Insure your memories with TROPHY REPLACEMENT INSURANCE a Safari Club International program designed exclusively by and for Toll-free Safari Club International Members You’ve chosen the best outfitter…… 1-800-227-3907 You’ve chosen the best taxidermist….. You’ve chosen the best way to display your trophies…… Ask yourself - Are you properly insured? Did you know that your homeowners insurance might not cover total replacement, including the hunt! But trophy insurance from Safari Club International will. SO NOW --- YOU CAN CHOOSE THE BEST INSURANCE COVERAGE TO INSURE YOUR MOST VALUED AND PRIZED POSSESSIONS. The Only Insurance of its Kind! The SCI Member Benefit Trophy Insurance provides comprehensive coverage on an “agreed value,” all risk, replacement cost basis. Flood and Earthquake coverage is included! The SCI Trophy Insurance will pay the average cost of the replacement hunt and the associated expenses based on the values provided in the Trophy Inventory section of this application. Check out other program highlights! • Values may be increased only if trophies are recorded in Boone & Crocket or SCI Record Books’ Top 10. Maximum coverage is limited to twice the value indicated • Taxidermy Coverage Available • For any size trophy collection – small or large • Deductible $250 • Additional Trophies may be added at anytime • Payment not required for application submission Applying for coverage is simple! • Complete and return the application • No appraisals necessary (in most cases) • Enter the quantity and location of items to be insured on the Trophy Inventory • Submit photos of your trophy collection APPLICATION - Please Print SCI Member Number: ___________________________ Since this application forms a permanent part of your policy, it is important to fill it out completely. This includes completing the tro- phy inventory sheets, indicating the quantity and location of each trophy. The master policy, which is issued to SCI, will list you as an additional insured and is designed to include the average cost of a guided hunt and the taxidermy fees, per the attached trophy inventory schedule. 1. Applicant’s Information Name: ________________________________________________________________________ Mailing Address: ___________________________________________________ City_____________________ State ______ Zip________ Phone Numbers: (H)____________________ (W)____________________ (Cell) __________________ E-mail: ________________________ 2. Trophy Location. Please provide the following for all locations where you retain trophies. All locations must be located in the US and its territories. Coverage is void if the location is vacant more than 30 days. (A) Primary Residence Address:__________________________________________________________________________________________ Building Age: _________ Construction Type: Masonry ___ Frame ____ Square Footage: _______________ Sprinkler System : Yes ___ No ___ Smoke Detector : Yes ___ No ___ Dead Bolt : Yes ___ No ___ Burglar Alarm : Yes ___ No ___ System Monitored: Yes ___ No ___ Monitored by: ___________________________ Do you have a trophy room? Yes ___ No ___ If yes, how many trophies in this room? _______________ Do you conduct business at this location? Yes ___ No ___ If yes, describe type of business: ____________________________________ Are any other businesses located within the same building? (ie. offices, stores, restaurant, etc.) Yes ___ No ___ Please describe _______________ Located within city limits? Yes ___ No ___ What County/Township or Parish _________________________ Road miles to nearest fire station ___________ Feet to nearest water source ___________ Type of water source (pond, pool, fire hydrant etc.) ________________________ Does local fire department have a “Pumper Truck”? Yes ___ No ___ If so, how many gallons? ______________ (B) Secondary Residence Address: ________________________________________________________________________________ Type of secondary location? (ie. Camp, ranch, vacation home etc.) _______________________________________________ How often and for what length of time and by whom is this location occupied? Please be very specific: ______________________________________________________________________________________________________________________ Building Age: _________ Construction Type: Masonry ___ Frame ____ Square Footage: _____________ Sprinkler System : Yes ___ No ___ Smoke Detector : Yes ___ No ___ Dead Bolt : Yes ___ No ___ Burglar Alarm :Yes ___ No ___ System Monitored: Yes ___ No ___ Monitored by: ___________________________ Do you have a trophy room? Yes ___ No ___ If yes, how many trophies in this room? ____________ Do you conduct business at this location? Yes ___ No ___ If yes, describe type of business: ____________________________Are