Rental Liability Application

Apply online for rental liability coverage. Every question from the printed Rental Liability application, in one form.

Complete this application online instead of filling in the PDF and emailing it back. 404 fields, grouped into 7 sections — open one section at a time. Fields marked * are required.

Note: 8 questions that share a single answer box in the printed PDF are asked separately here, so each can be answered on its own.

Section 1 — A. General Information

Proposed effective date

When is the quote needed by

Are you working with an agent/broker? Yes No

Producer name

Producer phone number

Producer email

Applicant’s name *

Applicant’s mailing address

City

State

Zip

Email *

Business telephone number *

Fax

Do you have more than one location? Yes No

Physical address of business if different

City

State

Zip

Physical address

City

State

Zip

Detailed description of business activities (specifically, and by location [1]

Detailed description of business activities (specifically, and by location [2]

Detailed description of business activities (specifically, and by location [3]

Detailed description of business activities (specifically, and by location [4]

Is this a new business? Yes No

Date business started

Years in business

Name_Row_1

Role_Row_1

Contact Number_Row_1

Email Address_Row_1

Name_Row_2

Role_Row_2

Contact Number_Row_2

Email Address_Row_2

Name_Row_3

Role_Row_3

Contact Number_Row_3

Email Address_Row_3

Annual payroll

Annual gross receipts

Does the insured have any contract requirements? (If yes, please attach a copy) Yes No

Section 2 — B. Insurance History

Why is the insured seeking new coverage

What is the target premium

Is the current insurance carrier offering a renewal quote? Yes No

If yes, please provide the premium offered

If no, explain

Company name

Coverage

Limits

Annual premium

Company name

Expiration date

Annual premium

$_Limits

$_Coverage type

Are any other markets offering coverage? Yes No

If no, please explain [1]

If no, please explain [2]

If yes, please provide limits, coverage and premium

Has the applicant or any predecessor ever had a claim? Yes No

Paid claims_/ /

Reserved claims_/ /

Total incurred claims_/ /

From To

Paid claims_/ /

Reserved claims_/ /

Total incurred claims_/ /

Fill 44 (table cell near “From To”)

Fill 441 (table cell near “From To”)

Paid claims_/ /

Reserved claims_/ /

Total incurred claims_/ /

Fill 45 (table cell near “From To”)

Fill 451 (table cell near “From To”)

Paid claims_/ /

Reserved claims_/ /

Total incurred claims_/ /

Fill 46 (table cell near “From To”)

Fill 461 (table cell near “From To”)

Paid claims_/ /

Reserved claims_/ /

Total incurred claims_/ /

Fill 47 (table cell near “From To”)

Fill 471 (table cell near “From To”)

Are you aware of any incident, event, or occurrence, loss that might reasonably be expected to lead to a claim Yes No

If yes, please explain [1]

If yes, please explain [2]

Section 3 — C. Desired Insurance

Per act/aggregate OR Per person/per act/aggregate Yes

Check Box376 (table cell near “Per act/aggregate OR Per person/per act/aggregate”) Yes

Check Box381 (table cell near “Per act/aggregate OR Per person/per act/aggregate”) Yes

Other

Other: Other Yes

Check Box377 (table cell near “Per act/aggregate OR Per person/per act/aggregate”) Yes

