Call Us Today:
541.482.1921

Hunting and Fishing Guides in Ashland and Medford, OR

GRIFFIN UNDERWRITING SERVICES

Phone: 503-528-2918 OR 866-528-2918 • Fax 425-453-8696

www.gogus.com

Outfitters and Guides Program Application

 

Applicant:            

 

Mailing Address:             

 

Physical Address:            

 

Applicant is:  Individual  Partnership  Corporation  Other:                                                                                     .

 

Policy Term:                    to      

 

Liability Limits Requested:  $300,000/$600,000  $500,000/$1,000,000  $1,000,000/$2,000,000

 

Operation

Gross Receipts

 Fishing Guide

     

 Hunting Guide

     

 Whitewater Rafting

     

 Other (specify):      

     

 Other (specify):      

     

 Other (specify):      

     

 

State (area of operation)

Rivers Used

Highest Government Rating

     

     

           

     

     

     

     

     

     

 

Boats Used

Horse Power

Capacity

     

     

     

     

     

     

     

     

     

 

Are Life Jackets Provided? Explain:       

 

Name of Guide

Age

# Years of Experience

Medical Qualifications

     

     

     

     

     

     

     

     

     

     

     

     

 

Minimum age requirement:   

 

Are Hold-harmless agreements/waivers obtained from participants?  No   Yes - attach sample

 

Are all rules and safety guidelines provided to participants?            Yes   No

 

Does applicant have other business ventures for which coverage is not requested?  No  Yes – explain and advise where insured:                                                                                                                                                                            .

 

Any Overnight Trips?  No  Yes – explain:                                                                                                                        .

 

Any Food or Beverage Served?  No  Yes – explain:                                                                                                          .

 

Is the insured currently licensed or in the process of being licensed?    No  Yes

 

 

Physical Damage:

Year

Make/Model

Serial Number

Motor

Coverage Limit

     

     

     

HP:      inboard  outboard

     

     

     

     

HP:      inboard  outboard

     

     

     

     

HP:      inboard  outboard

     

     

     

     

HP:      inboard  outboard

     

 

 Additional Interests:

Additional Insured

Certificate Holder

Interest

Name & Address

 

 

Oregon Marine Board

     

 

 

     

     

 

 

     

     

 

 

     

     

 

Prior Carrier Information:

Policy Term

Company Name

Policy Number

Limits

Premium

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

 

Loss History:

Date of Loss

Type

Description

Amount Paid

Reserve Amount

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

 

Comments:                                                                                                                                                                                 .

 

Agency: Reinholdt & O'Harra Insurance Agency

 

Producer Signature:_____________________________________________________    Date: ______________________

 

 

Applicant Signature:____________________________________________________    Date: _______________________

                                    (must be signed by an owner, partner or executive officer)

 

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ANOTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS THE PERSON TO CRIMINAL AND [NY: SUBSTANTIAL] CIVIL PENALTIES. (Not applicable in CO, DC, FL, HI, MA, MN, NE, OH, OK, OR, VT or WA; in LA, ME, TN and VA, insurance benefits may also be denied)

 

IN MASSACHUSETTS, NEBRASKA, OREGON AND VERMONT, ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ANOTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING INFORMATION CONCERNING ANY FACT MATERIAL THERETO, MAY BE COMMITTING A FRAUDULENT INSURANCE ACT, WHICH MAY BE A CRIME AND MAY SUBJECT THE PERSON TO CRIMINAL AND CIVIL PENALTIES.

 

IN WASHINGTON, IT IS A CRIME TO KNOWINGLY PROVIDE FALSE, INCOMPLETE, OR MISLEADING INFORMATION TO AN INSURANCE COMPANY FOR THE PURPOSE OF DEFRAUDING THE COMPANY. PENALTIES INCLUDE IMPRISONMENT, FINES, AND DENIAL OF INSURANCE BENEFITS. 

Our Location

Reinholdt & O'Harra Insurance

1756 Ashland St
Ashland, OR 97520
Main office: 541-482-1921
Toll free: 888-482-1921
Fax: 541-488-4458

Office Hours:

Mon: 8:30 AM - 5:00 PM
Tues: 8:30 AM - 5:00 PM
Wed: 8:30 AM - 5:00 PM
Thurs: 8:30 AM - 5:00 PM
Fri: 8:30 AM - 5:00 PM
Sat: Closed
Sun: Closed

Our Providers

Testimonials

Accommodating, professional, helpful, and quick. Very comfortable experience and I was impressed by their capabilities. Highly recommended.
- Brad M.
I feel lucky to have found an agent willing to provide this level of service. No need to look anywhere else!
- Michelle D.
Over the years we’ve never once had to worry about our coverage. My husband and I are long-time customers and proud to be.
- Carol S.
Surprisingly flexible and in-touch with my needs as a small business owner. Can’t ask for more.
- Spencer F.
They have strong ties with the community, and it shows. It’s nice to do business with people that really show they care about you and your family.
- Susan T.