Please note: All fields in this form are required.
I.   General Information
 
NAMED INSURED:

STREET:
CITY:
STATE:
ZIP:
COUNTRY:

 
LIST SUBSIDIARY COMPANIES OR EXPOSURES (I.E. TICKET BOOTHS, FOOD STAND, GIFT SHOPS,
MUSEUMS, OTHER RIDES OR AMUSEMENTS, PARK GROUNDS, ETC.):
 
 
LIST ALL ADDITIONAL INSUREDS TO BE NAMED WITH AN EXPLANATION AS TO WHY:
 
 
 HOW LONG HAS THE RAILROAD BEEN OPERATED BY CURRENT MANAGEMENT?

IF LESS THAN THREE (3) YEARS:
NAME OF PREVIOUS OPERATOR?
IF TRACK HAS BEEN OUT
OF USE, HOW LONG?
WHAT IS PRIOR RR EXPERIENCE
OF OFFICERS? (PLEASE FAX RESUMES)
WHAT IS PRIOR RR EXPERIENCE
OF KEY OPERATING PERSONNEL?
 
II.   Railroad Operational Information
 
DESCRIBE THE GENERAL CHARACTERISTICS OF THE RAILROAD YOU OPERATE AND SEND US BROCHURES,
PICTURES AND OTHER DESCRIPTIVE INFORMATION (I.E. MUSEUMS, GIFTSHOPS, RESTAURANTS):
 
 
TOTAL MILES OF TRACK: 
CLASS OF TRACK: EXCEPTED FRA-1 FRA-2 FRA-3 FRA-4  
 

IF NOT UNDER FRA, WOULD YOU DESCRIBE THE CONDITION OF YOUR TRACK AS:
(PLEASE FAX OR SEND COPY OF LAST INSPECTION REPORT)

 

 EXCELLENT GOOD FAIR  

 
No. OF LOCOMOTIVES:
No. OF PASSENGER CARS:
 
    GRADE CROSSING : PUBLIC PRIVATE  
No. NON-PROTECTED:
No. WITH CROSSBUCKS ONLY:
No. WITH DECENDING GATES:
 

HOW MANY TRAINS DO YOU OPERATE PER WEEK?
 (PLEASE FAX OR SEND SCHEDULE IF AVAILABLE)

 
AVERAGE No. OF CARS PER TRAIN:  
MAXIMUM No. OF CARS PER TRAIN:
AVERAGE No. OF
PASSENGERS PER TRAIN:
MAXIMUM No. OF
PASSENGERS PER TRAIN:
TOTAL ANNUAL No. OF PASSENGERS:
AVERAGE SPEED OF TRAIN:
MAXIMUM SPEED OF TRAIN:
 
PLEASE PROVIDE A LIST OF BRIDGES, TRESTLES AND TUNNELS. PLEASE FAX OR SEND FOR EACH LAST
INSPECTION REPORT. ALSO, INDICATE WHAT THEY CROSS OVER OR UNDER. (I.E. BODY OF WATER, HIGHWAY, MOUNTAIN)
 
 
WHAT IS YOUR RAILROAD OPERATING SEASON? ALL YEAR SEASONAL  
 
 
IF SEASONAL: FROM:  TO:  
 
IF SEASONAL, DO YOU HAVE "SHACKDOWN" RUNS PRIOR TO THE NEW SEASON? YES NO
 
DO YOU OPERATE OVER ANYONE ELSE'S TRACK? YES NO
IF YES, DESCRIBE
ALSO FAX OR SEND
COPY OF OPERATING
AGREEMENT
OR CONTRACT:
 
DO YOU ASSUME ANYONE ELSE'S LIABILITY? YES NO
IF YES, DESCRIBE
ALSO FAX OR SEND
COPY OF OPERATING
AGREEMENT
OR CONTRACT:
 
DO YOU OPERATE OR OFFER CHARTERS OR OTHER SPECIAL EVENTS? YES NO
IF YES, DESCRIBE:
 
DOES ANYONE ELSE OPERATE OVER YOUR TRACK? YES NO
IF YES, DESCRIBE:
 
DOES ANOTHER PARTY ASSUME YOUR LIABILITY? YES NO
IF YES, DESCRIBE
ALSO FAX OR SEND
COPY OF OPERATING
AGREEMENT
OR CONTRACT:

 
III.  Railroad Track Information
 

WHO INSPECTS YOUR TRACK AND HOW OFTEN?
PLEASE DESCRIBE:
 

 WHO MAINTAINS YOUR TRACK AND HOW FREQUENTLY?
PLEASE DESCRIBE:
 

LIST NORMAL TRACK MAINTENANCE OF WAY FOR EACH OF THE LAST FOUR (4) YEARS:

YEAR YOUR COST GRANTS SUBSIDIES  
$ $ $
$ $ $
$ $ $
$ $ $
 

ESTIMATE OF EXPENDITURES FOR COMING YEAR:

YEAR YOUR COST GRANTS SUBSIDIES  
$ $ $
 

DESCRIBE ANY TRACK REHAB WORK BEING DONE CURRENTLY OR PLANNED FOR THE COMING YEAR:

PLEASE DESCRIBE:

 
HAVE YOU HAD ANY DERAILMENTS IN THE LAST THREE (3) YEARS? YES NO
DATE OF LOSS CAUSE DAMAGES TO EQUIPMENT INJURIES

 
IV.  Other Operating Information

 
PLEASE PROVIDE THE FOLLOWING FOR THE LAST THREE (3) YEARS AND AND AN ESTIMATE FOR THE COMING YEAR:
YEAR GROSS REVENUE DINNER TRAINS REVENUE EXCURSION TICKET REVENUE OTHER PAYROLLS
 
ESTIMATE FOR COMING YEAR:
YEAR GROSS REVENUE DINNER TRAINS REVENUE EXCURSION TICKET REVENUE OTHER PAYROLLS
OTHER REVENUE:
 
PROVIDE THE CURRENT COST OF AN AVERAGE ADULT EXCURSION TICKET AND AN AVERAGE ADULT DINNER TRAIN TICKET:
EXCURSION TICKET PRICE:  $

 
DINNER TRAIN TICKET PRICE:                 $
 
  TRAIN RIDE FOOD OTHER TOTAL
BREAKDOWN OF DINNER TICKET PRICE: % % % 100%
PLEASE EXPLAIN OTHER:
 
DO YOU SELL, SERVE OR GIVE LIQUOR OR OTHER ALCOHOLIC BEVERAGES EITHER ON YOUR TRAINS OR AT YOUR FACILITIES? YES NO
IF YES, WHAT IS ANNUAL REVENUE FROM LIQUOR SALES:
DESCRIBE TRAINING OF SERVERS:

 
ADVISE No. OF VOLUNTEERS INVOLVED IN THE FOLLOWING: No. OF PEOPLE TOTAL COST
TICKET / GIFT SALES / RESTAURANT:
CAR HOST:
TRAIN OPERATIONS:
MAINTENANCE OF WAY:
 
DO YOU FOLLOW TRAIN (TOURIST RAILWAY ASSOCIATION, INC.) SAFETY RULES AND REGULATIONS? YES NO
DO YOU HAVE OTHER WRITTEN SAFETY RULES AND PROCEDURES? YES NO
DO YOU TEST FOR SAFETY RULE AND PROCEDURE KNOWLEDGE? YES NO
IF YES, DESCRIBE.
IF NO, WHY NOT AND
HOW DO YOU ENSURE
KNOWLEDGE?
 
PLEASE DESCRIBE ANY EMPLOYEE / VOLUNTEER SAFETY INCENTIVE PROGRAMS YOU MAY HAVE:
 
 
DO YOU HAVE A TRAINING PROGRAM? YES NO
IF YES, PLEASE DESCRIBE,
INCLUDING A DESCRIPTION
OF THE PROGRAM,
NUMBER OF CLASSES
PER YEAR AND ATTACH
MATERIALS:
IF NO, PLEASE
EXPLAIN WHY NOT:

 
     V.  Loss Information

 
PLEASE PROVIDE HARD COPY LOSS RUNS FOR THE PAST FIVE (5) YEARS. IF UNAVAILABLE, PLEASE PROVIDE A SUMMARY OF TOTAL LOSSES FOR THE PAST FIVE (5) YEARS:
YEAR POLICY PERIOD NUMBER OF
CLAIMS		 TOTAL LOSSES* EVALUATION
DATE

 
*TOTAL LOSSES MEANS ALL LOSSES INCLUDING THOSE WHICH MAY HAVE BEEN SETTLED WITHIN YOUR DEDUCTIBLE OR SELF INSURED RETENTION (SIR).

 
WHO HANDLES YOUR CLAIMS?
COMPANY NAMED:
 
DESCRIBE YOUR CLAIMS HANDLING PROCEDURES:

 

 
     VI.  Insurance Program

 
REQUESTED FROGRAM :
LIMIT OF LIABILITY DESIRED :   $
EACH INCIDENT RETENTION (EIR) DESIRED :

POLICY EFFECTIVE
DATE DESIRED :

    From:    To:   (mm/dd/yy)
FIRST COVERAGE
DATE DESIRED* :		   (mm/dd/yy)
 
*IF FIRST COVERAGE DATE IS PRIOR TO POLICY EFFECTIVE DATE, PLEASE FAX DECLARATIONS PAGE OF PREVIOUSCLAIMS-MADE POLICIES BACK TO DATE REQUESTED. ( Fax to 410.515.0154, Att: Joe Scheide)
 
CURRENT FROGRAM :
CARRIER(S) :
LIMITS AND SELF-INSURED RETENTION OR DEDUCTIBLE :    $

COVERAGE(S) :

PREMIUM :

    $

RATE :

    $
INDICATE RATING BASIS:

 

 
 VII.  Other Information

 

CONTACT FOR ENGINEERING INSPECTION :
NAME:
STREET:
CITY:
STATE:
ZIP:
COUNTRY:
PHONE:
FAX:
EMAIL:

 
     VII.  Agent or Broker Information

 
NAME:
STREET:
CITY:
STATE:
ZIP:
COUNTRY:
PHONE:
FAX:
EMAIL:

 
     VIII.  Acknowledgement


We acknowledge that we have received and read a specimen copy of the policy for which we are applying. We understand that the insurance afforded by this policy is on a claims made basis.

We know of no other relevant facts which might affect the company's judg ment when considering this application and herby agree that any answers given in this application shall not constitute notice of circumstances or notice of claim as provided for in the insuring agreements or conditions of any policy issued by the company to the applicant, prior to the inception date of the policy to which this application applies.

Should the company decide to issue any insurance following the submission of this proposal, then this proposal and any supplementary information pertaining hereto shall form the basis of any policy issued and be deemed incorporated therein.


The named insured on behalf of all proposed insured(s) warrants it has the authority to so a CT and that upon its inquiry all statements herein are true and correct to the base of its knowledge and that no material facts have been suppressed or misstated.
Submitted and dated at This Day of ,
  Submitted on behalf of the proposed insured(s) by:
 

  Relationship. Official title and/or position with the proposed named insured of the person who completed and signed this application:

 
 
Submit Form:  
Reset Form:  

For questions or information about the railroad protective online form call:

Joe Scheide, Director of Marketing

p. 410.515.1190 or 800.223.8098
f. 410.515.0154

or email: jscheide@cantonagency.com