SPECIALTY PROPERTY- LOGGING APPLICATION Applicant’s Name (Legal and Operating): Broker: Policy Period: to (12:01 AM) Applicant’s Address: Location of Insured’s Property: Principal Name: How Long in Business: Loss and Policy History Previous claims in the past 5 years? Yes, No Describe: Previous Insurer: Policy #: Has any insurer cancelled, declined or refused to renew Commercial Insurance in the past 5 years? Yes, No Supporting Business: Policy #: Company: Mortgagee Name: Address: Schedule Model Body List Price Item # Trade Name Model Serial # P. Price Year Type New Coverages Coverages Cont Equip- (Ded 5%) Item # Co. Ins % Amount Ins. Rate Premium LLDS-1128 Min $2500 Perils Yes Yes No. Co. Yes Yes No. Co. Yes Yes No. Co. Yes Yes No. Co. Please describe operations: Equipment must be protected by at least one 20 lb ABC fire extinguisher. Policy will be subject to warranty. Where will applicant be operating the above described equipment (specific location)? Address: How long has the applicant been in the logging/lumbering business? Where is equipment stored when not in use? Will applicants’ equipment be rented or leased? Rented Leased How often is equipment serviced & by whom? Please confirm amount of lien on each piece of equipment. Operators (Name and Experience): M.R.P: $ Total Premium: $
SPECIALTY PROPERTY- LOGGING APPLICATION Applicant’s Name (Legal and Operating): Broker: Policy Period: to (12:01 AM) Applicant’s Address: Location of Insured’s Property: Principal Name: How Long in Business: Loss and Policy History Previous claims in the past 5 years? Yes, No Describe: Previous Insurer: Policy #: Has any insurer cancelled, declined or refused to renew Commercial Insurance in the past 5 years? Yes, No Supporting Business: Policy #: Company: Mortgagee Name: Address: Schedule Item # Model Year Trade Name Model Body Type Serial # List Price New P. Price Coverages Item # Coverages Cont Equip- LLDS-1128 Perils (Ded 5%) Min $2500 Co. Ins % Amount Ins. Rate Premium Yes Yes No. Co. Yes Yes No. Co. Yes Yes No. Co. Yes Yes No. Co. Please describe operations: Equipment must be protected by at least one 20 lb ABC fire extinguisher. Policy will be subject to warranty. Where will applicant be operating the above described equipment (specific location)? Address: How long has the applicant been in the logging/lumbering business? Where is equipment stored when not in use? Will applicants’ equipment be rented or leased? Rented Leased How often is equipment serviced & by whom? Please confirm amount of lien on each piece of equipment. Operators (Name and Experience): M.R.P: $ Total Premium: $