Page 22 - Tree Line - North Carolina Forestry Association - Fourth Quarter 2024

PLEASE FILL OUT AND RETURN WITH PAYMENT
NOTE: This form is for NEW hunt clubs. Existing clubs and landowners
need to contact the NCFA office at (919) 834-3943.
In order to obtain a hunting lease or timberland insurance, all parties have to be a member of the NCFA.
NCFA’s Hunting Lease Liability Insurance Application
APPLY ONLINE
NAME OF HUNT CLUB:
____________________________________________________________________________________
Contact:
________________________________________________________________
NCFA Member #: _________________
Address:
__________________________________________________________________________________________________
City: ____________________________________________ State: ______________ ZIP Code: _________________
Phone: _______________________________________________________________________________________
E-mail: ________________________________________________________________________________________
The club must have a written lease with all landowners for coverage to apply.
NAME OF LANDOWNER:
(person, partnership or corporation)
_________________________________________________ NCFA Member #:______________
Landowner Representative (If different from above):___________________________________________________
Address:
_________________________________________________________________________________________________
City: ____________________________________________ State: ______________ ZIP Code: _________________
Phone: ________________________________________________________________________________________
E-mail: ________________________________________________________________________________________
Total Number of Acres: ____________________ County: ______________________________________________
Leasing from more than one landowner? Please attach a separate sheet with the above information for each landowner.
PREMIUM CALCULATION: COMPLETE OPTION 1 OR 2 (please check one)
OPTION 1: $1 Million General Liability Limit OPTION 2: $2 Million General Liability Limit
ACREAGE ✔ OPTION 1
PREMIUM
✔ OPTION 2
$2 MILLION PLAN
ACREAGE ✔ OPTION 1
PREMIUM
✔ OPTION 2
$2 MILLION PLAN
Less than 500 $215.00 $400.00
3001-3500 $600.00 $1,110.00
501-1000 $245.00 $455.00
3501-4000 $675.00 $1,250.00
1001-1500 $295.00 $545.00
4001-4500 $775.00 $1,435.00
1501-2000 $380.00 $705.00
4501-5000 $815.00 $1,510.00
2001-2500 $465.00 $860.00
Above 5000 $0.16 / Acre $0.30 / Acre
2501-3000 $520.00 $965.00
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: AssuredPartners SC – Outdoor, P.O. Box 5587, Deptford, NJ 08096
Coverage is subject to approval by AssuredPartners. Master Policy effective date is August 1 to August 1. Applications received after
August 1 of a given year will be effective upon approval and will expire on the following August 1.
20 ncforestry.org / FOURTH QUARTER 2024