HUB International Outfitters Liability/Property Questionnaire

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Outfitters Liability Insurance				Lodge Property Insurance

What are you looking to complete today?*

Outfitters Liability Insurance QuestionnaireLodge Property Insurance ApplicationBoth. Outfitters Liability Insurance Questionnaire AND Lodge Property Insurance Application

HUB International Outfitters Liability Questionnaire
Which province/territory do you primarily operate out of?*
Are any operations performed outside of Canada?*

YesNo
If Yes, please describe where and what operations are performed:*
Are you a member of and in good standing with a professional outfitting association?*

YesNo
Please specify your association: *
What is the expiry date of your current insurance policy?*

MonthDayYear
Date

Member Info
Name of Company:*
Provincial Association Outfitter ID Number:*
Are there any other company names?*

YesNo
Please enter all additional company names below:*
Name of Licensed Outfitter-Owner:*

First NameLast Name
Are there any other owners of the operation?*

YesNo
Please enter all additional owner names below:*
Mailing Address:*

Street Address

Street Address Line 2

CityProvince / Territory

Postal Code
Main Phone:*
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Email(s)*
Website(s)
Business Form:*

CorporationPartnershipIndividualOther

Ancillary Operations
Do you have any ancillary non-hunting/angling operations that you wish to be included in this coverage? For example: (Eco Tourism, Cabin Rentals, Watercraft/All-Terrain Vehicle/Other Rentals, Campground, Fuel Sales, Host Weddings)*

YesNo
Please provide details regarding all other business operations in addition to outfitting:*
What is the annual revenue generated by all ancillary operations?*
Do you provide non-hunting related trail riding?*

YesNo
Do all trail riders sign waivers?*

YesNo, all trail riders do not sign waivers
What is the annual non-hunting related revenue generated from trail riding activities?*

Would you like to fill out an Outfitters Lodge Property Insurance Application?*

YesNo

How many locations do you require insurance for?*

Location #1

Please provide information regarding the first location you would like insured
Location Address (Civic / Legal / Coordinates):*

Address

Province / Territory

Postal Code
Nearest Town / Community / Lake / River:*
Is there a responding Fire Hall?*

YesNo
Distance to responding Fire Hall (KM):*
Name of responding Fire Hall:*
Please describe fire protection equipment (ex: exterior sprinkler system, fire extinguishers, etc. )*
Does this location have it's own water treatment or power generation equipment?*

YesNo
What is the replacement cost limit for all water treatment / power generation equipment?*
How many buildings would you like to insure at this location? *

Location #2

Please provide information regarding the second location you would like insured
Location Address (Civic / Legal / Coordinates):*

Address

Province / Territory

Postal Code
Nearest Town / Community / Lake / River:*
Is there a responding Fire Hall?*

YesNo
Distance to responding Fire Hall (KM):*
Name of responding Fire Hall:*
Please describe fire protection equipment (ex: exterior sprinkler system, fire extinguishers, etc. )*
Does this location have it's own water treatment or power generation equipment?*

YesNo
What is the replacement cost limit for all water treatment / power generation equipment?*
How many buildings would you like to insure at this location?*

Location #3

Please provide information regarding the third location you would like insured
Location Address (Civic / Legal / Coordinates):*

Address

Province / Territory

Postal Code
Nearest Town / Community / Lake / River:*
Is there a responding Fire Hall?*

YesNo
Distance to responding Fire Hall (KM):*
Name of responding Fire Hall:*
Please describe fire protection equipment (ex: exterior sprinkler system, fire extinguishers, etc. )*
Does this location have it's own water treatment or power generation equipment?*

YesNo
What is the replacement cost limit for all water treatment / power generation equipment?*
How many buildings would you like to insure at this location?*

Business Interruption – Automatic Extensions of Coverage – All Other Mobile Property

The following few coverages are unique extensions in addition to the full extension package that comes with the policy. Would you like to increase the included limits?*

	Would you like options for higher limits?
Profits Business Interuption ($50,000 included by default)
Portable Outfitting Property - Away from insured premises for a maximum of 30 days ($50,000 included by default)
Outdoor Property - Including fences, docks wharfs, bridges & general landscaping. ($25,000 included by default)
Fine Arts - Including Wildlife Mounts (Taxidermy Cost Only Excluding Cost of Hunt) ($50,000 included by default)
Personal Property of Outfitter / Owner ($10,000 included by default)
Personal Property of Employee / Guide / Guest ($5,000 per person, $25,000 Per Occurrence included by default)

Do you want add coverage for any of the following? Please select all that apply:

All-Terrain Vehicles (Quads, Snowmobiles, Side By Sides, Etc.)Mobile Equipment (Skid Steer, Excavator, Dozer, Etc.)Watercraft
Please provide details for each All-Terrain Vehicle you would like coverage for:*
Please provide details for each Mobile Equipment you would like coverage for:*
Please provide details for each Watercraft you would like coverage for:*

Signature
Name*

First NameLast Name
Date*

MonthDayYear
Date
Signature*

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Please review your application to ensure accuracy and then click "Continue" to complete your application!
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HUB International Outfitters Liability Questionnaire

Member Info

Outfitting Services

Ancillary Operations

HUB International Outfitter Lodge Property Insurance Application

Location #1

Building #1

Building #2

Building #3

Building #4

Building #5

Location #2

Building #1

Building #2

Building #3

Building #4

Building #5

Location #3

Building #1

Building #2

Building #3

Building #4

Building #5

Business Interruption – Automatic Extensions of Coverage – All Other Mobile Property

Signature

Please review your application to ensure accuracy and then click "Continue" to complete your application!