Self-Insured Retention (SIR): $1,000 (Minimum) $2,500 $5,000 Other

1,000 (Minimum Yes

2,500 Yes

5,000 Yes

Other Yes

Inland Marine/Physical Damage Deductible: $1,000 (Minimum) $2,500 $5,000 Other

1,000 (Minimum Yes

2,500 Yes

5,000 Yes

Other Yes

Length of season

Forrest, park) Yes

Physical address_Row_1

Use_Row_1

Acreage/ square footage_Row_1

Type of location (area, river, National Forrest, park)_Row_1

Check Box385 (table cell near “Forrest, park)”) Yes

Check Box387 (table cell near “Forrest, park)”) Yes

Physical address_Row_2

Use_Row_2

Acreage/ square footage_Row_2

Type of location (area, river, National Forrest, park)_Row_2

Check Box386 (table cell near “Forrest, park)”) Yes

Check Box388 (table cell near “Forrest, park)”) Yes

Physical address_Row_3

Use_Row_3

Acreage/ square footage_Row_3

Type of location (area, river, National Forrest, park)_Row_3

Automobiles Yes

Snowmobiles Yes

Mopeds/scooters Yes

# of units_Automobiles

#of units_Snowmobiles

#of units_Mopeds/scooters

ATV/UTV Yes

Snow cat Yes

Motorcycles Yes

# of units_ATV/UTV

#of units_Snow cat

#of units_Motorcycles

Dirt bikes Yes

Motor boats Yes

Motorhomes/RV Yes

# of units_Dirt bikes

#of units_Motor boats

#of units_Motorhomes/RV

High performance Yes

Personal watercrafts Yes

Kayaks/canoes Yes

# of units_High performance or exotic autos

#of units_Personal watercrafts

#of units_Kayaks/canoes

X=Y / N Yes

Equipment Type_Row_1

Annual gross receipts_Row_1

Annual no. of guests or participants_Row_1

No. of days each person participated_X

Total user days_=

X=Y / N Yes

Equipment Type_Row_2

Annual gross receipts_Row_2

Annual no. of guests or participants_Row_2

No. of days each person participated_X

Total user days_=

Equipment Type_Row_3

Annual gross receipts_Row_3

Annual no. of guests or participants_Row_3

No. of days each person participated_X

Total user days_=

X=Y / N Yes

Section 4 — E. Employees

Retail sales

Rental fees

Guided trips

Other (please describe):

Total

Do you operate any other type of business or any other type of outfitting/guiding operations Yes No

If yes, please provide details

Outline receipts above Yes No

If so, list types of equipment sold

16–18 Yes

18–21 Yes

21 Yes

What are the minimum requirements and certifications for being an employee with your company [1]

What are the minimum requirements and certifications for being an employee with your company [2]

Road-use equipment: Are employee MVRs reviewed at a minimum annually? Yes No

Describe required training for reviewing MVRS [1]

Describe required training for reviewing MVRS [2]

Please list First Aid supplies and rescue equipment provided per rental [1]

Please list First Aid supplies and rescue equipment provided per rental [2]

What is the minimum and maximum age of participants? Renter: Min

Max

Min

Max

Min

Max

Outline risks of renting equipment in Yes

names/addresses of Yes

Liability release form Yes

A Liability Release will be provided at binding to use for all rentals; only our release will be acceptable Yes

Is there a suggested clothing or equipment list for your customers? No

Are helmets provided with all rentals regardless of age? Describe helmet types available No

If yes, please explain

Please list any required clothing or equipment during the rental [1]

Please list any required clothing or equipment during the rental [2]

Do you conduct a pre-ride briefing or safety check? Yes

Do you have a written pre-ride briefing or safety check?If yes, please provide a copy Yes

Do you conduct a pre-ride briefing or safety check? No

Do you have a written pre-ride briefing or safety check?If yes, please provide a copy No

Do you provide or require any type of communication devices during the rental (two-way radio, cell phone, etc Yes No

Section 5 — G. Equipment

What requirements do you review to approve renters [1]

What requirements do you review to approve renters [2]

What requirements do you review to approve renters [3]

List reasons you would decline a person from renting [1]

List reasons you would decline a person from renting [2]

Do you utilize video recording of signed waivers? Yes No

Require Yes

Require and Verify Yes

Neither Yes

Require Yes

Require and Verify Yes

Neither Yes

Please explain process

What type of experience is required to rent equipment

How is experience evaluated

Average length of a rental contract

Average cost per day

Do you offer chauffeur services with the rental? Yes No

Who is responsible for equipment maintenance

How often is equipment checked and inspected

Do you keep any maintenance records? Yes No

If yes, please describe

Do your customers rent any of your non-motorized equipment? Yes No

If yes, list all rented equipment other than motorized units

coverage up to a scheduled actual cash value amount. Coverage can be provided as a comprehensive package Yes No

owneragencycontractsInsured Yes

owneragencycontractsInsured

Other (describe):_1.

owneragencycontractsInsured Yes

owneragencycontractsInsured

Other (describe):_2.

Check Box413 (table cell near “owneragencycontractsInsured”) Yes

Check Box404 (table cell near “owneragencycontractsInsured”) Yes

Check Box407 (table cell near “owneragencycontractsInsured”) Yes

Check Box410 (table cell near “owneragencycontractsInsured”) Yes

Text4012 (table cell near “owneragencycontractsInsured”)

Check Box416 (table cell near “owneragencycontractsInsured”) Yes

Other (describe):_3.

