Christmas Tree Lot Insurance Questionnaire

Applicant's Name: *

Address: *

Mailing Address

Address (cont): *

Mailing Address - continued

Contact: *

Email *

Telephone: *

Website

Fax:

Applicant is:

Individual Partnership Corporation Other (specify) Other

Current Carrier:

Expiration Date:

Limits: ($)

Premium: ($)

Deductible: ($)

Limit of Liability Desired:

$300,000 $500,000 $1,000,000

GENERAL INFORMATION

1. Number of Sales Locations (Please list address of each location if owned or leased. List additional locations on separate page.)

Location 1:

Own Lease

Location 2:

Own Lease

2. Are any of the locations a nursery or tree farm?

Yes No

2a. If yes, what is the total acreage owned or leased?

3. Are customers allowed to cut or trim trees?

Yes No

3a. If yes, tools provided to cut trees-check all that apply:

Hand Saws Power Saws Hatchet or Axe Other

4. Do you load trees on/in customer vehicles?

Yes No

5. Other Activities:

5a. Hay Rides

Yes No

5ai. If yes, describe:

5b. Sleigh Rides

Yes No

5bi. If yes, describe:

5c. Amusement Devices

Yes No

5ci. If yes, describe:

5d. Food Sales

Yes No

5di. If yes, describe:

5e. Check if applicable:

Sledding/Tubing Hill Ice Skating Skiing Petting Zoo Craft Show Other

6. What are anticipated gross sales?

7. Will you have a max capacity limit for the number of people allowed on the premises at one time?

Yes No

7a. If yes, what will this capacity be?

8. Will you have signs posted regarding social distancing and mask recommendations?

Yes No

9. Will sanitizing stations be set up throughout the property?

Yes No

SIGNATURE

The information I have provided is true and accurate to the best of my knowledge. I have not willfully concealed or misrepresented any material fact(s) or information. I understand completion of this questionnaire does not compel the company to provide coverage.

Signature

Clear

Or Enter Your Full Name as Signature:

Date:

Questions? 877-244-9090
Kevin Morency | kmorency@morencyinsurance.com

Morency & Associates Inc.
141 New Shackle Island Rd, Hendersonville, TN 37075
Fax: 615-452-6580

https://christmastreefarminsurance.com/

Christmas Tree Farm Insurance Questionnaire