Checklist of Required Items

Property and Casualty Insurance for Private Clubs

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Completed Acord Applications, including expiring and target premiums 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 Completed and Signed Supplemental Applications Copies of All Applicators' Licenses Copy of Prior Pollution Declaration Page (Including retroactive date and Tank Schedule) Completed Directors & Officers (Including EPLI and Fiduciary) Liability Application - include all required attachments Copy of Current 5500 Annual Return Fiduciary Liability Questionnaire is needed only if ERISA Liability is desired Excess Crime (if limits exceed $250,000) Storage Tank Application Brokerage Agreement including W9 form Liberty Mutual Group of Companies is the underwriter for the Program and offers financial stability, excellent claims service, and specialized loss control services.