2010-2011 Application for Use of Alabama Forest Owners’ Association’s Hunting Lease Liability Group Insurance Policy HUNTING LEASE LIABILITY INSURANCE COVERAGE Hunting Lease Liability Insurance is available to each member of the Alabama Forest Owners' FOR THE SMALL FOREST LANDOWNER Association (AFOA) on land owned by the member which is leased to a hunting club. Land may be Insurance provided through Outdoor Underwriters, Inc., Columbia, SC located anywhere in the United States.* Lands that are subleased may not be included. AFOA is taking COVERAGE INCLUDES: applications for coverage under its 22nd one-year group policy which will become effective August 1, General Liability 2010 and will remain in effect to August 1, 2011. Coverage begins on or after August 1, 2010, based on $1,000,000 per occurrence date of receipt of correctly completed application and full payment. The policy names both the landowner $2,000,000 aggregate per hunting club limit and the hunting club as insured and each receives a certificate of insurance. Zero Deductible 2001 Occurrence Form This program offers broad coverage, but it must be remembered that the insurance is strictly “hunting Hunt Club Member vs. Hunt Club Member Coverage lease liability insurance” and does not take the place of liability insurance unrelated to leased hunting Hunting Club Guest Liability Coverage activities. Watercraft (longer than 19 feet and/or powered by motors greater than 25 hp) related accidents Contractual Coverage as well as commercial dove shoots and short term fee hunting are not covered. Fire Damage Coverage: $100,000 per occurrence, $1,000 deductible It is recommended that all details of the lease agreement between the landowner and the hunting club Med Pay: $5,000 be written and mutually agreed upon. It is further recommended that the lease agreement require the ADVANTAGES: hunting club to have written by-laws which are subject to approval by the landowner. Landowner certain of adequate coverage * New applications not accepted for land in AR, LA, MD, TN, or VA unless landowner is resident of or owns land in Alabama. Designed to meet needs of small landowner No Refunds Will Be Issued Application must be filled out completely in order to be processed. 2010-2011 Policy will become effective August 1, 2010, and will remain in effect to August 1, 2011. LANDOWNER INFORMATION Name of Person Representing Landowner (must have legal authority) ________________________________________________________________ Name of Landowner ________________________________________________________________________________________________________ Last Year’s AFOA Policy Identification Number if available (examples: 090001, 092073) __________________________ Mailing Address ___________________________________________________________________________________________________________ City, State & Zip Code ______________________________________________________________________________________________________ Home Telephone _________________________________________ Work Telephone __________________________________________________ Fax Number _____________________________________________ E-mail Address __________________________________________________ * Each distinct ownership, whether individual, partnership, trust, corporate, etc., must maintain a membership in AFOA and qualify separately for insurance coverage. AFOA requires that each ownership be represented by the landowner himself or a designated agent with legal authority to act as the landowner's agent (In most cases, the Hunting Club representative is NOT the designated agent with legal authority). HUNTING CLUB INFORMATION (Landowner should include the following information for each hunting club to be covered; make copies as needed.) Name of Club Representative ________________________________________________________________________________________________ Name of Hunting Club ______________________________________________________________________________________________________ Mailing Address ___________________________________________________________________________________________________________ City, State & Zip Code ______________________________________________________________________________________________________ Home Telephone __________________________________________ Work Telephone _________________________________________________ Fax Number _____________________________________________ E-mail Address __________________________________________________ Number of Members in Club ________ Location of Leased Land: County & State ______________________________________________________ Lease Price (optional question) $ __________ per acre Other non-cash requirements __________________________________________________ ________________________________________________________________________________________________________________________ Mail Application with 2 Checks Calculation of Fees for above landowner leasing to above club. Space reserved for AFOA use. payable to AFOA to: (no fractional acres) Landowner Membership dues: $ 15.00 AFOA - Hunting P. O. Box 361434 AFOA Landowner Processing Fee: (due once per policy-year) $ 28.00 Birmingham, AL 35236 Send two checks. Amount of first check = $ 43.00 Questions: Call (205) 987-8811 AFOA Hunting Club Processing Fee: (due for each club) $ 28.00 Personal Checks or Money Orders are acceptable. A $14 fee will be charged Acreage Fee:* (12 cents/acre x ________ acres) $____.__ for each “bad check.” Send two checks. Amount of second check = $____.__ Overpayments of $5+ will be refunded. Overpayments of less than $5 will be retained as a donation. * Acreage Fee includes an AFOA fee of 1 cent per acre.
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