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Application & Forms


     
A. Animal Life & Health      
    INSURANCE USE THIS
SUBJECT OF INSURANCE INSURER TYPE or PURPOSE APPLICATION
       
1-A. Application for HORSE MORTALITY INSURANCE All Companies, Except Hartford Horse Mortality, Surgical,                       Major Medical NAHA M -73-Side A
1-B. Vet Exam Form All Companies, Except Hartford Horse Mortality, Surgical,                   Major Medical NAHA M-73-Side B
       
2. Animal Mortality Application Hartford Ins Co Horse Mortality, Surgical,                   Major Medical LS 16 01 06 06
       
3. Horse Supplement Application All Companies Declare all Uses of a Horse  AA.AllComp.100
       
4. (Owner’s) Statement of Health All Companies, Except Hartford Declare Health & Soundness                  of Horse  AA.AllComp.101
       
5. (Owner’s) Statement of Health – Horses Only Hartford Ins Co Declare Health & Soundness                of Horse LS 16 23 03 06
       
6. Veterinarian’s Certificate of Examination All Companies Veterinarian’s Statement of Health Vet Exam 289.pdf
       
       
7. Justification of Value Record All Companies, Except Hartford To Establish Value of Horse FORMM-99.DOC
       
8. Substantiation of Value Form Hartford Ins Co. To Establish Value of Horse LS 16 22 03 06
       
9. Livestock Named or Specified Perils Application All Companies To Apply for Limited                                 Perils Coverage FORMM76 07/24/2007
       
10. International Air Transit Information Form All Companies To Apply for Air Transit Coverage  AA.AllComp.107
       
11. Loss of Use Examination Form Great American Ins Companies To Apply for Loss of Use Ins 5/001
       
12. Loss of Use Supplemental Questionnaire Great American Ins Companies To Apply for Loss of Use Ins  AA.GAIC.102
13. Loss of Use Renewal Examination Great American Ins Companies Vet Exam Form to Renew                       Loss of Use End. 5/001
       
14. Loss of Use Form Diamond States Ins Companies To Apply for Loss of Use Ins AEIG LOU Vet Cert
15. Stallion Breeding Soundness Veterinary Exam Great American Ins Companies To Apply for Stallion Infertility Ins AA.GAIC.103
       
16. Stallion Statement of Breeding Condition by Owner Great American Ins Companies To Apply for Stallion Infertility Ins AA.GAIC.104
       
17. Accident, Sickness and Disease Stallion Infertility - American Equine Ins Group To Apply for Stallion Infertility Ins AA.AEIG.105
       Supplemental Application      
18. Pending  Pending  Pending Pending
       
19. Stallion Infertility (Accident, Sickness, and Disease) Hartford Ins Co. To Apply for Stallion Infertility Ins LS 16 28 03 06
       
20. Breeding Soundness Evaluation Hartford Ins Co To Apply for Stallion Infertility Ins LS 16 27 03 06
       
 21. Animal Mortality Application / Other Than Horses                                            Hartford Ins Co & Other Cos  Life Ins on Animals other than horses  LS 16 24 03 06
               
       
 B.  HORSE BUSINESS TYPE  INSURER  INSURANCE TYPE  USE THIS APPLICATION
1. Diversified Horse Business a. Western World Group Liability NAHA Form 00-1 (14 pages)
     (Multiple Activity Types) b. Western World Group Equipment Floater NAHA Form 296 (3 Pages)
  c. Western World Group Home, Buildings, Equipment NAHA Form 298 (12 Pages)
  d. Great American Ins Co. Home, Buildings, Equipment, Liability GAIC Farm-AA-1 (13 Pages)
  e. Great American Ins Co. Care, Custody & Control Liability GAIC CCC-AA-2 (4 Pages)
  f. Great American Ins Co. Umbrella Liability GAIC Umbr–AA-3 (2 Pages)
       
2. Horse Owner, Boarding, a. Western World Group Liability NAHA Form 141 (3 Pages)
     Breeding, Training: b. Western World Group Equipment Floater NAHA Form 296 (3 Pages)
     8 Horses or Less      
       
3. Instructor a. Western World Group Liability NAHA Form 290 (5 Pages)
     (No Other Activities) b. Western World Group Equipment Floater NAHA Form 296 (3 Pages)
       
4. Horse Rental & Trail Rides, a. Western World Group Liability NAHA Form 291 (5 Pages)
      Guides & Outfitters b. Western World Group Equipment Floater NAHA Form 296 (3 Pages)
      (No Other Activities)      
5. Pony Ride Concession a. Western World Group Liability NAHA Form 289 (5 Pages)
      (No Other Activities) b. Western World Group Equipment Floater NAHA Form 296 (3 Pages)
       
6. Horse Drawn Vehicle Rides a. Western World Group Liability NAHA Form 292 (5 Pages)
      (No Other Activities) b. Western World Group Equipment Floater NAHA Form 296 (3 Pages)
       
7. Short Term Services: Western World Group Liability NAHA Form 154 (4 Pages)
     Pony Rides, Horse Drawn Rides,      
     Photo Prop (No other Activities)      
       
8. Short Term Events, Western World Group Liability NAHA Form 36 (2 Pages)
     Exhibitions, and Competitions      
     (No Other Activities)      
       
9. Farrier / Blacksmith a. Western World Group Liability NAHA Form 293 (3 Pages)
  b. Western World Group Equipment Floater NAHA Form 297 (2 Pages)
       
