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Head Office 120 Larch Street Sudbury, Ontario

P3E 1C2 Tel: 1 705 673 2000

1 800 461 1106 Fax: 1 705 675 7461

Western Office #203, 301-14 Street NW Calgary, Alberta T2N 2A1 Tel: 1 800 461 1106 Fax: 1 587 316 7495

www.gougeoninsurance.com

PROPERTY AND LIABILITY INSURANCE APPLICATION

GENERAL INFORMATION

Name of Applicant (list all legal entities):

Mailing Address:

Legal Address of locations to be insured:

Insurance Contact:

Business Phone:

Cellular Number:

Fax Number:

Email Address:

Website:

PLEASE NOTE THAT IF AN INSURANCE POLICY IS ISSUED SUBSEQUENT TO UNDERWRITERS RECEIPT OF THIS APPLICATION, IT WILL ATTACH TO AND FORM PART OF THE POLICY. COVERAGE UNDER

THAT POLICY RELIES ON THE ACCURACY OF THE INFORMATION PROVIDED HEREIN.

1. The applicant is a Corporation Partnership Joint Venture Club (nonprofit) Other

2. The applicant is the: Owner Lessee

3. Has any insurer cancelled or non-renewed coverage during the last 5 years? Yes No

If yes, explain:

4. Do you have any business activities in the United States of America otherthan sales visits?

Yes No

5. Do you have any assets in the United States of America? Yes No

If yes, explain:

6. Number of years in operation:

PROPERTY SECTION

1. Expiry date of current policy?

2. When closed, does someone regularly inspect the property? Yes No N/A

If yes, how often

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3. Please explain precautions taken to protect the property when closed

4. Distance to nearest Fire Hydrant: ft/metres N/A

5. Distance to Private Fire Hydrant: ft. N/A

6. Distance to nearest Firehall miles/kms N/A

If applicable, is the Fire all Volunteer OR Paid Fire Department

7. Do you have a fire pump on site? Yes No

If yes, H.P. # of feet of fire hose diameter of hose

8. Do you have a deep fat fryer unit? Yes No

If yes, is there an automatic fire suppression system? Yes No

a. Is there an annual maintenance contract for each unit? Yes No

b. Do you have Class K wet chemical portable fire extinguisher as backup? Yes No

c. Do all deep fat fryers have thermostats? Yes No

9. Do you use propane appliances in any of your buildings Yes No

If yes, please describe:

a) Are the propane appliances vented to the outside? Yes No

b) Do you have CO detectors in all buildings with propane appliances? Yes No

c) Are your guests provided written instructions on using and

operating the propane appliances? Yes No

10. Are all your buildings equipped with fire extinguishers that are serviced annually by a qualified

technician?

11. Please list all applicable Mortgagees and or Loss payees:

Mortgagee / Loss Payee#1: (Name & Address):

Mortgagee / Loss Payee #2: (Name & Address):

12. Property Schedules - Please attach existing property schedules from your present insurancepolicy or fill out the schedules provided at the end of this application.

Yes No

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13. Do you own and require coverage for any of the following Miscellaneous Property listed below:

Description of Property Replacement Cost

Parking Lots/Roads/Sidewalks $

Landscaping/Trees $

Powerlines/Transformers $

Lighting $

Underground Snowmaking, Air and Water Lines $

Underground Sewer and Waterlines $

Underground Gas Lines $

Underground Electrical Systems $

Golf Course – Greens, Tees and Fairways $

Reservoirs $

Dams $

Bridges $

Overpasses $

Other Infrastructure $

Other $

14. Do you wish to purchase Business Interruption coverage? Yes No

15. The Resort Program includes Crime coverage with a $1,000 limit.

Do you wish to purchase a higher limit? Yes No

If Yes, Limit required? $

Do you own or are you responsible for an Automatic Teller Machine (ATM)? Yes No

If Yes, a. what is the maximum amount of Cash the machine can hold? $

b. Where is the machine located?

c. Is the machine bolted down? Yes No

d. Describe briefly your procedure for filling the machine

16. Equipment Breakdown (Boiler & Machinery Coverage): Provides coverage for equipmentbreakdown of the following types of equipment: Heavy rotating machinery, snowmaking pumps,snowmaking compressors, generators, owned transformers, lift drive motor(s) and gear boxes.a. Do you want to purchase this coverage? Yes No

If yes, please answer the following questions only if your premises cannot be accessed by vehicle:

a. How do you access your premises?

b. What is your maximum value of refrigerated goods during youroperation season?

$

c. Provide details on your generators N/A

Number of Generators

Size of Generators

Provide Year/Make/Model

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Do you have a maintenance contract in place? Yes No

If yes, how often are generators serviced?

Do you have a Back-up Generator set-up for use? Yes No

Does the back-up have an auto-start? Yes No

If no back-up, please advise what you would do in a generator failure?

