Recreational Lease 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.
Landowner Information |
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| Name of Landowner* | Email Address* | ||
| Representative* | Main Number* | ||
| Mailing Address* | Mobile | ||
| Fax | |||
| City* | |||
| State* | How did you find us?* | ||
| Zip* | Please describe | ||
Club Information |
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| Club Name* | Email Address* | ||
| Representative* | Main Number* | ||
| Mailing Address* | Fax | ||
| City* | |||
| State* | |||
| Zip* | |||
| Desired Effective Date* | |||
| Number of Members* | |||
| Commercial Operation or Club Lease?* | |||
| County & State of Acres | |||
| Number of Acres* | |||
| What activities are performed on the property?* |
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| Present Carrier | |||
| Expiration Date | |||
| Losses in the Past Five Years | |||
| Approximate Number of Trails* | |
| Average Length of Trails* |
| Are trails maintained by club? | * | ||
| Are trails maintained by landowner? | * | ||
| Are ATV's leased or rented? | * | ||
| Are locations fenced or posted? | * | ||
| Any leased hunting or commercial hunting? | * | ||
| Are certificates of insurance required for any leased or commercial hunting? |
* | ||
| Any watercraft or docks? | * | ||
| Any buildings? | * | ||
| Any lakes or ponds? | * | ||
| Any dams, spillways, or bridges? | * | ||
| Any property used for mining? | * | ||
| Any property containing gas or oil wells? | * | ||
| Any of the property leased for farming? | * |
Attach or mail a copy of Hold Harmless agreement with club member signatures and listing of all club members.*
Payments are accepted over the phone via Visa, MasterCard, or by Check/Money Order in the mail.
