Phone: (954) 441-8881
Fax: (954) 441-3771
E-mail: /
1001 Brickell Bay Drive, Suite 1100,
Miami, FL 33131
Attention: Hellen Mena Savitt
(305) 961 6231 Phone Direct
(800) 743 3486 Phone
(305) 372 1465 Fax

Tour Operators Liability Application

Basic Information
Name of legal entity: / DBA (Does business as):
Address: / Country: / Zip/Postal code:
Insurance contact person: / Phone number:
E-mail: / Website or brochure:
Company Information
Are you an active, dues paying member of the Florida-Caribbean Cruise Association? □ Yes □ No
Type of insurance:
□ General Liability □ Contingent Auto Liability □ Contingent Watercraft Liability
Describe your business operations:
How many years has this business been in operation?
Current & projected annual revenue for tour operations (US$):
General Liability
Who is your insurance company?
What are you insurance limits?
Policy effective date: / Policy premium (US$):
Automobile Liability
Who is your insurance company?
What are your insurance limits? / Policy effective date:
Policy premium (US$): / Total number of owned/leased vehicles:
Please indicate the total number of people transported annually in vehicles with a capacity of 40 or more occupants:
Please indicate the total number of people transported annually in vehicles with a capacity of less than 40 occupants:
Do you ever sub-contract tour operations work? If so, do you require certificates of insurance from sub-contractors?
Watercraft Liability
Who is your insurance company?
What are your insurance limits? / Policy effective date:
Policy premium (US$): / Total number of owned/leased watercraft:
Please indicate the total number of people transported annually:
Do you ever sub-contract tour operations work? If so, do you require certificates of insurance from sub-contractors?

Tour Operators Liability Application Page 2

Loss History
Describe any claims that have occurred within the last 3 years (description, date of claim, claim status – open or closed):
Certificates of Insurance
Please attach a list of any entities of which you are required to provide a certificate of insurance (entity name, address, contact person, contact phone, fax or e-mail)
Notice: This application is for the purpose of obtaining a quotation and does not bind the applicant or the Company to complete the insurance. The Undersigned declares that to the best of his/her knowledge, the statements set forth herein are true and that no other material information has been withheld. The undersigned also agrees that the existence of any policy that may be issued will not be disclosed to the host government. This form shall be the basis of insurance should a policy be issued. If the information supplied herein changes between the date completed and the effective date of the insurance, the undersigned shall notify the Company of the changes and the company reserves the right to modify or withdraw any offer for insurance.
Fraud Warning: Any person who knowingly and with intent to defraud any insurance company or other 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 act, which is a crime and may subject such person to criminal and civil penalties.

______

Applicants Signature Date


Phone: (954) 441-8881
Fax: (954) 441-3771
E-mail: / / Aon Risk Services
1001 Brickell Bay Drive, Suite 1100,
Miami, FL 33131
Attention: Hellen Mena Savitt
(305) 961 6231 Phone Direct
(800) 743 3486 Phone
(305) 372 1465 Fax

