• Log In
  • Register
  • Contact
  • Local, Regional & National Jobs

Loggers Broad Form

Make the Wise Choice (209) 223-1870 (m-f 9:00am to 4:30pm pst)

  • Home
  • About
    • Contact
  • General Liability
  • Loggers Broad Form
  • Loggers Equipment
  • Transportation
  • Workers Compensation
  • Join Associated Loggers

Loggers Broad Form Insurance



  • APPLICANT INFORMATION

  • LOGGERS THIRD PARTY PROPERTY DAMGAGE LIABILITY POLICY APPLICATION

    Note: At the end of this form there is an “upload” button which will allow you to upload .pdf files. Feel free to submit your current/expiring policy, loss runs and any hold harmless agreement you hold. If you need assistance in completing this form call 209 223-1870.
  • Contact Information








  • Applicants Information





































  • Coverage Required


  • DD slash MM slash YYYY

  • Payroll “estimates” for the next 12 months in the following

  • Logging Operations







  • Activities: Please check all that apply

    The total of all check boxes in this section should total 100%. If there is no activity please insert “0” (zero)


































  • Additional Insured



  • Underwriting continued

















  • Commercial General liability is required along with LBF.

    We can provide a quot on Logger Broad Form but note. The carrier will required proof of “General Liability” in order to issue / keep the Loggers Broad Form Policy.




  • You can either upload them here, fax, email or mail the hold harmless agreements. Our fax number is 209 223-3227, email to insurance@athenainsurance.com or Athena Insurance P.O. Box 390, Pine Grove CA 95665.
  • Drop files here or

    Accepted file types: jeg, pdf, Max. file size: 7 MB, Max. files: 9.

      Please use this area to upload such items such as loss runs, current/expiring policy and hold harmless agreement. Multiple file upload is allowed.








    APPLICANT INFORMATION

    LOGGERS THIRD PARTY PROPERTY DAMGAGE LIABILITY POLICY APPLICATION

    Note: At the end of this form there is an "upload" button which will allow you to upload .pdf files. Feel free to submit your current/expiring policy, loss runs and any hold harmless agreement you hold. If you need assistance in completing this form call 209 223-1870.
    Underwriters will rely upon each and every response given in this application and any supplemental application or questions in deciding whether or not to insure you. And if so, at what premium, terms and conditions. Underwriters regard every response to be material to their decisions. Failing to answer or answering any question below incorrectly could invalidate any policy of insurance written by underwriters for your business.

    Contact Information

    Email(Required)

    Applicants Information

    For example, the company name is xyz, inc. and the owner is name Steve Valencia. Steve Valencia would be the first named insured. Although there are other officers in a corporation only one can be named as first named insured and they alone are the only person to which all legal notices are directed.
    Physical address
    Mailing address

    Coverage Required

    DD slash MM slash YYYY

    Payroll "estimates" for the next 12 months in the following

    If none type none
    If none type none
    If none type none
    If none type none
    If none type none
    If none type none
    If none type none
    If none type none
    If none type none
    If none type none
    If none type none
    If none type none

    Logging Operations

    List all areas project to work in over the next twelve months
    Do you own the land upon which you or others are operating?
    If "NO", are all required permits in place with appropriate authorities?
    Is there a signed contract with the owner?
    For example do you require it be surveys and marked. Are foresters required to flag the boundaries and / or trees?

    Activities: Please check all that apply

    The total of all check boxes in this section should total 100%. If there is no activity please insert "0" (zero)
    1. Felling(Required)
    2. Tree Trimming(Required)
    3. Log Road Building(Required)
    4. Skidding(Required)
    5. Excavation(Required)
    6. Blasting/Use of Explosives(Required)
    7. Work in Residential Areas(Required)
    8. Slash Burning(Required)
    8b. Slash burning: Do you only burn at times or under conditions approved by proper state or federal authorities?
    9. Sawmill Operations (including portable)(Required)
    10. Woodworking(Required)
    11. Manufacturing(Required)
    12. Use of Aircraft, Helicopter or Watercraft(Required)
    13. Work for Utility Companies(Required)
    14. Work close to Power Lines(Required)
    15. Construction of Bridges, Tunnerls or Dams(Required)
    16. Other type of work(Required)

    Additional Insured

    Are any of the Additional Insured a Utility Company?

    Underwriting continued

    Do you subcontract any of your logging and ancillary work or operations to any third parties?(Required)
    Do all subcontractors provide evidence of insurance equal to or greater than your liability limtis?
    Are you named as "Additional Insured" on Subcontractors policies?
    Have you sustained any losses, insured or uninsured, which would have been covered under this form of insurance had you carried such policy?(Required)
    Have there been any fires or Claims for fires occurring in the last 10 years on the land while you were working on that land?(Required)
    Please provide details including date and location
    Have you ever had a liability insurance policy cancelled, declined, non-renewed or has any carrier posed any special terms?(Required)
    Do you have Commercial General Liability?

    Commercial General liability is required along with LBF.

    We can provide a quot on Logger Broad Form but note. The carrier will required proof of "General Liability" in order to issue / keep the Loggers Broad Form Policy.
    Do you require coverage for Oregon Fire Suppression Costs?(Required)
    Do you hold any hold harmless agreements?(Required)
    You can either upload them here, fax, email or mail the hold harmless agreements. Our fax number is 209 223-3227, email to insurance@athenainsurance.com or Athena Insurance P.O. Box 390, Pine Grove CA 95665.
    Drop files here or
    Accepted file types: jeg, pdf, Max. file size: 7 MB, Max. files: 9.
      Please use this area to upload such items such as loss runs, current/expiring policy and hold harmless agreement. Multiple file upload is allowed.
      Terms of Service

      Legal
      • Terms of Use
      • Privacy
      Contact
      • My Account
      • Contact
      Quote
      • General Liability
      • Loggers Equipment Insurance
      • Loggers Broad Form Insurance

      © LoggerBroadForm.com 2016-2023 all rights reserved | Broker/Agent Athena Insurance and Financial Services - California License 0588228 | In other States Broker/Agent license is Steve Valencia | National Producer Number 2709340