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SCI Guides & Outfitters General Liability Application

PLEASE REVIEW THE INFORMATION YOU'VE ENTERED AND MAKE ANY CHANGES ON THIS PAGE BEFORE SUBMITTING

  Section A: Applicant Information
  Business Name: Applicant's Name:
  Mailing Address: City: ST: Zip:
  Location Address: City: ST: Zip:
  Telephone Number: Fax Number:
  Email: Website:
  States in which you operate: Is your business domiciled in the US? Yes No
  Do you operate outside the US? Yes No If yes, please describe:
  Check here to confirm you are an SCI individual member Member #
  Name of your SCI Affiliated State Association
1.
Type of Ownership: Corporation Partnership Limited Liability Company
  Individual Joint Venture Other
2. Names of owners/partners/officers:
  Name Title Years of G&O Experience
(1.)
(2.)
(3.)
3. Has the business owner(s), partners or officers ever voluntarily surrendered or had any outfitters license refused, revoked, or suspended?
Yes No      If yes, please provide details in Section N at bottom of this page.
4. Number of years in business:
If your business is less than four years old, please describe prior experience in Section N at bottom of this page.
5. What percentage of your operations are: Guided: % Unguided: %
6. What percentage of your business engages in operations other than hunting/guiding/outfitting %
7. Do you have brochures? Yes No     If yes, please provide a copy of the brochure.
  Section B: Guide Information
8. List of Guides Including Owners (If more than five, please list in Section N at bottom of this page.)
 
Guide's Name Date of Birth Years of Experience Employee/Independent
  Independent Guides must provide you with a certificate of insurance.
9. Are guides licensed and certified for Outfitting? Yes No
10. Has any guide been involved in an incident which resulted in serious injury or death? Yes No,
If yes, provide detailed description in Section N at bottom of this page.
11. Have guides completed: First Aid Training CPR EMT Training Wilderness Training
Other:
12. Have guides completed any other safety classes or education? Yes No     
If yes, describe:
13. Do you conduct a reference check for guides that you hire? Yes No  
If yes, describe types of references checked:
  Section C: Additional Insureds
NOTE: YOU MUST ATTACH COPIES OF ANY
HOLD HARMLESS AGREEMENTS OR CONTRACTS
14. Are you required to list any Government entity or Land Owners as Additional Insureds?     
If yes please list them:
  Name: Address:
  Suite/Attn: City: ST: Zip:
  Name: Address:
  Suite/Attn: City: ST: Zip:
  Name: Address:
  Suite/Attn: City: ST: Zip:      
 

If additional space is needed, use Section N.
  Section D: Premium Basis
Your premium is based on your estimated gross receipts for a twelve month period commencing with the effective date you have requested on your policy. Since the rates vary for each classification, it is necessary for you to put a check mark next to each category that applies and insert your estimate of gross annual receipts for each classification. If none enter zero. There should be no blank spaces under gross receipts. Please be sure to check all operations that you conduct even if no gross receipts are generated. No coverage is present for operations you conduct but do not check on this application nor is their any coverage for unguided operations. 
  Operations Gross Receipts
1. Animal Breeding, Boarding or Training $
2. ATV Tours $
3. Backpacking/Hiking $
4. Big Game Hunting (Deer, Boar, Elk, Bear) $
5. Bike Trips/Mountain Biking $
6. Bird Hunting Facilities/Preserves $
7. Boat Tours $
8. Camping Facilities $
9. Canoe/Kayak/Float & White Water Raft Trips $
10. Climbing $
11. Cross Country Skiing $
12. Dog Sled/Snowmobile Tours $
13. Drop Camps (unguided) $
14. Equipment Rental/Sales $
15. Fishing $
16. Lodging not in conjunction with hunting $
17. Nature Trips and Photo Tours $
18. Pack Trips $
19. Shooting Range $
20. Trail Rides $
21. Trap/Skeet/Sporting Clays $
22. Other $
  Total Gross Receipts $
     
  # OF BOATS      # OF BOATS EXCEEDING 26' IN LENGTH
     
15. Do you contract out any of the above to other vendors? Yes No
If yes, which ones: At what cost: and please confirm that you retain copies of their certificates of insurance on file. Yes  
  Section E: Pack Trips
16.

