INSURANCE APPLICATION: FOR HUNTING CLUBS ONLYfloridaforest.org/.../Outdoor...brochure-2016.pdf ·...
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Hunt Club Name Contact Name Email Phone Address City State Zip Signature of club representative Hunting Lease Liability provides protection for occurrences arising out of activities and operations of the hunt club and its members, guests or invitees on acreage leased to the hunting club by the timberland owner. Please answer the following questions. Comprehensive General Liability Limit of Liability: $1,000,000 each occurrence $2,000,000 aggregate Deductible: $0 per occurrence Master policy basis. Coverage does not apply to commercial hunting operations including for profit guided or fee hunting. Landowner Name Email Phone Mobile Address City State Zip Number of Acres Property Location (County, City and State) Leasing from more than one landowner? Please attach a separate sheet with the above information for each landowner . (This is for one landowner leasing all of his/her property to one club.) (Includes Fire Damage Liability on Hunting Lease Insurance) (This line is subject to a minimum premium of $200) Yes/No Are locations fenced or posted? Any leased hunting or commercial hunting? If yes, are Certificates of Insurance required? Any active mining on the property? If yes, are Certificates of Insurance required? Any watercraft or docks? Any buildings? Any lakes or ponds? Any dams/spillways/bridges? Any of the property leased for farming? If yes, are Certificates of Insurance required? TIMBERLAND LIABILITY INSURANCE HUNTING LEASE LIABILITY INSURANCE INSURANCE APPLICATION: FOR LANDOWNERS ONLY INSURANCE APPLICATION: FOR HUNTING CLUBS ONLY Please answer the following questions. What is the property used for? Signature of Landowner Premium Calculation - Timberland Liability Insurance - ONLY Number of acres to be covered x $.31 per acre = Total amount due for timberland liability insurance Total Due: (This line is subject to a minimum premium of $175) Premium Calculation - Hunting Lease Liability Insurance - ONLY Number of acres to be covered x $.19 per acre = Number of additional insured (Landowners x $26 each) = Total amount due for hunting lease liability insurance Total Due: (This line is subject to a minimum premium of $150) Premium Calculation - COMBINED Timberland Liability and Hunting Lease Liability Insurance Number of acres to be covered x $.45 cents per acre = Number additional insured (Landowners x $26 each) = Total Payment Due: FFA P.O. Box 1696 Tallahassee, FL 32302 includes Fire Damage Liability Total amount due for combined hunt lease liability and timberland insurance MAIL ALL CHECKS AND FORMS TO: Please Specify Effective Dates: June 1 to June 1 October 1 to October 1 Easy Online Applications & Payments www.ffa.outdoorund.com Named Insured: FFA Hunting Club that is a member of the Florida Forestry Association. Separate certificate will be issued to each hunting club. PLEASE READ! ALL POLICY TYPES MUST FILL THIS PORTION OUT ATTENTION:: ARE YOU PURCHASING A COMBO POLICY? PLEASE USE THE CALCULATION BELOW Please Note: If you wish to purchase the Combined Timberland & Hunting Lease Liability Insurance, you must fill out the Hunting Lease Liability application and the Timberland Liability application and then use the COMBINED formula for your calculations. Timberland Liability Coverage provides legal liability coverage for timberland owners. This coverage is designed to provide General Liability protection for owners of timberland. Comprehensive General Liability Limit of Liability: $1,000,000 each occurrence $2,000,000 aggregate Deductible: $250 per occurrence Landowner Name Email Phone Mobile Address City State Zip Number of Acres Timberland Location (County, City and State) Named Insured: FFA Timberland Owner who is a member of the Florida Forestry Association. Yes/No Yes/No Owners, Landlord & Tenant - Liability limited to $1,000,0000 per occurence Special master policy rating basis. Liability coverage for landowner does not provide protection for owned timber. (Separate coverage is available for fire, lightning, wind, flood & ice.) Coverage is subject to approval by Outdoor Underwriters, Inc. Applications received will be effective upon approval and expired according to policy terms.
Transcript of INSURANCE APPLICATION: FOR HUNTING CLUBS ONLYfloridaforest.org/.../Outdoor...brochure-2016.pdf ·...
Hunt Club Name
Contact Name Email Phone
Address City State Zip
Signature of club representative
Hunting Lease Liability provides protection for occurrences arising out of activities and operations of the hunt club and its members, guests or invitees on acreage leased to the hunting club by the timberland owner.
Please answer the following questions.
Comprehensive General LiabilityLimit of Liability: $1,000,000 each occurrence
$2,000,000 aggregateDeductible: $0 per occurrence
Master policy basis.Coverage does not apply to commercial hunting operations including for profitguided or fee hunting.
Landowner Name
Email Phone Mobile
Address City State Zip
Number of Acres Property Location (County, City and State)
Leasing from more than one landowner? Please attach a separate sheet with the above information for each landowner.
(This is for one landowner leasing all of his/her property to one club.)