Section 6 — Commercial Equipment Schedule

UNIT TYPE_Row_1

YEAR_Row_1

MAKE AND MODEL_Row_1

VIN # (12 DIGITS)_Row_1

*ACV VALUE_Row_1

UNIT TYPE_Row_2

YEAR_Row_2

MAKE AND MODEL_Row_2

VIN # (12 DIGITS)_Row_2

*ACV VALUE_Row_2

UNIT TYPE_Row_3

YEAR_Row_3

MAKE AND MODEL_Row_3

VIN # (12 DIGITS)_Row_3

*ACV VALUE_Row_3

UNIT TYPE_Row_4

YEAR_Row_4

MAKE AND MODEL_Row_4

VIN # (12 DIGITS)_Row_4

*ACV VALUE_Row_4

UNIT TYPE_Row_5

YEAR_Row_5

MAKE AND MODEL_Row_5

VIN # (12 DIGITS)_Row_5

*ACV VALUE_Row_5

UNIT TYPE_Row_6

YEAR_Row_6

MAKE AND MODEL_Row_6

VIN # (12 DIGITS)_Row_6

*ACV VALUE_Row_6

UNIT TYPE_Row_7

YEAR_Row_7

MAKE AND MODEL_Row_7

VIN # (12 DIGITS)_Row_7

*ACV VALUE_Row_7

UNIT TYPE_Row_8

YEAR_Row_8

MAKE AND MODEL_Row_8

VIN # (12 DIGITS)_Row_8

*ACV VALUE_Row_8

UNIT TYPE_Row_9

YEAR_Row_9

MAKE AND MODEL_Row_9

VIN # (12 DIGITS)_Row_9

*ACV VALUE_Row_9

UNIT TYPE_Row_10

YEAR_Row_10

MAKE AND MODEL_Row_10

VIN # (12 DIGITS)_Row_10

*ACV VALUE_Row_10

LENGTH (BOATS/PWC)_Row_1

ENGINE YEAR/MAKE (BOATS/PWC)_Row_1

ENGINE SERIAL # (BOATS/PWC)_Row_1

TOTAL HP (BOATS/PWC)_Row_1

MAX SPEED (BOATS/PWC)_Row_1

LENGTH (BOATS/PWC)_Row_2

ENGINE YEAR/MAKE (BOATS/PWC)_Row_2

ENGINE SERIAL # (BOATS/PWC)_Row_2

TOTAL HP (BOATS/PWC)_Row_2

MAX SPEED (BOATS/PWC)_Row_2

LENGTH (BOATS/PWC)_Row_3

ENGINE YEAR/MAKE (BOATS/PWC)_Row_3

ENGINE SERIAL # (BOATS/PWC)_Row_3

TOTAL HP (BOATS/PWC)_Row_3

MAX SPEED (BOATS/PWC)_Row_3

LENGTH (BOATS/PWC)_Row_4

ENGINE YEAR/MAKE (BOATS/PWC)_Row_4

ENGINE SERIAL # (BOATS/PWC)_Row_4

TOTAL HP (BOATS/PWC)_Row_4

MAX SPEED (BOATS/PWC)_Row_4

LENGTH (BOATS/PWC)_Row_5

ENGINE YEAR/MAKE (BOATS/PWC)_Row_5

ENGINE SERIAL # (BOATS/PWC)_Row_5

TOTAL HP (BOATS/PWC)_Row_5

MAX SPEED (BOATS/PWC)_Row_5

LENGTH (BOATS/PWC)_Row_6

ENGINE YEAR/MAKE (BOATS/PWC)_Row_6

ENGINE SERIAL # (BOATS/PWC)_Row_6

TOTAL HP (BOATS/PWC)_Row_6

MAX SPEED (BOATS/PWC)_Row_6

LENGTH (BOATS/PWC)_Row_7

ENGINE YEAR/MAKE (BOATS/PWC)_Row_7

ENGINE SERIAL # (BOATS/PWC)_Row_7

TOTAL HP (BOATS/PWC)_Row_7

MAX SPEED (BOATS/PWC)_Row_7

LENGTH (BOATS/PWC)_Row_8

ENGINE YEAR/MAKE (BOATS/PWC)_Row_8

ENGINE SERIAL # (BOATS/PWC)_Row_8

TOTAL HP (BOATS/PWC)_Row_8

MAX SPEED (BOATS/PWC)_Row_8

LENGTH (BOATS/PWC)_Row_9

ENGINE YEAR/MAKE (BOATS/PWC)_Row_9

ENGINE SERIAL # (BOATS/PWC)_Row_9

TOTAL HP (BOATS/PWC)_Row_9

MAX SPEED (BOATS/PWC)_Row_9

LENGTH (BOATS/PWC)_Row_10

ENGINE YEAR/MAKE (BOATS/PWC)_Row_10

ENGINE SERIAL # (BOATS/PWC)_Row_10

TOTAL HP (BOATS/PWC)_Row_10

MAX SPEED (BOATS/PWC)_Row_10

LIEN HOLDER NAME & ADDRESS_Row_1

UNITS OF INTEREST_Row_1

LIEN HOLDER NAME & ADDRESS_Row_2

UNITS OF INTEREST_Row_2

LIEN HOLDER NAME & ADDRESS_Row_3

UNITS OF INTEREST_Row_3

Section 7 — Representations And Warranties

Applicant

Agent/Broker

Signature

Print name

Submissions are routed to our service team for review. We use the information you provide only to prepare your quote.