Equine and Farm - General Liability


    Section 1 - General Information

  • Section 2 - Organization

  • *If "YES", please provide "Loss Run" report from your current insurance company.

  • Section 5 - General Liability

  • (If "NO" to volunteers over 18, complete the Abuse Supplement - section 12)

  • What is the experience requirements for:

  • Animals

  • Adoption

  • Events

  • Other Activities

  • Other Exposures

  • (If "YES" to offering day camps/activities for children, complete the Abuse Supplement - section 12)

  • Training

  • Animal Control/Humane Officers

  • Director & Officers Liability (If "Non Applicable", please move to next section)

    This is a claims made policy.

  • (Copy of prior uninterrupted insurance is required to honor a retroactive date prior to effective date)

  • Retention is $1,000

    Exposures

  • *If "YES", please provide "Loss Run" report from current company and a copy of the current Directors & Officers Liability Policy declaration page*

  • Financial Information:

  • If your organization is new, please provide estimated financial data above.

  • Financial Controls

  • Claims/Incidents

  • Hired & Non-Owned Auto Liability (If "Non Applicable", please move to next section)

  • Section 12 - Abuse and Youth Volunteer Supplemental

    Prior to hire, does the organization do the following?

    Obtain a complete employment/volunteer application?

  • Check personal or business references?

  • Check National Sex Offender Public Registry?

  • Conduct criminal background checks?

  • Have a written sexual abuse policy?

  • Do staff and volunteers sign-off on abuse policy?

  • Youth Volunteers


  • Warranty

    The application for this policy is incorporated and warranted as part of this policy. This insurance policy is being issued in reliance on the accuracy, truthfulness, and completeness of the application.

    Any inaccuracy, falsity, or omission, regardless of the nature, shall entitle us to rescind the policy.

    I declare that the information provided in this application is accurate, true, and complete and that each location currently complies and will comply with the rules and regulations set by state and federal law.

    I understand that if I willfully do not comply with these rules and regulations that coverage is null and void and any claims may be denied and premium returned.

    If the information supplied on the application changes between the date of the application and the effective date of the insurance, I will immediately notify AWOIP of any changes.

    In the event of any changes AWOIP may withdraw or modify any outstanding quotations and/or agreement to bind the coverage.

    I must notify AWOIP of any changes in operation of this business during the policy period, and failure to do so may result in cancellation of the coverage or denial of a claim.

    I hereby authorize AWOIP to obtain information necessary for the evaluation in determining acceptability, including, but not limited to, physical inspections and inquiries with the state/county regulators.

    This application does not guarantee approval for insurance. AWOIP reserves the right to decline coverage.


    This application requires the following attachments:

  • By checking the box below, you are agreeing to the Terms & Conditions, including, but not limited to:

    The policy will be issued in reliance on the accuracy, truthfulness, and completeness of the application. Any inaccuracy, falsity, or omission, regardless of the nature, shall entitle us to rescind the policy.

    A copy of this application will be incorporated and attached to the Policy.

    Terms & Conditions


  • Cyber Suite Liability - Opt-Out

    If you do not wish to have Cyber Suite Liability Insurance extended to cover your business, you will need to complete the opt-out form and forward to your agent.


    I decline to have the Cyber Suite Liability Insurance extended to cover my business.

    I understand that I am responsible for the cost of an actual or suspected violation of a privacy regulation due to a security breach.

    This includes results in an unauthorized release of protected personal information which is any private, non-public information of any kind in our care, custody or control.

    I understand and agree that the Cyber Suite Liability Insurance will not be available to me to recover expenses due to a security breach.

    I hereby certify that I am authorized to sign on behalf of my company, partnership, etc.


  • Employment Practices Liability - Opt-Out

    If you do not wish to have the Employment Practices Liability Insurance extended to cover your business, you will need to complete the opt-out form and forward to your agent.


    I decline to have the Employee Liability Insurance extended to cover my business.

    I hereby certify that I am authorized to sign on behalf of my company, partnership, etc.