Logging & Lumbering Supplemental Application
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1*Please visit
or contact your
current All Risks, Ltd. producer to submit applications.
Logging & Lumbering Supplemental Application
(Complete in addition to ACORD)
1. Name of Applicant: ___________________________________________________________________________________
2. Are you licensed for Logging & Lumbering in the states you work in?
Yes
No
License number(s): ___________________________________________________________________________________
3. Number of employees (other than owners)? ___________________
Number of owners: _________________________
4. Payroll of employees (other than owners) $ ___________________
5. Do you use subcontractors?
Yes
No
Describe work: ______________________________________________________________________________________
___________________________________________________________________________________________________
6. Do you belong to any trade associations such as AF&PA, SAF, or TOC?
Yes
No
If yes, which? ________________________________________________________________________________
7. Do you have any saw or planning mill operations?
Yes
No
8. Do you own land where harvesting operations are being conducted?
Yes
No
Are you hired by a landowner, land developer, or general contractor?
Yes
No
If yes, please specify: __________________________________________________________________________
9. Do you own any forestland?
Yes
No
If yes, how many acres: ___________________
10. Do you conduct skyline yarding operations to use helicopters to conduct logging operations?
Yes
No
11. Are fire extinguishers easily accessible on all mobile equipment?
Yes
No
12. What agreements have been entered into concerning the condition of the land once the logging
operations are completed?
Yes
No
13. Have you posted warning signs along access roads and worksite perimeters to keep the public from trespassing in areas
where timber harvesting is taking place?
Yes
No
14. Do you permit drivers of non-owned vehicles to assist with loading operations?
Yes
No
(This practice should be prohibited.)
15. Do you use explosives?
Yes
No
16. Are visitors and workers prohibited from smoking while at the worksite?
Yes
No
17. Do you sell forest products (e.g., timber, shredded bark, firewood, etc.) that may have been contaminated with chemicals
(e.g., herbicides, pesticides, or insecticides)?
Yes
No
If yes, please describe: _________________________________________________________________________
18. Do you operate as a forestry service? (cruising, providing timber, firefighting, forest management plans
and reforestation).
Yes
No
If yes, please describe: _________________________________________________________________________
19. Do you own or operate a crane?
Yes
No
Size of boom and jib: ___________________________________________________________________________
Applicant’s Signature: ________________________________________________
Date: ______________________
Title: _________________________________________
Producing Agent: __________________________________
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Logging & Lumbering Supplemental Application – 01.17
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