Quote Loggers Broad Form Liability Insurance

Please check all the boxes that apply to your operations now or that will apply to you operations over the next 12 months.
This form is a fact finder. Please help us to determine which of our insurance markets are the best fit for your business. Thank you.
- 1. Logging or Tree removal in Residential areas where the employee and /or owner “payroll is over 20%”

Loggers General Liability or Loggers Broad Form

If you need a consultation please call 209 223-1870. All Loggers Broad Form Insurance requires General Liability also. So, if you need for example “Loggers Broad Form” coverage and DO NOT currently have general liability please check “Both”
Need by Date (please allow at least 5 days leeway at a minimum)*

MM slash DD slash YYYY

Many quotes can be provided within 5 working days. Loss runs are required if you have prior insurance. (5 years if possible)
Choose the type of quote(s) you require*
- Both Loggers Broad Form and General Liability
- General Liability Only
- Loggers Broad Form Only
- Both Loggers Broad Form, General Liability and more
- Workers Compensaton
- Trucking / Transportation
- Inland Marine / Equipment
Please explain "other"

LOGGERS THIRD PARTY PROPERTY DAMAGE QUESTIONNAIRE

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
Name of person completing this form*
Phone*
Cell Phone
Email*

Enter Email

Confirm Email
Applicants Information
Name of Company*
Entity type*
Name of owner or first named insured if different from company name*
LTO license number / Timber License
Contractor's License Number
Physical address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Is the physical address the same as the "mail address?"*
Mailing address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Number of employees*
Number of years in business*
Briefly describe your experience*
Coverage Required
Limits*
Deductible*
Payroll "estimates" for the next 12 months in the following
1. Logging on your lands
1. Payroll
2. Logging by owner
2. Payroll
3. Logging by employees
3. Payroll
4. Log Road Building
4. Payroll
5. Subcontract Logging
5. Payroll
6. Subcontract Log Hauling
6. Payroll
7. Truck Drivers
7. Payroll
8. Other describe
8. Payroll
Please provide percentage Owner/Officers/Partners are active at job site

Logging Operations
List areas of operation: (States, Counties, Towns & Regions)
Do you own the land upon which you or others are operating?*
- Yes
- No
If "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 do you use to determine boundaries and identify trees for cutting?*

Commercial General liability is required along with LBF.

We can provide a quote on Logger Broad Form but note. The carrier will required proof of “General Liability” in order to issue / keep the Loggers Broad Form Policy.
What are the General Liability current limits?
What is the name of your current insurance carrier?
What is the current policy term? (start date & expiration date)
Do you require coverage for Oregon Fire Suppression Costs?*
- Yes
- No
Do you hold any hold harmless agreements?*
- Yes
- No
Please explain the circumstances and provide copies.

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.
File Upload of existing documents
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
- I agree to the Terms of Service

WHAT YOU SHOULD BE AWARE OF

As part of our insurance service process the first step is gathering information about your operations and insurance history.

We have several Insurance Companies and each has some similarities and some have varying differences in their underwriting and market appetitie. Their appetite will vary from Insurance Carrier to Insurance Carrier and from State to State.

In General here is our Agency determines which market(s) would be “a fit” for your business.

Claims History
Slash Burning
Portable Sawmills
Work near Utility lines
Fighting of Wildfires
Amount of work in Residential Areas
Other operations that are not logging
Naming Utility Companies as an Additional Insured.

Loggers General Liability or Loggers Broad Form

LOGGERS THIRD PARTY PROPERTY DAMAGE QUESTIONNAIRE

Contact Information

Applicants Information

Coverage Required

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

Logging Operations

Activities: Please check all that apply

Additional Insured

Underwriting continued

Commercial General liability is required along with LBF.