Do you conduct Pack Trips with animals? Yes No,     If yes, please check all that apply:

Hunting Camping Fishing
Nature/Photography Other:  
17. What is the average duration of the trip: Full Day Overnight # of nights
18. Are these trips guided or unguided?
19.

What is the guide to guest ratio on these pack trips? # of guides to # of guests

20. Type of animal used: None Horses Llamas Mules Other
21. Are mules used for riding? Yes No
22. Please describe the type of terrain:
23. What is the minimum/maximum age required for trips: Min Max       
24. Miles traveled per day:  
  Section F: Operations
25.

Does the applicant: (check all that apply)
Use your own land in your outfitting operation Use leased land
Use State/Federal Land; Use private land
26.

Number of acres of private land that you   Own:    Lease: : square miles of public land you use:

27. What percentage of your operation is on Forest Service wilderness areas or Bureau of Land Management land? %
28. Do you lease any land you own, sublease any land you lease, or broker any land that you control? Yes No
29. Do you have overnight stays? Yes No If yes, overnight stays are in: (check all that apply)
applicant dwelling lodge tents cabins other:
30. Are all employees 18 years or older? Yes No
31. Do you sell alcoholic beverages? Yes No If yes, check all that apply: Beer Wine Liquor
32.

Do you include alcoholic beverages in your daily rate? Yes No
If yes, check all that apply: Beer Wine Liquor

33. Are guests allowed to bring their own alcoholic beverages? Yes No; check all that apply: Beer Wine Liquor
34. Is alcohol allowed: Before the Trip, During the day At Breaks After the day's hunt is completed
35. Is food provided by guides? Yes No,
If yes, please describe:
36. Where are meals served? (i.e. campsite; lodge; applicant's/guide's personal dwelling)
37. How do you maintain proper food temperatures during trips?
38. Are proper food storage methods followed to prevent wildlife in camp area? Yes No
39. Does the applicant use All Terrain Vehicles (including mules & gators), Snowmobiles, Golf Carts, Mopeds?
Yes No
40. If yes, are they used for(check all that apply) Business Personal Public Other:
41.

If yes to All Terrain Vehicles/Snowmobiles, are they used for: Hunting Game Retrieval
Feeding of Animals Sightseeing Other:

42. Do you use 3 wheel ATV's? (IF YES, INELIGIBLE FOR PROGRAM) Yes No
43. Are regular maintenance records maintained for each vehicle? Yes No
44. Are guests allowed to drive / ride: All Terrain Vehicles (including mules & gators), Snowmobiles, Golf Carts, Mopeds?
Yes No
45. If yes, what is the minimum age of rider/driver?
46. Are helmets required at all times? Yes No
47. Are guests allowed to bring their own ATV's, Snowmobile, Golf Carts, and Mopeds?
(You should get insurance certificates from these guests) Yes No
  Note: There is No liability coverage for vehicles used for nonbusiness/personal use nor is there
liability coverage for vehicles owned by guests.
  Section G: Safety
48. Are customers required to complete a health and medical form prior to the trip? Yes No
49. Do you prescreen guests to determine their ability prior to taking part in activities? Yes No
50. List reasons why the applicant would decline a person from taking part in an activity (i.e. health, age, weight, alcohol, general, pregnancy):
51. Are instructions given to guests by a qualified guide prior to trips explaining the hazards of operations and the proper use of equipment? Yes No
If yes, are they Verbal or Written(If written please provide a copy.)
52. Does the applicant have written: Safety procedures, Evacuation plan,
Emergency plan, given to all staff members? Yes No
(Provide a copy.) Note: Plans and procedures must address extended overnight accommodations and finding lost parties.
53. Is a waiver/release of liability signed by each participant for all activities (including parent/legal
guardian of minor)? Yes No
If yes, please provide a copy of your waiver.
54. Are waivers kept available on premises or archived for a minimum of 5 years? Yes No
55. Which safety items are guides required to take on each trip: 50' Buoyant Rope First Aid Kit
Mobile Phones Flares Heart Defibrillator 2-way Radios Snake Bite Kit GPS
Other:
56. Are all state safety regulations and rules followed and enforced? Yes No
57. Do you file an itinerary with the Forest Service, or another entity? Yes No
58. Describe all rest stops and/or breaks:
59. Do you provide hunter safety training or require hunting safety certificates from your customers?
Yes No  
  Section H: Hunting
60. What is the guide to guest ratio while hunting? # guides to # guests
61. What is the maximum number of hunters at any one time:
62. What is the minimum age required for hunting:
63. Are minors always accompanied by an adult? Yes No
64. Is all hunting done on foot? Yes No       If no, explain:
65. Are hunters usually back by dusk? Yes No
66. What type of game is being hunted?
Bear Deer Elk Cougars/Mountain Lions Hogs Turkey
Upland Birds Waterfowl Other:
67. Is all game hunted considered "fair chase"? Yes No
68. Does applicant use any boats for hunting operations? Yes No
  If yes, are boats adequately secured when not being used? Yes No
69. What type of firearms/bows are used: Rifle Shotgun Pistol Black powder / Muzzle Loader
Crossbow Recurve/Compound Other:
70. Do guests bring their own firearms/bows? Yes No
71. Does applicant provide or rent any firearms/bows for guests? Yes No
If yes, indicate type, condition, and age of firearms/bows:
72. Do you allow loaded firearms indoors? Yes No
Do you transport loaded firearms? Yes No
73. Hunting weapons are sighted in: Onsite Shooting Range Offsite Shooting Range
Other:
74. What type of vehicle is used to transport hunters: Modified Vehicle All Terrain / Utility Vehicle
Other:
75. Are any of the vehicles licensed for road use? Yes No
76. Hunting stands used are: Manufactured Homemade Portable Permanent N/A (not applicable)
77. Type of hunting stand: Tree Self Supporting Structure Ladder Climbing Other:
78. Who installs the hunting stands: Guide Guest Other:
79. How often are hunting stands checked for safety: Each use Weekly Seasonal
Other:
80. Are safety harnesses required? Yes No
81. Are hunters required to wear fluorescent orange per state requirements? Yes No
82. Are dogs used for hunting? Yes No
If yes, how many dogs are owned by applicant:
What percentage of your customers bring their own dogs? %
83. Are all dogs required to have current vaccinations? Yes No
(You should require guests to provide vaccination certificates)
  Section I: Boats           Not Applicable
84. Are boats used for: Hunting Fishing Boat Rental Transport to hunting areas
85. Is daily rental of boats provided to guests? Yes No
If yes, are they guided or unguided
86. On what bodies of water does use take place? check all that apply:
Rivers Lakes Ponds Ocean Bay Inlets
87. List names if a major body of water:
88. If rivers, what classes are navigated: Class I Class II Class III Class IV or higher
89. Are guests allowed to operate boats? Yes No
90. Ratio of guides to boats:
91. Do you provide Coast Guard approved life vests (personal floatation devices)? Yes No
Do you require that guests wear them? Yes No
92.

Describe the boat types (jon, float/drift, row, canoe or other) that you use in your hunting operations:

Type Length Capacity Horsepower

 

  Section J: Equestrian           Not Applicable
93. If Horses are used, please advise the total number of horses that are Owned: Leased: Other:
94. Horses used for: (check all that apply) Pack trip, Hunting Trail rides Fishing Other:
95. Do you rent or supply horses to the public? Yes No
96. Are they rented to the public on a: Hourly, 1/2 Day, Daily, Other basis?
97. Number of days for hunting trips: Maximum Minimum
98. What percent of the applicant's horse operations are: % Guided % Unguided
99. What is the guide to guest ratio? guides to guests
100. Number of horses in use for guest riding at any one time -- Maximum: Average:
101. What age is the youngest rider the applicant will allow on a horse?
102. Does the applicant ever allow: double riding Yes No or bareback riding? Yes No
103. Are ASTM/SEI certified helmets used at all times while mounted by:
Everyone; Everyone under 18; or not required?
104. Is there a signed helmet rejection form? Yes No
105. Does your state have an Equestrian Liability Law? Yes No
106. Footwear/apparel required by you for riders: Boots/Heeled Shoes Long Pants Other:
107. Explain other safety procedures followed:
108. Does the applicant allow customers to bring their own horses? Yes No
109. Average number of horses boarded: For guests: For nonguests: N/A
110. Does the applicant lease horses from customers? Yes No If yes, number of horses leased:
111. Where are horses kept off season? Applicant's Premises, Leased Land, Other:
112. Are horses used for personal use during off season? Yes No
113. Are horses not owned by the applicant boarded at facilities you own or rent? Yes No
114. What is the required experience of riders:
Beginner/Novice, Intermediate/Some experience, Advanced
Section K: Prior Carrier Information
Please provide threeyear priorcarrier and loss information. Please provide Carrier, Name, Limits and Losses incurred.
  Carrier Name Limits Premium Losses
Current year:
Prior year
2nd Prior
 