(Includes Fire Damage Liability on Hunting Lease Insurance)(This line is subject to a minimum premium of $200)
Outdoor Underwriters Inc.140 Stoneridge Dr., Ste. 265
Columbia, SC 29210
MAIL ALL CHECKS AND FORMS TO:
Please Specify Effective Dates:July 1, 2012 to July 1 October 1, 2012 to October
Easy Online Applications & Paymentswww.tfa.outdoorund.com
Yes/No
PLEASE READ!ALL POLICY TYPES MUST FILL THIS PORTION OUT
Are locations fenced or posted? Any leased hunting or commercial hunting?If yes, are Certificates of Insurance required?Any active mining on the property?If yes, are Certificates of Insurance required?
Any watercraft or docks?Any buildings? Any lakes or ponds?Any dams/spillways/bridges?
Any of the property leased for farming?If yes, are Certificates of Insurance required?
TIMBERLAND LIABILITY INSURANCEHUNTING LEASE LIABILITY INSURANCEINSURANCE APPLICATION: FOR LANDOWNERS ONLYINSURANCE APPLICATION: FOR HUNTING CLUBS ONLY
Please answer the following questions.
What is the property used for?Signature of Landowner
Premium Calculation - Timberland Liability Insurance - ONLY
Number of acres to be covered x $.31 per acre =Total amount due for timberland liability insurance Total Due:
(This line is subject to a minimum premium of $175)
Premium Calculation - Hunting Lease Liability Insurance - ONLY
Number of acres to be covered x $.19 per acre =
Number of additional insured (Landowners x $26 each) =Total amount due for hunting lease liability insurance Total Due:
(This line is subject to a minimum premium of $150)
Premium Calculation - COMBINED Timberland Liability and Hunting Lease Liability Insurance
Number of acres to be covered x $.45 cents per acre =
Number additional insured (Landowners x $26 each) =
Total Payment Due:
FFAP.O. Box 1696
Tallahassee, FL 32302
includes Fire Damage Liability
Total amount due for combined hunt lease liability and timberland insurance
MAIL ALL CHECKS AND FORMS TO:
Please Specify Effective Dates:June 1 to June 1 October 1 to October 1
Easy Online Applications & Paymentswww.ffa.outdoorund.com
Named Insured: FFAHunting Club that is a member of the Florida
Forestry Association.Separate certi�cate will be issued to each hunting club.
PLEASE READ!ALL POLICY TYPES MUST FILL THIS PORTION OUT
ATTENTION:: ARE YOU PURCHASING A COMBO POLICY? PLEASE USE THE CALCULATION BELOW
Please Note:If you wish to purchase the Combined Timberland & Hunting Lease Liability Insurance, you must fill out the Hunting Lease Liability application and the Timberland Liability application and then use the COMBINED formula for your calculations.
Timberland Liability Coverage provides legal liability coverage for timberland owners. This coverage is designed to provide General Liability protection for owners of timberland.
Comprehensive General LiabilityLimit of Liability: $1,000,000 each occurrence
$2,000,000 aggregateDeductible: $250 per occurrence
Landowner Name
Email Phone Mobile
Address City State Zip
Number of Acres Timberland Location (County, City and State)
Named Insured: FFATimberland Owner who is a
member of the FloridaForestry Association.
Yes/No Yes/No
Owners, Landlord & Tenant - Liability limited to $1,000,0000 per occurenceSpecial master policy rating basis.Liability coverage for landowner does not provide protection for owned timber. (Separate coverage is available for fire, lightning, wind, flood & ice.)
Coverage is subject to approval by Outdoor Underwriters, Inc. Applications received will be effective upon approval and expired according to policy terms.
IMPORTANT NOTICE
All questions relating to insurance coverage should be directed to Outdoor Underwriters, Inc. at (866) 961-4101.
Questions concerning FFA membership status should be directed to FFA at (850) 222-5646.
Discounted liability insurance rates apply only to Florida Forestry Association members in good standing with the appropriate Hunting Club orTimberland Owner membership.
Separate checks must be written to FFA and Outdoor Underwriters, Inc.
Check #1: The insurance premium must be made payable to Outdoor Underwriters, Inc. (refer to rates). Check #2: FFA dues must be made payable to Florida Forestry Association.
(refer to dues schedule on back panel).
The FFA Hunting Lease Liability & Timberland Liability Program is underwritten through OutdoorUnderwriters, Inc.
Questions? Call today: (866) 961-4101 FLORIDA FORESTRY ASSOCIATION
P.O. Box 1696 Tallahassee, FL 32302
Join the Florida Forestry Association!Members of the Florida Forestry Associationare eligible to take advantage of discounted
insurance programs.
up to 500 500 - 1,000
1,000 - 5,000 5,000 - 10,000
more than 10,000
$87$197$493$929$395 + $.079/acre on total acreage
Landowner Membership dues(based on acreage) are:
Hunting Club Membership dues(based on acreage) are:
up to 3,000 over 3,000
$66$191
The Florida Forestry Association (FFA) is a statewide membership organization representing all aspects of the forest industry. Our mission is to promote the reponsible and sustainable use of Florida’s forest resources.
FFA advocates to foster positive regulatory, economic, and social climates and to protect our members’ ability to grow, harvest and use forest resources.
COMBINED PAYMENTS ON ONE CHECK WILL BE RETURNED.
