Premier Canada Assurance Managers Ltd. Is One of Canada S Largest Managing Underwriting s2

ADVENTUREGUARD SUPPLEMENTAL QUESTIONNAIRE – EQUINE RISKS / Page 1 of 1
THIS IS A SUPPLEMENTAL QUESTIONNAIRE ONLY. PLEASE COMPLETE THE ADVENTURE ACTIVITIES APPLICATION FIRST.
APPLICANT:
Legal Name of Company:
Operating Name:
EQUINE OPERATIONS:
1) Are horses used in:
a. Trail Rides? / Yes No
b. Sleigh Rides? / Yes No
i. Please describe Sleigh – how many clients at a time, how high are the sides, what is the terrain:
c. Hunting? / Yes No
i. If Yes, Please complete the hunting supplement.
d. Pony Rides? / Yes No
e. Hay Rides? / Yes No
i. Please describe wagon – how many clients at a time, how high are the sides, what is the terrain, what kind of wheels?
2) How many horses are used in your operations?
a. Are the Rented/Leased Owned Both
3) Do you require all participants to use an industry approved helmet? Yes No
a. If NO, under what circumstances will you waive this requirement?
4) How do you match horse to rider?
5) Do your participants ride?
a. Western? Yes No %
b. English? Yes No %
6) Do you allow participants to ride double? Yes No
7) Do you board horses for a fee? Yes No
8) Do you allow participants to take part in the following:
a. Jumping / Yes No
b. Racing / Yes No
c. Roping / Yes No
d. Barrel Racing / Yes No
e. Cattle Drives / Yes No
f. Branding / Yes No
g. Any rodeo style events / Yes No
THIS IS A SUPPLEMENTARY QUESTIONNAIRE ONLY. A QUOTATION CANNOT BE OFFERED WITHOUT THE COMPLETED ADVENTURE ACTIVITIES APPLICATION.

Premier Canada Assurance Managers Ltd. is one of Canada’s largest Managing Underwriting Agents. The underwriting insurance carrier varies by line of business and region - please refer to specific quote for declaration of the underwriting insurance company(s).

** Email application and attachments to - **
Vancouver - T 604.669.5211 F 604.669.2667 / London - T 519.850.1610 F 519.850.1614
Rev. Jan 21, 2015