For manual submission, download this form here.

COMMERCIAL GENERAL LIABILITY QUESTIONNAIRE FOR
EQUESTRIAN FACILITIES OPERATORS

TO BE COMPLETED AND SIGNED BY THE INSURED. ALL VALUES ARE SUBJECT TO REVIEW BY UNDERWRITING.

IMPORTANT: THIS IS NOT A BINDER. INCOMPLETE AND/OR UNSIGNED APPLICATIONS WILL BE RETURNED.

NAME OF INSURED (to appear on policy)*:
OPERATING NAME*:
STREET ADDRESS*:
CITY*:
POSTAL CODE*:
PROVINCE*:
PRIMARY CONTACT NAME*:
BUSINESS PHONE NUMBER*:
FAX NUMBER:
EMAIL ADDRESS*:
INSURED IS:

PROPOSED INCEPTION DATE FOR INSURANCE:

NAME ALL PARTNERS AND/OR OFFICERS


ADDITIONAL INSUREDS TO BE NAMED ON POLICY (please explain working relationship)

DO YOU OWN / RENT / LEASE PREMISES OR PART THEREOF
please provide location, describe building(s) and advise how often used and for what purpose.

IF PREMISE(S) IS(ARE) RENTED / LEASED, PLEASE PROVIDE OWNER INFORMATION:

NAME OF OWNER(S):
STREET ADDRESS:
CITY:
POSTAL CODE:
PROVINCE:
BUSINESS PHONE NUMBER:
HOME PHONE NUMBER:
FAX:
EMAIL ADDRESS:

TOTAL ACREAGE OF FARM:

ARE ANY CROPS GROWN? Yes No
If yes, please describe.

ARE ANY PRODUCTS SOLD TO THE GENERAL PUBLIC? Yes No
If yes, please explain.

DO YOU OWN OR LEASE ANY OTHER PROPERTY? Yes No
If yes, please provide legal address & purpose of lease.

DO YOU (SUB)LEASE ANY PART OF THE PREMISES TO OTHERS? Yes No
If yes, for what purpose?

IS THIS THE FULL-TIME OCCUPATION/ACTIVITY OF THE APPLICANT? Yes No
1) If NO, what is the full-time occupation?
2) If YES, length of time in business at this location
3) Please explain total experience in the equestrian field, including years

PLEASE LIST TYPE AND USE OF ALL BUILDINGS ON PROPERTY:

IS THERE AN INDOOR ARENA ON THE PROPERTY? Yes No Dimensions:

IS THERE A VIEWING ROOM? Yes No

Yes No If Yes, type of heat:

IS THERE A SWIMMING POOL ON THE PROPERTY? Yes No
dimensions: depth: use:

IS THERE A POND ON THE PROPERTY? Yes No
dimensions: depth: use:

ARE THERE SHELTERS PROVIDED IN PADDOCKS, RUNS? Yes No

WHAT TYPE OF FENCING IS USED ON THE PROPERTY?

AGE OF FENCING:

IS THE FENCING GOOD ENOUGH TO PREVENT HORSES FROM GETTING LOOSE? Yes No

IS THERE A GATE IN PLACE TO PREVENT HORSES FROM GETTING LOOSE ONTO THE ROADWAY? Yes No
If NO, what safety measures are in place?

WHO IS RESPONSIBLE FOR THE MAINTENANCE OF BUILDINGS, FENCING, ETC.?

HORSE SHOWS
DO YOU ORGANIZE OR OPERATE HORSE SHOWS ON THE PREMISES? Yes No
How many annually? Length of show:
DO YOU ORGANIZE OR OPERATE HORSE SHOWS OFF THE PREMISES? Yes No
How many annually? Length of show:
TYPE OF SHOW(S):	Non-Permit (boarders/members only) Non-Permit (open) Equine Canada Permit (sanctioned)
If Equine Canada Shows, please provide dates required:
SHOW 1	from: to:
SHOW 2	from: to:
SHOW 3	from: to:
SHOW 4	from: to:
DO YOU PROVIDE STABLING FOR COMPETING (OUTSIDE) HORSES? Yes No
HOW MANY HORSES PARTICIPATE AT THE SHOWS?
WHAT TYPE OF CLASSES DO YOU OFFER AT THE SHOWS?

HORSE CLINICS

DO YOU ORGANIZE OR OPERATE CLINICS ON THE PREMISES? Yes No

DO YOU ORGANIZE OR OPERATE CLINICS OFF THE PREMISES? Yes No

TYPE OF CLINIC:

Western

Combined Training

Hunter / Jumper

Dressage

Other (please specify)

HOW MANY PARTICIPANTS AT EACH CLINIC?