17. Director’s and Officer’s Liability is available at competitive pricing.a. Do you want to purchase this coverage? Yes No

If yes, please answer the following questions:

a. Is the organization in arrears in its payments of monies payable toRevenue Canada or the provincial ministries of revenues (includingsource deductions, GST and PST)?

Yes No

b. Is the organization currently or has it at any time during the pastthree years been in breach of any of its debt covenants, loanagreements, contractual obligations, or does it anticipate any suchbreach occurring within the next 12 months?

Yes No

c. If the organization holds a charitable status, has the status everbeen removed or been subject to review?

Yes No

18. Accidental Death and Dismemberment Coverage is available for your volunteers.a. Do you want to purchase this coverage? Yes No

If yes, how many volunteers do you have?

COMMERCIAL GENERAL LIABILITY SECTION

1. Location and description of business activities that are to be insured:

2. Do you have any business activities in the United States of America otherthan sales visits?

Yes No

3. Do you have any assets in the United States of America? Yes No If yes, explain:

4. Expiry date of current policy:

5. Limit of Liability required: $

6. What is your preferred deductible? (Minimum of $10,000) $

7. What is your estimated number of downhill skier visits?

What is your number of nordic skier visits?

What is your number of tube park visits?

What is your number of mountain biking visits?

8. Do you sponsor competitive ski races? Yes No

If yes, please describe:

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9. Activities/Operations:

Activity/Operation

Are these activities/operations conducted at your

premises?

Are these activities/operations

concessioned? Notes

Cat Skiing Yes No Yes No

Cross Country Skiing Yes No Yes No

Freestyle Air Bag Yes No Yes No

Half Pipes Yes No Yes No

Helicopter Skiing/Hiking/Fishing/Biking

Yes No Yes No

Ice Skating Yes No Yes No

Inverted Aerial Maneuvers Yes No Yes No

Luge/Bobsledding Yes No Yes No

Snowbikes Yes No Yes No

Snowmobile/ATV Tours Yes No Yes No

Snowmobile Races Yes No Yes No

Snowshoeing Yes No Yes No

Snow Tubing Yes No Yes No

Terrain Park Yes No Yes No

Tobogganing Yes No Yes No

Other activity/operations: Airport or Landing Strip Yes No Yes No

Amusement Park Devices Yes No Yes No

Archery Yes No Yes No

Bungee Jumping Yes No Yes No

Campground Yes No Yes No

Climbing Wall(s) Yes No Yes No

Concerts, Shows, Theatrical Events

Yes No Yes No

Fireworks Yes No Yes No

Go Karts Yes No Yes No

Golf Course(s) Yes No Yes No

Hang Gliding/Paragliding/Parasailing

Yes No Yes No

Hard Rock Climbing Yes No Yes No

Heath/Spa/Athletic Club Yes No Yes No

Hiking Yes No Yes No

Hot Air Ballooning Yes No Yes No

Lift Construction for Others Yes No Yes No

Motocross Races Yes No Yes No

Mountain Biking Yes No Yes No

Paintball Yes No Yes No

Parachuting Yes No Yes No

Rafting/Boating/Kayaking Yes No Yes No

Real Estate Development Yes No Yes No

Real Estate Management Yes No Yes No

Ropes Course Yes No Yes No

Saddle Animal – Horseback Riding

Yes No Yes No

Sale of Owned Ski Lifts Yes No Yes No

Scuba Diving Yes No Yes No

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Activity/Operation Are these activities/operations conducted at your premises?

Are these activities/operations concessioned?

Notes

Skate Park Yes No Yes No

Sleigh/Carriage/Hay Rides Yes No Yes No

Special Events Yes No Yes No

Summer Camps Yes No Yes No

Swimming Pools and Saunas Yes No Yes No

Tennis/Racket Courts Yes No Yes No

Trampoline Yes No Yes No

Utilities Yes No Yes No

Water Slide Yes No Yes No

Zip Line(s) Yes No Yes No

Other: Yes No Yes No

Other: Yes No Yes No

10. Describe any other activity not included above that you require insurance for:

11. Provide details of any special events or activities planned:

12. Do you require all concessionaires to carry their own insurance andrequest to be added as an Additional Insured?

Yes No

13. Do you request copies of insurance certificates from all concessionairesfor your records?

Yes No

14. Provide breakdown ofestimated annualGross Receipts:

Lift Tickets $

Cross Country Passes $

Summer Passes $

Membership Dues/Fees $

Ski/Equipment Rentals $

Bike/Equipment Rentals $

Mountain Biking $

Accommodations $

Food $

Liquor $

Ski School $

Pro Shop Sales $

Daycare $

Golf Course $

Spa $

Facility Rental(s) $

Real Estate Sales $

Other (describe): $

Other (describe): $

TOTAL GROSS RECEIPTS $

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15. Total number of employees:

Full time year round

Seasonal

Practicum Students:

Volunteers:

Contracted Ski Guides:

Other Contracted Employees

Annual Payroll $

16. Are all employees and contractual workers covered under Workers’Compensation?

Yes No

Do you obtain written confirmation from Workers' Compensation in respectto coverage for your contracted employees?

