Business office and mailing address:
Specify split of activities conducted by the:
Explain how you verify your staff’s qualifications, certifications, and experience.
Self-employed owners may voluntarily opt out and Independent Contractors may be exempted (refer for advise to your provincial WC office).
General Financial Information
How much of this is from donations :
Insurance History Information
If this is an Outdoor Adventure business that is described below check off
activities to be insured under this policy. Check all that are applicable.
IF YOUR BUSINESS INCLUDES ACTIVITIES NOT LISTED HERE, PLEASE CHECK 'OTHER' AND DESCRIBE BELOW.
Please expand on the description of all operations from above.
If #22 above does not describe your activities, please describe your business operations as fully as possible:
Trails. If your business operations include work on off-road trails in Canada,
please advise the nature of your responsibilities for the trails.
Ex. Contractor developing trails, user group maintaining trails, organization simply utilizing existing trails.
How many kilometers of trails are involved?
Please detail any responsibilities you have if bridges are involved.
Please indicate whether you have developed and implemented the following documents, plans, and procedures as part of your overall risk management program:
If you currently have coverage placed elsewhere (not with OASIS):
Effective date of coverage desired:
Commercial General Liability Insurance Limit desired:
$1,000,000 $2,000,000 $5,000,000
More than $5,000,000
If you require certificates of insurance for third parties,
please indicate the name and address of the entity requesting the certificate as well as the reason for the certificate.
Loss History for the last five years:
Where (a) an Applicant for this contract gives false particulars to the prejudice of the insurer or knowingly misrepresents or fails to disclose any fact in any part of this application
required to be stated therein; or (b) the insured contravenes a term of the contract or commits a fraud; or (c) the insured willfully makes a false statement in respect of a claim, a claim
will become invalid and the Insured’s right to recovery is forfeited. The Applicants have reviewed contents of this application and acknowledge that all the information is true and '
correct and understand that this application for insurance is based on the truth and completeness of this information.
I have provided personal information in this document and I may in the future provide further personal information. Some of this personal information may include, but is not limited to, my credit information and claims history. I authorize my broker or insurance company to collect, use and disclose any of this personal information, subject to the law and to my broker’s or insurance company’s policy regarding personal information, for the purposes of communicating with me, assessing my application for insurance and underwriting my policies, evaluating claims, detecting and preventing fraud, and analyzing business results. I confirm that all individuals whose personal information is contained in this document have authorized that I agree to the above on their behalf.