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CA Broker #025008
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Home
Forest & Timber
Timber & Logging Insurance Overview
Quote Loggers Broad Form Insurance
Wildland Firefighters
Quote Wildland Firefighter Insurance
Utility Line Clearance Insurance
Quote Utility Line Insurance
Inland Marine Timber & Loggers
Quote Inland Marine Timber & Loggers
Construction
Contractor Insurance
Commercial Auto
Tree Contractor Insurance
Utility Line Clearance Insurance
Quote Utility Line Insurance
Agriculture
Winery Insurance
Quote Winery Insurance
Other Businesses
Business Auto
CBD, HEMP & MORE
Transportation Insurance
Commercial Earthquake
Personal Insurance
Homeowner Insurance
Investor Policy 10 + homes
Vacation Rental Insurance
Vacant Home Insurance
Quote Vacant Home Insurance
About Us
About Us
Our Insurance Carriers
Contact
FAQ
Newsletter
News Letter Archive
Quote Utility Line Insurance
Athena Insurance and Financial Services
Quote Tree Contractor Insurance
Step
1
of
12
8%
What is your requested effective Date? ("need by date""
MM slash DD slash YYYY
CHECK THE BOXES BELOW TO SELECT THE TYPES OF INSURANCE YOU WOULD LIKE TO A OBTAIN QUOTE(S) ON.
Check those boxes for which you want a quote
General Liability
Loggers Broad Form
Commercial Auto
Tree Contractor GL
Inland Marine / Equipment
Pollution
Workers Compensation
Trucking / Log Hauling
Property / Buildings
Directors & Officers E & O
Directors & Officers E & O
CHECK OFF ALL ACTIVITIES YOU PERFORM DIRECTLY OR THAT YOU SUB-CONTRACT OUT TO OTHERS TO DO FOR YOU
Please check all operations/activity performed directly
Tree Falling
Tree Trimming
Mastication
Log hauling
Slash Burning
Residential Tree Work
100% Forest work
Work near Power lines
Work for Utility companies
Portable Sawmill Work
Sawmill (not portable)
Manufacturing
Log Road Building
Skidding
Blasting/Use of Esplosives
Wood Working
Use of Aircraft/Helicopter/Watercraft
Build Bridges, Tunnels or Dams
Other
NEXT, BASED UPON THE "ACTIVITIES" YOU SELECTED "ESTIMATE HOW MUCH 'PAYROLL' WILL BE PERFORMED IN EACH KIND OF WORK
We realize no one knows exactly but please provided some estimates. For the owner of the company use a figure of $33,600 regardless of how much you make. For example, one owner and one employee. Employee payroll 35,000. You would use total payroll of $68,600. Some rating bases will vary and your agent will explain to you which rating bases we use for your quote.
Tree Falling %
Tree Trimming %
Mastication %
Log Hauling %
Slash Burning %
Residential Tree Work %
100% on Forest Lands
Work Near Power Lines %
Work For Utility Companies %
Portable Sawmill Work %
Sawmill (not portable) %
Manufacturing %
Log Road Building %
Skidding %
Blasing / Use of Explosives %
Wood Working %
Aircraft/Helicopter/ Watercraft Use %
Construct Bridges, Tunnels or Dams %
Other %
You marked "other" for activities. Please describe the other kinds of work you perform
Are you all done with this section? If you need help call us we will go though this process with you. Call (209) 223-1870
Yes, I am good with my responses
I am not sure please call me when I am done
No, I am lost
Please call (209) 223-1870 and leave us your phone number and a good day & hours to call
Contact, Business and Entity Information
Name Person Completing this form
Person, not the business name
Legal Business Name
If no dba then individual name
Timber License /Vendor license (if none type "none"
Please provide your State/County license or vendor number
Federal Employer ID#
Are you a member of any other trade Associations or Organizations?
Associated Logger of California
The Louisiana Forestry Association
Other
Please provide the name
Primary Office Phone
Mobile / Cell Phone
Email
Enter Email
Confirm Email
Website
Business Entity Type
How is your business entity formed?