C. Benevolent Horse Clubs & Associations Liability      
    INSURANCE USE THIS
CLUB TYPE INSURER TYPE APPLICATION
1. Riding & Breed Clubs Western World Group Liability NAHA Form 32 (3 Pages)
       
2. Mounted Patrol Units Western World Group Liability NAHA Form 258 (2 Pages)
      Questionnaire      
       
3. Horse Rescue Orgs Western World Group Liability NAHA Form 300 (4 Pages)
       
4. Firearms Carry and / or Use Western World Group Liability NAHA Form 257 (1 Page)
      Questionnaire      
       
5. Short Term Events, Exhibitions, Western World Group Liability NAHA Form 36 (2 Pages)
      and Competitions      
      (No Other Activities)      
       
       
       
D. Directors & Officers Liability      
    INSURANCE USE THIS
  INSURER TYPE APPLICATION
1. Directors & Officers Tudor Insurance Co Liability TU DEPL (4 Pages)
     All States      
       
       
E. Agri-Tourism      
    INSURANCE USE THIS
BUSINESS TYPE INSURER TYPE APPLICATION
1. Agri-Tourism – Diversified Various Liability Application Pending
       
2. Tractor Drawn Rides Western World Group Liability NAHA Form 294 (3 Pages)
  (No Other Activities)    
       
       
       
    FOR USE  
F. Miscellaneous Forms INSURER WITH FORM NO.
       
1. Prior Incident/Claim Disclosure – Liability Western World Group   NAHA Form 254
       
2. Insured’s Statement of Western World Group   NAHA Form 269
     No Claims, Losses, or Incidents  
       
       
       
       
    FOR USE  
G. Claims Reporting Forms INSURER WITH FORM NO.
       
1. First Report – Incident / Accident / Claim  Western World Group Liability NAHA Form 14
       
2. Staff Witness Report  Western World Group Liability NAHA Form 210
     Liability Incident / Accident / Claim      
       
       
       
    FOR USE  
H. Forms Order Blanks INSURER WITH FORM NO.
1. NAHA Member Forms Order Varies  To Order Member Forms Form 59B
       
2. Broker Forms Order Varies  For Brokers to Order Supply Forms Form AHBR005
       
       
       
  FOR USE   USE
I. NAHA Risk Reduction Programs WITH FORM NO. TYPE
1. Risk Reduction Program for Equine Liability NAHA Form 265 Members Only
      Business Owners & Operators     View & Print w/Password
       
2. Risk Reduction Program for Benevolent Liability NAHA Form 16 Members Only
      Horsemen’s Associations or Clubs and Equine     View & Print w/Password
      Events, Exhibitions and Competitions      
       
3. Risk Reduction Program for Non-Commercial Liability NAHA Form 16 Members Only
     Personal and / or Pleasure Horse Owners, or Lessees     View & Print w/Password
       
       
       
       
  FOR USE   USE
J. NAHA Contract & Agreement Models WITH FORM NO. TYPE
       
1. Horse Boarding Agreement and Liability Release Liability 2 Members Only w/ Password
      View / Modify / Print
       
2. Stallion Breeding Contract and Release Liability 3 Members Only w/ Password
     Agreement with Live Foal Guarantee     View / Modify / Print
       
3. Horse Training Agreement and Liability Release Liability 4 Members Only w/ Password
      View / Modify / Print
       
4. Riding Instruction and / or Driving and / or Training      
      Instruction Agreement, Liability Release and Liability 5 Members Only w/ Password
      Assumption of Risk Agreement [For Individuals]     View / Modify / Print
       
5. Horse Rental Agreement and Liability Release and     Members Only w/ Password
     Assumption of Risk Agreement (For Individuals) For Liability 8 View / Modify / Print
     Operators That Allow Riders 16 Years and Older to      
     Accept or Refuse Protective Headgear      
       
6. Horse Rental Agreement and Liability Release and Liability 8.08 Members Only w/ Password
     Assumption of Risk Agreement (For Individuals) For     View / Modify / Print
     operators That Require All Riders to Wear      
     Protective Headgear      
       
7. Horse Rental Agreement and Liability Release and Liability FAM 08 Members Only w/ Password
     Assumption of Risk Agreement (For Families) For     View / Modify / Print
     operators That Allow Riders 16 Years and Older      
     to Accept or Refuse Protective Headgear      
       
8. Horse Rental Agreement and Liability Release and Liability FAM 08.08 Members Only w/ Password
     Assumption of Risk Agreement (For Families) For     View / Modify / Print
     operators That Require All Riders to Wear      
     Protective Headgear      
       
9. Horse Activities Warning, Risk Reduction Liability 15 Members Only w/ Password
     Suggestions and Assumption of Risk Agreement      
     (Does not contain Liability Release wording]      
       
10. Horse Club Event Agreement & Release Waiver Liability 30 Members Only w/ Password
      View / Modify / Print
       
11. Equine Drawn Vehicle Ride Warning Form Liability 108 Members Only w/ Password
       and Agreement     View / Modify / Print
       
12. Horse Riding Agreement and Liability Release Liability 27 Members Only w/ Password
      (for individuals riding their own animals on     View / Modify / Print
       Non-owned premises)      
       
13. Horse Loan Agreement and Liability Release Liability 127 Members Only w/ Password
       (for individuals riding horses borrowed from     View / Modify / Print
       THIS STABLE, but not for hire)      
       
14. Lease Agreement Liability 28A Members Only w/ Password
      View / Modify / Print
       
15. Optional Lease Agreement Clauses Liability 29A Members Only w/ Password
      View / Modify / Print