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5. Are any repairs performed in house? Yes No
If yes, please describe:
6. Are ATV’s used on the property? Yes No
If yes, please describe vehicles, use, and who has access to vehicles: ___________________________________
__________________________________________________________________________________________________
7. Do your employees use their personal vehicles completing their job duties? Yes No
If yes, please describe: ________________________________________________________________________
__________________________________________________________________________________________________
8. Do you hire or rent any motor vehicles for short periods of time (rentals, not long term leases)? Yes No
If yes, please describe: ________________________________________________________________________
__________________________________________________________________________________________________
GENERA
L INFORMATION river and Vehicle/ATV Safety Information
1. Do you permit hunting, fishing, or other sporting or recreational activities? Yes No
Describe:
a. Is a fee charged? Yes No
2. Are guests that use the property for hunting and similar activities required to sign waivers? Yes No
3. Do you provide saddle animal rental? Yes No
4. If yes, do you require waivers from all participants? Yes No
5. Do you board animals for other on your premises? Yes No
FRAUD WARNING
NOTICE TO ALABAMA, ALASKA, ARIZONA, ARKANSAS, CALIFORNIA, CONNECTICUT, DELAWARE, GEORGIA, IDAHO, ILLINOIS, INDIANA, IOWA, KANSAS,
MARYLAND, MASSACHUSETTS, MICHIGAN, MINNESOTA, MISSISSIPPI, MISSOURI, MONTANA, NEBRASKA, NEVADA, NEW HAMPSHIRE, NORTH CAROLINA,
NORTH DAKOTA, OREGON, RHODE ISLAND, SOUTH CAROLINA, SOUTH DAKOTA, TEXAS, UTAH, VERMONT, WASHINGTON, WEST VIRGINIA, WISCONSIN, AND
WYOMING APPLICANTS: In some states, any person who knowingly, and with intent to defraud any insurance company or other person, files an application for
insurance or statement of claim containing any materially false information, or, for the purpose of misleading, conceals information concerning any fact material
thereto, may commit a fraudulent insurance act which is a crime in many states.
NOTICE TO COLORADO APPLICANTS: It is unlawful to knowingly provide false, incomplete or misleading facts or information to an insurance company for the
purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance
company or agent of an insurance company who knowingly provides false, incomplete or misleading facts or information to a policy holder or claimant for the
purpose of defrauding or attempting to defraud the policyholder or claiming with regard to a settlement or award payable for insurance proceeds shall be
reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.
NOTICE TO DISTRICT OF COLUMBIA APPLICANTS: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding
the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially
related to a claim was provided by the applicant.
NOTICE TO FLORIDA APPLICANTS: Any person who knowingly and with intent to injure, defraud or deceive any insurance company files a statement of claim
containing any false, incomplete or misleading information is guilty of a felony of the third degree.
NOTICE TO HAWAII APPLICANTS: For your protection, Hawaii law requires you to be informed that presenting a fraudulent claim for payment of a loss or benefit
is a crime punishable by fines or imprisonment, or both.
HUNTING AND SADDLE ANIMAL
