Hunting Lease Insurance in Alabama by acu34660


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									                    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.

 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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