Tour Operator Supplemental Questionnaire

Name of Applicant:
General Information
1. List all entities to be insured, including all trade names. Attach a separate sheet if necessary.
2. List all branch locations (including a mailing address if different from above) Attach a separate sheet if necessary.
3. Number of employees (other than owners) / Full Time: / Part Time:
4. What percentage of your company’s tour/excursion participants come from cruise lines? %
What percentage of the applicant’s services is represented by the activities listed below?
1. / ATV’s (All terrain vehicles) / % / 23. / Rappelling / %
3. / Beach Tours / % / 24. / Rock Climbing / %
4. / Biking / % / 25. / Rodeo Shows / %
5. / Bird Watching / % / 26. / Sailing (Catamaran & Other) / %
6. / Boat Rental (no motor) / % / 27. / Scooters / %
7. / Culinary Tours / % / 28. / Scuba Diving / %
8. / Deep Sea Fishing / % / 29. / Snorkeling / %
9. / Duck Tours / % / 30. / Swimming Encounters: Sharks, dolphins & turtles stingrays / %
10. / Dune Buggies / % / 31. / Towable Rides (Banana Boats) / %
11. / Go-carts / % / 32. / Tubing Cave or River / %
12. / Golfing / % / 33. / Trolley Rides / %
13. / Helicopter Tours / % / 34. / Wake Boarding / %
14. / Hiking / Trekking / % / 35. / Whale & Dolphin Watching / %
15. / Historical & Cultural Tours/ Museums / % / 36. / Walking Tours / %
16. / Horseback Riding / % / 37. / Water Parks / %
17. / Jeep Tours / % / 38. / Water Skiing / %
18. / Kayaking & Canoeing / % / 39. / Wave Runners / %
19. / Mountain Climbing / % / 40. / Water Taxi Tours / %
20. / Nature Tours / % / 41. / Zipline / Canopy Tours / Aerial Tram / %
21. / Parasailing / % / 42. / Other activities: Describe below %
22. / Party Cruises / %
Risk Management
1. Are all participants given safety instructions before a tour and/or excursion? / Y___ / N___
2. Are there qualification requirements in place that participants must meet to go on a specific tour/excursion? / Y___ / N___
3. Are alcoholic beverages ever supplied or permitted on your tours? / Y___ / N___
4. Does the Applicant have written policies & procedures to ensure proper serving of alcoholic beverages to individuals? / Y___ / N___
Check all the following loss control/risk management procedures that are currently used by your organization
______Operations Manual (written procedures) / ______Guidelines for employee qualification requirements
______Loss Control Manual (written procedures) / ______Training program for new employees
______Crisis Management Plan / ______Written procedures manual for all employees
______Maintenance program for all equipment / ______Continuing education/certification programs
______Use of disclaimers/responsibility clauses on brochures / ______Employee criminal background check
______Use of waivers/hold harmless release(s) for: ____ a. Hotel/cruise employee members
____ b. Tour participants
Subcontractors
1. What percentage of your operation is subcontracted? / %
2. Are there standardized procedures for the collection of certificates of insurance from all subcontractors? / Y____ / N____
3. Is the applicant listed as an Additional Insured on these certificates? / Y____ / N____
4. Does the applicant have a written and standardized subcontractor selection process? / Y____ / N____

THE UNDERSIGNED IS AN AUTHORIZED REPRESENTATIVE OF THE APPLICANT AND REPRESENTS THAT REASONABLE ENQUIRY HAS BEEN MADE TO OBTAIN THE ANSWERS TO QUESTIONS ON THIS APPLICATION. HE/SHE REPRESENTS THAT THE ANSWERS ARE TRUE, CORRECT AND COMPLETE TO THE BEST OF HIS/HER KNOLEDGE..

Applicants Signature: / Date:
Print Name: / Title:

September 23, 2009

Attn: Aon Risk Services, Inc. of Florida

Fax: 305-372-1465

RE: BROKER’S/AGENT’S LETTER OF AUTHORIZATION

To Whom It May Concern:

This is to advise that effective September 23, 2009, we have appointed Aon Risk Services, Inc. of Florida (“Aon”) as the exclusive Broker/Agent of Record for Insert Your Company Name Here with respect to its Tour Operators Liability Program (hereafter “Insurance”) for the purpose of obtaining a quotation for insurance coverage. This appointment rescinds all previous appointments and the authorization contained herein shall remain in full force and effect until cancelled in writing by us.

This letter also constitutes authorization to any underwriter to furnish Aon representatives with all information pertaining to any and all insurance contracts, rates, rating schedules, surveys, reserves, retention or other data they may require as respects the Insurance. We request that you do not communicate such information to anyone else.

It is hereby acknowledged and agreed that Aon has made no representation as to the availability of insurance coverage, the reasonableness of the terms thereof or the financial solvency of any carrier.

Thank you for your courtesy and cooperation.

Sincerely yours,

Authorized Signature: ______

Name: ______

Title: ______