Woodchuck Application

Brokerage Information:


Applicant Information:


Is there any USA exposure?:
Are employees covered by workers compensation?:
Does applicant have insurance now?:
Has this form of insurance, or any other similar insurance ever been cancelled or declined by any company or Lloyds?:
Was insurance carried?:
Has the application suffered any losses during the past 5 years which would have been covered under this form of insurance if the applicant carried such a policy?:

Does insured clear land?:
Does insured do any burning of land?:
Does the insured operate a portable sawmill as a stationary sawmill business?:
Does the insured do any tree falling?:
Is there any contemplated waterborne exposure?:
If equipment is open, is area fully enclosed by fence?:
Is maintenance log kept for each piece of equipment?:
Is each item of heavy equipment equipped with at least one ABC rated fire extinguisher of the following size and type?:
Will the equipment be hired out?:
If so, is the equipment operated solely by employees of the applicant?:
Is the equipment listed above, the only logging equipment owned and operated by the applicant?:
If portable sawmill, will the sawmill be housed or sheltered when in use?:

With respect to trucking/hauling, please provide the following:

Any hauling to USA?:
Are all vehicles covered by an auto policy?:
Is trucking/hauling for insured’s logs only?:

Is replacement cost wanted?:
Is there a mortgage or lienholder on the items?:
Can you confirm that no item of equipment has a mortgage of more than 75% of its current actual cash value?:

Do you know the applicant personally?:

Do you handle applicant’s other insurance?:
Is this risk a renewal to your agency?:
I agree that by submitting this application, I am electronically signing the application. Please note: policy not bound until you receive confirmation: