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HUNTING LEASE LIABILITY INSURANCE Type of Insurance Acreage

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					HUNTING LEASE LIABILITY INSURANCE
                       Type of Insurance
                                                                                                                    Acreage Rates
                         * Comprehensive General Liability
                         * Limit of Liability:    $ 1,000,000 Each Occurrence                                Less than 250          $ 180.00
                                                  $ 2,000,000 Aggregate                                          251 to 499         $ 190.00
                         * Deductible:            $ 0 Per Occurrence
                         * Medical Payments:      $ 5,000                                                        500 to 750         $ 205.00
                         * Fire Damage Liability: $ 50,000                                                     751 to 1000          $ 220.00
Named Insured                                                                                                1001 to 1250           $ 235.00
Georgia Forestry Association member hunting clubs.
                                                                                                             1251 to 1500           $ 250.00
A separate certificate of insurance will be issued to each hunting club.
                                                                                                             1501 to 1750           $ 265.00
* Master policy to be maintained with the Georgia Forestry Association.
                                                                                                             1751 to 2000           $ 280.00
* Landowners should be listed as additional insured party.
* The club must have a written lease with any and all landowners listed on this                              2001 to 5000           $ 0.14/acre
  application for coverage to apply
                                                                                                                 Over 5000          $ 0.13/acre
* Membership in GFA included for hunt club.

APPLICATION - HUNTING LEASE LIABILITY INSURANCE
Your Hunt Club Name:
c/o:
Address:
City:                           State:               Zip:           E-mail:
Home Phone:                                 Work Phone:                Cell Phone:
Number of Club Members:
Signature of Club Representative:
If leasing from more than one landowner, please attach a separate sheet with the information listed below for each
landowner.
Landowner Name:                                                 Number of acres:
Address:
City:                           State:               Zip:       E-mail:
Home Phone:                                 Work Phone:             Cell Phone:
Location of property as described on lease:
Premium Calculation - Hunting Lease Liability Insurance
Number of acres                               See Rate Table Listed Above = $
Total Number of Landowners                    X $25 each                  = $
Total amount due for hunting lease liability insurance                    = $
                                                                            Client Code: GEORGFOR1
                      Please make check for insurance payable to Georgia Forestry Association
  Coverage is subject to approval by Davis-Garvin Agency. Master Policy effective date is September 1, 2010 to September 1, 2011. Applications received
      after September 1, 2010 will be effective upon approval and will expire September 1, 2011. Premiums are fully earned - no refunds will be issued.

IMPORTANT NOTICE:
   Master policy is on file with the Association and a copy is available from Davis-Garvin Agency
   upon request.
   Insurance coverage questions should be directed to Davis-Garvin Agency, Inc. Contact the
   Hunt Club Department at (800) 845-3163.
   Questions concerning GFA Membership should be directed to Georgia Forestry Association at
   (478) 992-8110.
                                   MAIL PAYMENT AND APPLICATION TO:

                                                                 GFA
                                                             PO BOX 1217
                                                          FORSYTH, GA 31029

				
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Description: Hunting Lease Liability Insurance document sample