any other businesses located within the same building? (ie. offices, stores, restaurant, etc.) Yes ___ No ___Please describe________________ Located within city limits? Yes ___ No ___ What County/Township or Parish __________________________ Road miles to nearest fire station ___________ Feet to nearest water source ______________ Type of water source (pond, pool, fire hydrant etc.) __________________________ Does local fire department have a “Pumper Truck”? Yes ___ No ___ If so, how many gallons? ______________ (C) Business Residence Address: ________________________________________________________________________________ Describe type of business you conduct at this location? (ie. Insurance, medical, dentist office, etc.) _______________________________ Where are trophies located within this business? _____________________________________ Does the public have supervised access to the trophies? Yes ___ No ___ Are any other businesses located within the same building? (ie. Offices, stores, restaurant, etc.) Yes ___ No ___ Please describe _______________________________________________________ Do you own the building that your business is located at: Yes ___ No ___ Building Age: _________ Construction Type: Masonry ___ Frame ____ Square Footage: _________ Sprinkler System : Yes ___ No ___ Smoke Detector : Yes ___ No ___ Dead Bolt : Yes ___ No ___ Burglar Alarm : Yes ___ No ___ System Monitored: Yes ___ No ___ Monitored by ___________________________ Located within city limits? Yes ___ No ___ What County/Township or Parish ______________ Road miles to nearest fire station _________ Feet to nearest water source ___________ Type of water source (pond, pool, fire hydrant etc.) _____________ Does local fire department have a “Pumper Truck”? Yes ___ No ___ If so, how many gallons? __________ (D) Storage Facility – Name and Address: ____________________________________________________________________________ Why are your trophies in storage? _____________________________________ How long do you anticipate leaving your trophies in storage? ____________________ Are any other businesses located within the same building? (ie. Offices, stores, restaurant, etc.) Yes ___ No ___ Please describe. __________________________ Is your unit climate controlled? Yes ___ No ___ How is your unit separated from other storage units? ________________________________________ How many storage units at this facility? ________________________ Located within city limits Yes ___ No ___ What County/Township or Parish __________________ Road miles to nearest fire station _________ Feet to nearest water source ________Type of water source (pond, pool, etc.) ________________ Does local fire department have a “Pumper Truck”? Yes ___ No ___ If so, how many gallons? __________ Building Age: _________ Construction Type: Masonry ___ Frame ____ Square Footage: ___________ Sprinkler System : Yes ___ No ___ Smoke Detector : Yes ___ No ___ Dead Bolt : Yes ___ No ___ Burglar Alarm : Yes ___ No ___ System Monitored: Yes ___ No ___ Monitored by ___________________________ Gated entry to the security units? Yes ___ No ___ Additional security measures taken by Storage Facility (ie full-time security guard) ___________________________________________________ 3. Off Premises Taxidermy Coverage. Taxidermy coverage provides extended coverage for your trophies while in the care, custody and control of your taxidermist whom must be located within the United States, but only for the perils covered within the scope of the policy. Please indicate on the trophy inventory which trophies are located at the taxidermist by placing a “T” in the location box on the inventory form. If you are interested in this additional coverage for an additional premium per taxidermist, please complete the following for each taxidermist studio: Taxidermist #1 Name and Address: ____________________________________________________________________________________ Taxidermist #2 Name and Address: _____________________________________________________________________________________ Please circle the coverage limit desired: $25,000 limit ($150 additional premium) OR $50,000 limit ($225 additional premium) 4. Total Inventory Value. When totaling your values, please be sure to multiply the value by the number of trophies when you have more than one of any kind of trophy. Location A: $_________________________ PLEASE NOTE: We now offer insurance for “unprotected or high risk” Location B: $_________________________ locations. Higher rates will apply to those trophies housed at Location C: $_________________________ those locations according to underwriting guidelines. Location D: $_________________________ Location T: $_________________________ TOTAL: $_________________________ multiply by