ARE THE CLINICIANS INSURED SEPARATELY UNDER THEIR OWN POLICY? Yes No

IS A RELEASE SIGNED BY ALL RIDERS / MEMBERS, OR IF A MINOR, SIGNED BY PARENT / GUARDIAN? Yes No

Please mail or fax a copy of the release used.

WHAT TYPE OF SAFETY GEAR IS REQUIRED OF ALL RIDERS IN SHOWS, CLINICS, LESSONS, ETC.?

DO YOU PROVIDE ANY OF THE SAFETY GEAR? Yes No
If Yes, how often is it checked?

DO YOU PROVIDE FOOD, BEVERAGES AND/OR ALCOHOL AT ANY SHOW OR CLINIC? Yes No
If Yes, please provide the breakdown of annual gross receipts:	Food & Beverage:
	Alcohol:
Is provided food/beverage catered or homemade?	catered homemade
If alcohol is served, in whose name is the liquor license?

RIDING INSTRUCTION

DO YOU PROVIDE RIDING INSTRUCTION ON THE PREMISES? Yes No
Number of students:	Number who are boarders:
DO YOU PROVIDE RIDING INSTRUCTION OFF THE PREMISES? Yes No
Number of students:

DO YOU OWN OR LEASE HORSES USED FOR RIDING INSTRUCTION? Yes No
If YES, how many (max)?

DO YOU OWN ANY HORSES NOT USED FOR RIDING INSTRUCTION? Yes No
If YES, how many (max)?
Please describe activity/use:

AVERAGE NUMBER OF STUDENTS (EXCLUDING BOARDERS) DURING THE WINTER MONTHS:
AVERAGE NUMBER OF STUDENTS (EXCLUDING BOARDERS) DURING THE SUMMER MONTHS:

INSTRUCTORS ARE:

owners

employees

contractors

LIST QUALIFICATIONS, EXPERIENCE AND AGE OF ALL INSTRUCTORS, INCLUDING YOURSELF IF YOU GIVE LESSONS

TYPE OF LESSONS:

Western	Pleasure/Halter	Games	English Equitation
Hunter / Jumper	Dressage	Combined Training (3 day)	Vaulting

Other (please specify)

DO YOU PROVIDE RIDING INSTRUCTION TO THE PHYSICALLY OR MENTALLY HANDICAPPED? Yes No

If YES, please indicate...

number of students: age of students:

instructors:

LIST QUALIFICATIONS, EXPERIENCE AND AGE OF:
Instructor(s):
Horse(s):

DO ANY OF YOUR BOARDERS HAVE COACHING/TRAINING PROVIDED BY OUTSIDE CONTRACTORS (coaches not employed by you/farm)? Yes No

**NOTE: Outside Coaches will not be insured by this policy for their activities. If they operate on your premises, it is a requirement of this insurance that they provide proof of liability insurance with appropriate coverages and limits. Further, it is required that they name you on their policy as Additional Insured and that we receive a copy of this endorsement.**

TRAINING / BOARDING

DO YOU TRAIN HORSES OTHER THAN BOARDED HORSES? Yes No

owned: non-owned:

DO YOU ATTEND HORSE SHOWS WITH BOARDERS AND/OR HORSES IN TRAINING (non-owned) OFF PREMISES? Yes No

If YES, how often annually?
Do the owners of the horses also attend?	Yes No
DO YOU BOARD HORSES? Yes No
If YES, how many maximum?
How many horses during summer?
How many horses during winter?
What is the average value of boarded horses?
What is the minimum value of boarded horses?	How many horses at this value do you board?
What is the maximum value of boarded horses?	How many horses at this value do you board?

BREEDING

DO YOU OWN A STALLION USED FOR BREEDING ON OR OFF YOUR PREMISES? Yes No
If YES, how many?
HOW MANY (non-owned) MARES DID THE STALLION(S) BREED ON OR OFF PREMISES (natural/A.I.)...
LAST YEAR? NEXT YEAR?
WHAT IS THE AVERAGE VALUE OF MARES (non-owned) VISITING YOUR STALLION(S)?
DO YOU HARVEST AND/OR TRANSPORT SEMEN? Yes No
If YES, how often and where?

TRANSPORTING OTHER PEOPLE'S HORSES

DO YOU TRANSPORT HORSES FOR OTHERS? Yes No

DO YOU USE YOUR OWN TRUCK AND TRAILER FOR TRANSPORTING OTHER PEOPLE'S HORSES? Yes No

WHAT PERCENTAGE OF YOUR BUSINESS DOES TRANSPORTING REPRESENT? %

WHAT PERCENTAGE OF THIS BUSINESS IS "SHIPPING OF BOARDED HORSES"? %

ANNUAL SHIPPING MILEAGE:

Kms

WHAT IS THE HIGHEST VALUE OF HORSES TRANSPORTED?

