carrier | Limits of Liability | Premium | |
| Last Year | |||
| Two Years Ago | |||
| Three Years Ago | |||
|
Describe any past losses Please include as much detail as possible including dates, descriptions of incidents, reserves, and amounts. |
|||
| Name | Complete Address | ||
| Interest |
| Number of Forestry Employees* | Total Forestry Payroll* | $ | |
| Number of Executive Officers* | Total Executive Officer Payroll* | $ | |
| Sub-Contractors Cost | $ | ||
| What activities are subs used for? | |||
| What percentage of your business is control burn?* |
|||
- All brochures describing any and all services; or website address above.
- Three years hard copy Loss Runs, if unavailable, provide a no loss letter signed by insured.
You can upload your documents below or email them to support@outdoorund.com or fax them to 803-451-5695.
| Is Applicant a Graduate, Registered Forester? | |
| Give a brief description of applicant’s activities and Operations |
| Does the applicant: | |||
| Use subcontractors? | * | ||
| Work in populated or urban areas? | * | ||
| Lease any premises? | * | ||
| Operate business on a part-time basis? | * | ||
| Draw plans, designs or specifications other than forest management? | * | ||
| Use explosives? | * | ||
| Own, operate, or lease aircraft or watercraft? | * | ||
| Use/distribute/mix/apply pesticides or herbicides? | * | ||
| Lease equipment to others? | * | ||
| Employ seasonal or migrant labor? | * | ||
| Perform work underground? | * | ||
| Perform tunneling/excavation/earth moving work? | * | ||
| Perform or subcontract logging operations? | * | ||
| Perform control burns? | * | ||
| Maintain Certificates of Insurance on all subcontractors? | * | ||
| Employ only salaried employees? | * | ||
| Have formal maintenance and safety programs in effect? | * | ||
| Comply with all applicable OSHA standards? | * | ||
| Are you a member of Association of Consulting Foresters (ACF) or Society of American Foresters (SAF)? If so which one: |
| Any other information carrier needs to be aware of? |
Payments are accepted over the phone via Visa, MasterCard, or by Check/Money Order in the mail.
