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Logging and Log Hauling General Liability and Loggers Broad Form Application

Make sure to complete all items marked required. You can save this application and continue it later by selecting “Save & Continue” at the bottom on this page.

if different from mailing

15. Indicate the type of logging and other work performed by the applicant:

16. Does the applicant perform any non-logging operations or use their equipment for non-logging operations?(Required)

17. How many individuals are employed by the applicant in each of the following categories?

18. Does the applicant hire day/temp/cash only labor or participate in employee leasing program?(Required)
19. Does the applicant employ subcontractors for any operations, including hauling?(Required)

If yes, provide the name of each subcontractor and the type of work they are performing:

20. Are all sub-contractors required to:

20a. Provide a certificate of insurance with limits of at least $1,000,000 for general liability?(Required)
20b. Provide a certificate of insurance with limits of at least $1,000,000 for Loggers Broad Form Property Damage?(Required)
20c. Provide a certificate of insurance with limits of at least $1,000,000 for auto?(Required)
20d. Sign a sub-contractor agreement which includes hold harmless & indemnification wording in your favor?(Required)
20e. List you as Additional Insured on both their GL & Auto policies?(Required)
20f. Offer waiver of subrogation in your favor?(Required)
20g. Offer primary/non-contributory wording in your favor?(Required)
21. Do sub-contractors ever drive your vehicles?(Required)
22. Do sub-contractors ever haul trailers you own?(Required)
24. Does the applicant build any roads or landings?(Required)
25. Does the applicant work on any street, road or bridge projects other than logging roads?(Required)
30. Does the applicant load trucks owned by others?(Required)
31. Does the applicant own, lease or operate a quarry or sand and gravel operation?(Required)
32. Does the applicant perform any automobile, equipment or truck maintenance or repair for others?(Required)
33. Does the applicant perform any slash burning?(Required)
34. Is the applicant contracted to assist fighting forest fires?(Required)
35. Do you require Waiver of Subrogation endorsement on CGL and W.C.?(Required)
36. Do you cut trees within 250 feet of any structure?(Required)
37. Do you perform any of the following activities or any related activities: arborist, tree trimming, urban logging, land clearing, right of way clearance, road or power line clearance, etc.?(Required)
This field is for validation purposes and should be left unchanged.
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