Commercial General Liability Application For Logging Contractors
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Commercial General Liability Application For Logging Contractors
Applicant is:
Individual
Partnership
Corporation
Joint Venture
Other (Specify)
1. a) Name of Applicant: _____________________________________________________________________
b) Name of Principal(s): ____________________________________________________________________
c) Subsidiaries, Partners and Joint Ventures: ____________________________________________________
2. Postal Address: ___________________________________________________________________________
3. a) Number of years in operation: _______________
b) Number of years experience: ________________
4. a) Description of Insured’s operation: _________________________________________________________
b) Do you anticipate entering other operations during the term?
Yes
No
If yes, please explain: ______________________________________________________________________
5. a) Estimated annual receipts: ________________________________________________________________
b) Estimated annual payroll: ________________________________________________________________
c) Number of employees: __________________________________________________________________
d) Are all employees covered by Worker’s Compensation?
Yes
No
If no, please give details/split between different types of occupation/number of employees/payroll
________________________________________________________________________________________
6. a) Describe any sublet work (independent contractors) and give cost (Attach a list if necessary):
________________________________________________________________________________________
b) Are sub-contractors required to carry liability insurance?
Yes
No
c) Are sub-contractors required to submit liability certificates?
Yes
No
d) Is a formal contractual agreement entered into with sub-contractors?
Yes
No
If the answer is yes, is a hold harmless in your favour?
Yes
No
Attach a copy of the usual contract form, if possible.
7. a) Give details of unlicensed automobiles or specially licensed automobiles for which compulsory automobile
insurance does not apply: ___________________________________________________________________
b) Is there an automobile policy covering these vehicles:
Yes
No
8. How many employees regularly drive their own vehicles on company business (include logging trucks, etc):
Type of vehicles: ________________________________________________________________________
Number of each: _________________________________________________________________________
What is the cost of hired autos: ______________________________________________________________
9. Is there any non-owned aircraft or watercraft exposure by way of ownership, use or operation of any aircraft
or watercraft by or on behalf of the Applicant?
Yes
No
If yes, please explain: ______________________________________________________________________
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Parent category: Business