Prezerve - Hunting Preserve and Hunt Club General Liability Insurance

* required fields

* Contact Person:

* Business Name:

Type of Business:

Hunting Preserve	Rod & Gun Club	Hunting Lodge
Trap, Skeet

Entity Type:

Individual	Partnership
Limited Liability Corp.	Corporation

* Address:

* County:

* City:

* State: * Zip:

* Phone:

Fax:

* Email:

Web:

* Current Insurance Co.:

* Current Premium Payment:

Mo.

Qtr.

Half

Year

* Gross Revenue:

Yes	No
		* Current Client with Prezerve / Mourer Foster
		* Previous Client but laps policy with Prezerve / Mourer Foster

Liability Limit:

100,000 / 300,000	300,000 / 500,000	500,000 / 800,000
800,000 / 1,000,000	1,000,000 / 2,000,000

Other Information:

Yes
	Do you operate any other businesses from this location?
	If yes, describe business:

Is you location within 50 miles of the Gulf of Mexico or the Atlantic Ocean?		Yes		No
What is the Fire Protection Class of your location?

Distance to Fire Station: miles		Distance to Fire Hydrant: feet
Is the responding fire department:		Staffed Volunteer?
Are there other fire control water sources available?		Pool Pond/Lake Water Tank

Is your location prone to grass fires and/or forest fires?	Yes	No
Are there buildings at your facility with limited access due to forest, terrrain or season?	Yes	No
Are your buildings located in heavily wooded areas?	Yes	No
Is the clearing from forest / wooded area greater than 150 feet?	Yes	No

Is your business operated year round?

Yes

If no, provide the number of months you are operational:

mos.

Are your buildings occupied year round?

Yes

If no, is there a caretaker on site?

Yes

or contracted?

Yes

If no, are buildings winterized?

Yes

Basic Property Information

Are there smoke alarms in all corridors and bedrooms?		Yes		No
Are smoke alarms hardwired to electrical system?		Yes		No

Do any buildings have cooking facilities?		Yes		No
If yes, list building numbers:

Do any buildings have wood burning fireplaces and/or wood stoves?	Yes	No
If yes, list building numbers:
If yes, are the chimneys and flues cleaned annually?	Yes	No

Do any buildings have any ACTIVE Knob & Tube and/or Aluminum wiring?		Yes		No
If yes, list building numbers:

Number of Docks?

Number of Boat Slips?

Age:

Complete the following questions only if property coverage is requested

Construction:

Frame Metal

Dock Type:

Floating Fixed

Does the Dock have a roof?	Yes	No
If roofed, has proper engineering for wind / snow loads been assessed?	Yes	No
Does the water around the Dock freeze?	Yes	No
If yes, what date on average?
Are the Docks removed in the winter?	Yes	No

Activities Conducted	Number of Guides	Number of Units

Club Members		Members
Acreage Leased		Acres
Acreage Owned		Acres
Archery Range		Stations
Range (Rifle & Pistol) indoor		Lanes
Range (Rifle & Pistol) outdoor		Lanes
Sporting Clay
Trap & Skeet
Big Game Hunting
Upland Bird Hunting
Waterfowl Hunting
Lakes or Ponds
Boats
Farming: Crops, Livestock		Revenues
Clubhouse		Square Feet
Lodging		Rooms
Restaurant
Liquor Sales
Retail Sales
Docks & Piers
ATV-guided
ATV-unguided
Youth Programs

Check all that apply to your operation:

For Profit

Not-for-Profit

Open to Public

Private Membership

Do you require participants to sign a liability waiver?	Yes	No
How many years have you been operating?		Years
If you are a new venture, how many years of prior experience?		Years
Are any operations conducted outside of the United States?	Yes	No
Do you hire guides as subcontractors?	Yes	No
If yes, do you obtain proof of insurance?	Yes	No

List safety procedures and guidelines:

Total number of units/rooms for lodging?
What is the square footage of the main lodge or clubhouse?		s.f.
Number of RV Spaces / Tent Sites?
Maximum guest capacity is:
Do you have a swimming pool or swimming area?	Yes	No
If yes, do you have a diving board?	Yes	No

Number of Special Events per year:
Revenue generated from Special Events:	$
Number of Participants:
Number of Spectators:
Number of Volunteers:
How many field trial events are held annually?
What is the minimum age of a volunteer gunner - bird boy?

What percentage of your hunting operations are unguided?

What type of game is being hunted?	Elk	Deer	Exotics
	Bear	Turkey	Waterfowl
	Upland Birds	Hogs	Alligators
	Other:

Are tree stands used?

Yes

Do you use any of the following to transport hunters? If so, how many.	ATV's
	Horses
	Snowmobiles
	Boats
	Other Unlicensed Vehicles

Exposure Information

Use of helmets on ATV's is	mandatory	frequent	rare	nonexistent	N/A
Use of muzzleloaders is		frequent	rare	prohibited
Use of pistols is		frequent	rare	prohibited
Use of modified weapons is		frequent	rare	prohibited
Tree stand use is		frequent	rare
Tree stand safety harness use is	mandatory	frequent	rare	nonexistent
Heavy equipment use is		frequent	rare	nonexistent
ATV, Hunting Buggy, Argo use is		frequent	rare	nonexistent
Snowmobile use is		frequent	rare	nonexistent
Sponsored youth events are		frequent	rare	nonexistent
Members sign liability waivers	mandatory	frequent	rare	nonexistent	N/A
Guests sign liability waivers	mandatory	frequent	rare	nonexistent	N/A
Clients sign liability waivers	mandatory	frequent	rare	nonexistent	N/A

Is a rangemaster/supervisor on premises during shooting hours?	Yes	No
What is the minimum age of an unsupervised shooter?		Years
Is the premise secured and locked when not operating?	Yes	No
Are range rules and safety guidelines posted in a conspicuous manner?	Yes	No
What is the maximum distance of ranges?		Yards

What type and kind of backstop or berm is used? Describe:

Number of watercraft: (Schedule of boats will be required)

How are boats used?	Hunting	Fishing	Boat Rental	Other:
On what bodies of water used?	Rivers	Lakes/Ponds	Ocean	Bays/Inlets
If Rivers, what classes are boated?	Class I	Class II	Class III	Class IV	Class V

Are life vests (PFD's) required?		Yes		No
Are life vests (PFD's) provided?		Yes		No

Do you raise game birds for sale to others?		Yes		No
Do you sell game birds to restaurants or to other food processors?		Yes		No

Do you sell handguns?		Yes		No		How many a year?
Do you sell used guns?		Yes		No		How many a year?

Gross Receipts

Prior 12 Months' Actual Total Receipts:	$
Estimated Total Receipts for Next 12 Months:	$

Membership Dues:	$
Rifle / Pistol Range	$
Shotgun Range / Trap & Skeet	$
Pro-Shop or Retail Operations	$
Of this amount, how much is gun sales?	$
Restaurant Sales	$
Of this amount, how much is liquor sales?	$
Lodging	$
Gunsmithing	$
Game Bird Sales to Others (preserves, restaurants, etc.)	$
Other	$

Loss History

Do you have any knowledge of any incident which may lead to a claim?

Yes

If yes, please describe: