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• Copies of all current policies, including expiring premiums
  (required for our unique experience rating system)
• Completed Acord Applications
• Schedule of Current Vehicles
• Schedule of Drivers and License Numbers
  • Copies of Licenses
• Schedule of maintenance Equipment & Golf Carts
  (Include Replacement Cost Value for each item)
• Four Years of Hard-Copy Loss Information for each coverage being requested
• Current Audited Financial Statement or Income and Expense Statement
• Copy of Score Card for the Golf Course
• Completed and Signed Golf & Country Club Program Questionnaire
• Completed Fiduciary Questionnaire
• Statement of Property Values and Appraisal if Available
• Completed Golf Course or Country Club Pollution Liability Supplemental Application (Pesticide/Herbicide)
  • Copies of All Applicators' Licenses
  • Copy of Prior Pollution Declaration Page
    (Including retroactive date and Tank Schedule)
• Completed Directors & Officers Liability Application
  • NCA Directors' and Officers' / Employment Practices
  • Fiduciary Liability Application
    • Schedule of Directors and officers
    • Copy of By-Laws and Employee Handbook
    • Copy of Current 5500 Annual Return
    • NCA Program Highlights
• Storage Tank Pollution Liability Application
• Hartford Excess Crime Application
• Please include an original letterhead and sign the enclosed letters of authorization to be utilized as needed
• Brokerage Agreement including W9 form

 * Fiduciary Liability Questionnaire is needed only if ERISA Liability is desired

Liberty Mutual Group is the underwriter for the Program and offers financial stability, excellent claims service, and specialized loss control services.