Please select from this list
Individual / Soleproprietorhip
Incorporated
Limited Liability Corporation / LLC
General Partnership
1. Name of Owners/Officers/Partners
First
Last
1. Title
1. % Ownership
2. Name of Owners/Officers/Partners
First
Last
2. Title
2. % Ownership
Tick the check box to add more
Add More Owners/Officers/Partners
Please add all additional Owners/Officers/Partners names, title and percent of ownership
Mail Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Are you currently insured or have you had insurance recently?
Yes
No
Narrative of your operations.
Please explain "other"
Financial and Experience Information
What is your standing with your past insurance carrier(s)
Please select
All premiums for past and current audits paid current
All audits paid but have not been audited for this expiring period
In collections from unpaid / disputed audit
Total Years experience
Have you or a subsidiary had a bankruptcy in the last five years?
Yes
No
Years of Experience
Years as business owner(s)
Based on the States in which you operate please select which States have buildings such as offices, storage yards, or warehousing
Alabama
Idaho
Michigan
New York
Tennessee
Alaska
Illinois
Minnesota
North Carolina
Texas
Arizona
Indiana
Mississippi
North Dakota
Utah
Arkansas
Iowa
Missouri
Ohio
Vermont
California
Kansas
Montana
Oklahoma
Virginia
Colorado
Kentucky
Nebraska
Oregon
Washington
Connecticut
Louisiana
Nevada
Pennsylvania
West Virginia
Delaware
Maine
New Hampshire
Rhode Island
Wisconsin
Florida
Maryland
New Jersey
South Carolina
Wyoming
Georgia
Massachusetts
New Mexico
South Dakota
Other
Hawaii
Buildings and other Structures
In the State of Alabama "check" all "types" of structures needing property insurance. Later in this application we will as about what types of coverage is needed, use and ownership/rental/lease questions.
Office(s)
Storage Yard(s)
Warehouse(s)
Building 1
Estimated Year of Construction
Building 1. Occupied or Vacant
Occupied
Vacant
Vacant since what date?
Name or reference for building 1
Bldg 1 squarefootage
Building 1 Occupancy Type
Please select
Own
Lease / rent
"If owned" - Built of Construction Material Type
Please select
Wood Frame
Steel Frame
Manonry
Combination Steel, wood, masonry
What is the physical address of Building 1 in Alabama?
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
"If over 14 years old" Building Updates & Construction
Approximate Age of Roof and type of material
Please state year of updates to electrical 'if any"
Please state year of plumbing "if any"
Please state year of heating updates "if any"
Please select the liability limits required by your operations
Limits of base policy for Loggers broad form (and general liability if quote for gl requested)
$1,000,000 per occurrence / $1,000,000 aggregate
$1,000,000 per occurrence / $2,000,000 aggregate
$2,000,000 per occurrence / $2,000,000 aggregate
Excess Umbrella with higher limits
Please input the desired Excess Liability Limits
Logger Broad Form
Payroll Estimates for the Next 12 months
Of our total payroll including owner provide "estimates" in $dollars$. (NOTE: For the owner use a standard of $33,600. for example 50% logging adn 50% road building divide the owner payroll of $33,600 between the two categories) For employees payroll use actual payroll estimates.
Logging on "your land"
Logging (performed by owner on others land)
Logging by employees
Log Road Building
Subcontract Logging
Subcontract Logging "Hauling"
Truck Driver Payroll
Other Payroll
What percentage of time are Owners/Officers/Partners active at job site?
Logging Operations
Areas of operations (States, Counties, Towns or Regions)
Do you own the land upon which you or others are operating?
Yes
No
Your response was "No"... Are all required permits in place with appropriate authorites?
Yes
No
Is there a signed contractor with the owners?
Yes
No
What precautions do you take to prevent trespassing onto other land?
What "methods" do you use to determine and identify trees for cutting?
Inland Marine for tools and equipment coverage
List all heavy equipment. Include year, make, model and estimated current value
General Liability
Limits of Liability
Please select
$1,000,000/$1,000,000
$1,000,000/$2,000,000
$2,000,000/$2,000,000
$3,000,000/$3,000,000
Workers Compensation
Name of current insurance carrier for workers compensation
Commercial Auto / Transportation
Name of current commercial auto carrier
Driver Informaion
Driver name
Vehicles & Trailers
Year, Make and model
Thank you. Please note coverage is not bound
I understand this is just a quote
I need coverage now!