Page 21 - Tree Line - North Carolina Forestry Association - Second Quarter 2022

PLEASE FILL OUT AND RETURN WITH PAYMENT
Timberland Liability
Insurance Coverage Information
TIMBERLAND LIABILITY INSURANCE HIGHLIGHTS:
• AdmittedCarrier(ARated)
• ComprehensiveGeneralLiability
• LiabilityLimit:$1,000,000or$2,000,000 each occurrence/$2,000,000 aggregate
• Deductible:$0peroccurrence
• Liabilitycoverageforthelandowner does not provide protection for
owned timber, damage to buildings or other property, or any business operations on the premises
AVAILABLE TO LANDOWNERS IN NORTH CAROLINA, SOUTH CAROLINA & VIRGINIA
TheNCFA’sTimberlandLiabilityInsuranceisdesignedtocovergeneralrisksassociated with being a landowner. The one-year policy is effective August 1 and expires August 1 of the following year. Coverage is for liability claims arising from timberland ownership, including invited and uninvited guests. We offer this policy through our collaboration with AssuredPartners. This policy can also be purchased online at their website: www.apoutdoorinsurance.com.
APPLY ONLINE
The policy names the landowner as the insured. Landowners will receive a certificate of insurance. Landowners must be a member of NCFA to purchase this timberland insurance coverage.
The NCFA annual membership for landowners is $50 for ownership up to 500 acres, plus $.025 per acre for any acreage above 500 acres. See page 24.
Application - Timberland Liability Insurance
Landowner Name: ___________________________________________________________________________________________ Contact Name:____________________________________________ NCFA Member #: __________________________________ Address: ___________________________________________________________________________________________________ City:_________________________________________________State: _______________ ZIP: ____________________________ Phone:________________________________ E-mail:______________________________________________________________ Number of Acres: ________________________ Location (County): _________________________________________________ Describe any past losses: ____________________________________________________________________________________ ___________________________________________________________________________________________________________
Circle one
Any commercial or business operations of any kind conducted on the premises?.......................................... Any of this property leased for farming? .................................................................................................. Any of this property leased for hunting (private or commercial)?................................................................. If yes to any of the above questions, do you require them to secure coverage elsewhere
and provide a certificate of insurance naming you as additional insured?................................................ Any of this property ever used for mining or containing gas or oil wells? ...................................................... Is this property fenced or posted?........................................................................................................... Any lakes or ponds on this property?....................................................................................................... Any dams / spillways / bridges on this property? ....................................................................................... Any watercraft or docks on this property? ................................................................................................ Any buildings, structures, towers, or housing accommodations on this property?..........................................
Y N Y N Y N
Y N Y N Y N Y N Y N Y N Y N
Premium Calculation: Complete Option 1 OR 2
OPTION 1: $1,000,000 Liability Limit (Each Occurrence)
Number of acres to be covered_____ X 0.31 = $ _________ (Subject to $200 Minimum Premium)
OPTION 2: $2,000,000 Liability Limit (Each Occurrence) Number of acres to be covered_____ X 0.57 = $ _________
(Subject to $200 Minimum Premium)
Signature of Landowner: _____________________________________________________________ Date:_________________________
Please make check for insurance payable to AssuredPartners or visit www.apoutdoorinsurance.com to apply & pay online. Mail form and payments to: Assured Partners, P.O. Box 21627, Columbia, SC 29221
Coverage is subject to approval by AssuredPartners. Master Policy effective date is August 1, 2022 to August 1, 2023. Applications received after August 1, 2022 will be effective upon approval and will expire on August 1, 2023.
Landowners must be a member of NCFA to purchase this timberland insurance coverage. See page 24 for dues and payment information.
ncforestry.org / SECOND QUARTER 2022 19