General Liability | Loggers Broad Form

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You have the option to choose just General liability, Just Loggers Broad Form or the two policies GL and LBF.

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Company Information

Desired effective date

Company Name*

Timber license / Contractor License

Company Type

Please Explain Other entity type

First Named Insured's Name (First and Last name)

Is the First Named insured completing this form?

Yes, the First Named Insured is completing this form

No, someone on behalf of the first named insured

First and last name of person completing this for on behalf of the first named insured

Phone*

Email*

Enter Email Confirm Email

Website

Mailing Address

Street Address City State ZIP Code

Is the "mail" address that same as the physical location?

Yes

No

Physical Location

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have more than one physical location? (This includes locations rented, leased or owned)

Yes

No

Please list all locations

Number of Employees

Number of years in business

Limits of Liability

$500,000/$1,000,000

$1,000,000/$1,000,000

$1,000,000/2,000,000

$2,000,000,$2,000,000

Please select a deductible

Do you require higher limits that those above? If yes, please describe

Yes

No

Whats excess limits do you require?

If any, how many additional insureds will you have during the course of the year?

List Areas of Operation (States, Counties, Towns or Regions

Loggers Broad Form Section

Do you own the land upon which you or others are operating?

Yes

N0

You answered no. Are all required permits in place with appropriate authorities?

Yes

No

Is there a signed contract with the owner?

Yes

No

Please provide a description of your Logging Operations

What precautions do you take to prevent trespassing onto others land?

What methods to you use to determine boundaries and identify trees for cutting?

Activity / Operations you much check all that apply. Working in a class of activity that is "not" disclosed will cause coverage issues. Declare any work performed.

Untitled

First Choice

Second Choice

Third Choice

Payroll %

General Liability Section

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