WHAT IS THE AVERAGE VALUE OF HORSE TRANSPORTED?

IN WHAT NAME IS THE TRUCK/TRAILER REGISTERED IN?

HOW MANY TRAILERS DO YOU OWN?

MISCELLANEOUS INFORMATION

DO YOU OWN ANY OTHER LIVESTOCK? Yes No

DO YOU OWN ANY DOGS? Yes No

HAVE THE DOGS EVER BITTEN OR THREATENED TO BITE? Yes No

DO YOU JUDGE, COURSE DESIGN, STEWARD OR OFFICIATE AT ANY HORSE SHOWS? Yes No

If YES, number of times at...

Equine Canada Permit shows:

Non-Equine Canada Permit shows:

Are the shows held on or off premises?

HOW MANY EMPLOYEES DO YOU HAVE? Full Time Part Time Casual

Yes No

DO YOU OWN A TRACTOR? Yes No

DO YOU OWN AN A.T.V., SNOWMOBILE, MOTORCYCLE OR ANY OTHER 'OFF-ROAD' RECREATIONAL VEHICLE? Yes No

**NOTE: These vehicles must be insured separately under an automobile policy.**

RIDING CAMPS

DO YOU OPERATE DAY CAMPS? Yes No

DO THE PARTICIPANTS STAY OVERNIGHT? Yes No

ARE THE COUSELLORS THE SAME EMPLOYEES WORKING ON THE FARM? Yes No

DATES OF CAMP(S):

HOW MANY SESSIONS?

HOW LONG IS EACH SESSION?

HOW OLD ARE THE PARTICIPANTS?

HOW MANY PARTICIPANTS IN EACH SESSION?

ARE THESE THE SAME STUDENTS WHO NORMALLY RECEIVE RIDING INSTRUCTION FROM YOU (as specified in "RIDING INSTRUCTION")? Yes No

DO YOU PROVIDE ANY FOOD OR BEVERAGE TO THE PARTICIPANTS? Yes No

WHAT ACTIVITIES ARE PART OF THE CAMP?

**NOTE: Please provide a schedule of a typical day at camp, showing ALL activities available.**

IF ACTIVITIES INCLUDE SWIMMING:

ARE THERE ANY OTHER ACTIVITIES, OR DO YOU PROVIDE ANY OTHER SERVICE ON THE PREMISES NOT DESCRIBED ABOVE? Yes No

**NOTE: If any activity is off premises and you provide transportation to the participants, please provide details of the activity to your automobile insurer.**

RISK MANAGEMENT:Please provide a copy of your risk management form(s) or waiver(s) of liability.

BOARDING AGREEMENT:Please provide a copy of your boarding agreement.

GROSS REVENUE

OPERATION

LAST YEAR

NEXT YEAR (projected)

TOTALS

**NOTE: Trail riding and/or rental of horses to the general public on an hourly basis, hay rides, pony rides, sleigh rides, are excluded under this insurance policy.**

List all CLAIMS, POTENTIAL CLAIMS or ACTIONS pending or brought against you or any employee in the last three years


HAVE YOU HAD PREVIOUS INSURANCE?	Yes No
If Yes, indicate Company name:
Indicate policy number:
Expiry date:

I UNDERSTAND THAT THE INSURANCE BEING APPLIED FOR, IF ACCEPTED BY THE INSURING COMPANY, WILL BE BASED ON THE STATEMENTS AND INFORMATION IN THIS APPLICATION.

IF ANY INFORMATION IS WITHHELD OR FALSELY STATED, INSURANCE ISSUED MAY BE SUBJECT TO CANCELLATION OR MODIFICATION AS PROVIDED BY THE LAWS OF THE PROVINCE IN WHICH THE APPLICATION WAS ACCEPTED OR THE POLICY ISSUED.

I CERTIFY THAT THE INFORMATION HEREWITH IS TRUE AND IS A COMPLETE DESCRIPTION OF THE ACTIVITIES THAT I WISH TO INSURE AND FURTHER, THAT ALL CLAIMS INFORMATION AS REQUESTED HAS BEEN COMPLETELY DISCLOSED.

SIGNATURE (ENTER YOUR NAME)*:		date signed
			D	M	YEAR

COMMERCIAL GENERAL LIABILITY QUESTIONNAIRE FOREQUESTRIAN FACILITIES OPERATORS

COMMERCIAL GENERAL LIABILITY QUESTIONNAIRE FOR
EQUESTRIAN FACILITIES OPERATORS