Explain any claims or claims circumstances that occurred within the past 3 years:
Section L: Excess Limits
You can increase your coverage by adding layers of excess coverage in increments of $1,000,000. Additional layers up to a total of $10,000,000 may be purchased Premiums for each layer will be quoted separately. Excess limits are not applicable for Hired and Non-Owned Automobile Coverage.

Yes, I want to apply for excess limits. Please quote on $ /> ,000,000 of excess coverage.
  Section M: Hired and Non-Owned Coverage
This coverage protects the named insured to the extent of liability imposed by law and within the policy limits against claims for accidents due to guides and outfitters, employees, partners, or other agents op erating their own automobiles in the course of your business. The annual additional premium for a $1,000,000 limit of liability is $322. NOTE: If your business currently has Owned Automobile coverage, the Hired and NonOwned Automobile coverage is not available under our policy as it should be included on your business auto policy. No coverage is provided for Uninsured and Underinsured Motorists.

Please indicate your interest in this coverage:
Yes, I want this coverage and have completed the supplemental application in Section M.
No, I do not want this
1. Name of Applicant:
2. Does the applicant purchase an Auto Liability Policy for the purpose of covering owned autos in the business name? Yes No
3. How many locations does an employee drive to on the guides and outfitter's behalf in a given day?
None 1-3 3-5 locations more than 5 locations?
4. How many clients are transported as part of your business during the average hunting season?
  1. What is the total number of employees/guides who transport clients in their own vehicles?
  2. What is the total number of employees/guides who transport clients in the clients' own vehicles?
  3. What is the total number of employees/guides who transport clients in the applicant's vans or other vehicles?
5. For what reasons are clients transported?
6. What is the total number of employees/officers and partners who drive on the organizations behalf?
7.
  1. Is nonowned automobile mileage incurred by employees reimbursed by the applicant? Yes No
  2. What percentage of employees who transported clients in their own vehicle received reimbursement last year? %
  3. What was the total mileage reimbursed for the last fiscal year? Miles
8. On the average how many individuals are transported per trip?
9. What evidence of auto insurance does your organization require from employees/ volunteers using their personal autos?
none certificates of insurance copy of Auto ID Card copy of auto policy
Other Explain:
10.

Does the applicant:
Have a formal written policy on personal usage that addresses acceptable business use of personal vehicles? Yes No
Does the applicant check MVRs and have disciplinary procedures for unacceptable MVRs? Yes No

Do you have a verification procedure regarding personal auto coverage and personal use reimbursement procedures? Yes No  
Signature:       Date:
Sportsman's Insurance Agency, Inc.
1364 N. US 1, Suite 503
Ormond Beach, FL 32174
Phone (800) 9257767 or (386) 6772588 Fax Number (386) 6773292
email: SCIGuides@siai.net  
I understand that this application and all information supplied is part of the application process and relied upon by the insurance company in determining whether to provide the insurance coverage herein requested and that the application will become a part of any contract of insurance entered into. Any material misrepresentation or false statement may entitle the insurance company to rescind the policy, voiding all insurance coverage. I hereby warrant, represent and confirm that I have read all of the questions and answers on this application and that to the best of my knowledge, all information provided in this application is complete, true and correct. I further war rant that I have made or will make the necessary maintenance inspections and that all necessary repairs have been made to ensure that my property and operations are and will remain in compliance with any underwriting criteria furnished me.
Requested Start Date (mm-dd-yyyy)
Date: Authorized Signature and title:  
Section N: Additional information
( From Other information you would like to add. )