Quote Utility Line Insurance |

Step 1 of 12

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

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

0 of 60 max characters

Legal Business Name

If no dba then individual name

0 of 90 max characters

Timber License /Vendor license (if none type "none"

Please provide your State/County license or vendor number

0 of 15 max characters

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

Enter Email Confirm Email

Website

Business Entity Type

How is your business entity formed?

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

0 of 700 max characters

Mail Address

Street Address Address Line 2 City State ZIP Code

Are you currently insured or have you had insurance recently?

Yes

Narrative of your operations.

0 of 10000 max characters

Please explain "other"

Financial and Experience Information

What is your standing with your past insurance carrier(s)

Total Years experience

Have you or a subsidiary had a bankruptcy in the last five years?

Yes

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

"If owned" - Built of Construction Material Type

What is the physical address of Building 1 in Alabama?

Street Address Address Line 2 City State 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

0 of 20 max characters

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)

0 of 1000 max characters

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

Yes

Your response was "No"... Are all required permits in place with appropriate authorites?

Yes

Is there a signed contractor with the owners?

Yes

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

0 of 5000 max characters

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

0 of 5000 max characters

Inland Marine for tools and equipment coverage

List all heavy equipment. Include year, make, model and estimated current value

General Liability

Limits of Liability

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!

Quote Utility Line Insurance

Quote Tree Contractor Insurance

CHECK THE BOXES BELOW TO SELECT THE TYPES OF INSURANCE YOU WOULD LIKE TO A OBTAIN QUOTE(S) ON.

CHECK OFF ALL ACTIVITIES YOU PERFORM DIRECTLY OR THAT YOU SUB-CONTRACT OUT TO OTHERS TO DO FOR YOU

NEXT, BASED UPON THE "ACTIVITIES" YOU SELECTED "ESTIMATE HOW MUCH 'PAYROLL' WILL BE PERFORMED IN EACH KIND OF WORK

Please call (209) 223-1870 and leave us your phone number and a good day & hours to call

Contact, Business and Entity Information

Financial and Experience Information

Years of Experience

Buildings and other Structures

Building 1

"If over 14 years old" Building Updates & Construction

Please select the liability limits required by your operations

Logger Broad Form

Payroll Estimates for the Next 12 months

Logging Operations

Inland Marine for tools and equipment coverage

General Liability

Workers Compensation

Commercial Auto / Transportation

Driver Informaion

Vehicles & Trailers

Terms & Legal

Primary Target Markets

Where We Advertise