Yes No

17. How often are the lifts inspected?

Annually Semi-Annual

Quarterly Bi-Monthly

Monthly Other:

18. Name of lift servicing company or Government Agency

19. Are lifts maintained to manufacturers’ specifications? Yes No

20. Do you have a formal written plan for lift evacuation and emergencytransportation? Yes No

21. Do your area’s lifts and tows meet current CSA Z98 Passenger Ropeway &Conveyor Standards? Yes No

22. Do you have a formal employee training program (including refreshercourses) for lift operations and supervisory staff?

Yes No

23. Do you use the following Waivers of Liability?a. Ticket Waiver Yes No b. Season Pass Waiver Yes No c. Ski Equipment Rental Waiver Yes No d. Exclusion of liability posters at your ticket window and lift line Yes No e. Other activities (i.e.: Special event Waivers) Yes No f. Assumption of Risk Form Yes No

24. Are skiers provided with maps and updated reports on the conditions of theslopes?

Yes No

25. Are hazards on slopes / trails marked and barriers provided? Yes No

26. Are ski patrollers accredited and approved in accordance with theestablished standards set by their association?

Yes No

If no, provide details of patrollers training:

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27. What precautions will be taken to avoid avalanches? If explosives are used, how are theysafeguarded?

28. Do you have a corporate environmental policy? Yes No

29. Do you have an Association Incident Investigation Manual and are youremployees familiar with it?

Yes No

30. Describe any work done for you on a contract basis: N/A

Estimated annual contract cost: $

Do you obtain certificates of insurance and request to be added as an Additional Insured?

Yes No

31. Automobile Liability: N/A

a. Please provide number of owned/leased vehicles:

Private Passenger Trailers

Vans Tankers

Buses Light Truck (up to 1 ton)

Ambulances Heavy Truck (over 1 ton)

Tractors

Other (please specify):

b. Are any of the above vehicles engaged in the following?

i. Long haul (over 160 kilometres/100 miles) operations? Yes No

Operating in the United States? Yes No

If “Yes”, please state number and type:

ii. Transportation of explosives, munitions, corrosives, liquefiedpetroleum gas (including butane or propane), radioactivematerials or other hazardous commodities? Yes No

If “Yes”, please give details:

iii. Transportation of gasoline and/or fuel use? Yes No

If “Yes”, please give details:

iv. Transportation of public or employees? Yes No

c. i. Limit of Automobile Liability insurance carried: $

ii. Name of insurer:

iii. Expiry date:

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32. Aircraft Liability: N/A

a. Make, model and seating capacity of all aircraft owned, leased or chartered:

b. Are any of your employees involved in piloting of an aircraft? Yes No

c. Full description of plans to own, lease or charter any aircraft within next 12 months:

33. Watercraft Liability: N/A

a. Description of watercraft used or chartered, area of operation and use:

b. Please describe any bare-boat chartering:

34. Describe any Errors and Omissions Exposures you may have: N/A

Medical:

Real Estate:

Design:

Limited Partnerships:

Other:

35. List all leased premises (short or long term) in your care, custody or control:

Location Occupancy Estimated Value

$

$

$

$

36. List ALL insurance claims during last five (5) years or provide a loss run: None

Date Details of Loss Present Reserve

Claim Paid

$ $

$ $

$ $

$ $

$ $

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37. Does the Applicant or any person(s) to be covered under this policy haveknowledge or information of any specific fact that may reasonably give riseto a claim?

Yes No

If yes, please details:

38. Additional information, if any:

DUTY OF DISCLOSURE In addition to providing all basic information necessary to enable us to place your risk, you must ensure that you are complying with your legal duty of disclosure of all material matters relating to the risk. In particular, you must satisfy yourself as to the accuracy and completeness of the information you provide to insurers. In this respect, you must provide all information relating to the risk, whether favorable or not, which would influence the judgment of a prudent insurer in determining whether he will take the risk, and, if so, for what premium and on what terms. If you do not disclose all such information, insurers have the right to void the policy from its inception, which will lead to claims not being paid.

We know of no other relevant facts that might affect underwriters’ judgment when considering this

application.

Signature: Date:

Name: Title:

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Property Schedules

1. List all Buildings, Stock and Equipment to be insured or attached a copy of your currentschedules.

Structure Detail information (separate attachment) is required for every structure over 700 square feet or $50,000 in value or more.

Item # Building Name Size

(Sq. Ft)

Cost/ft Building (Replacement Cost) Equipment (Replacement

Cost)

Stock (Actual Cash Value)

BUILDING, STOCK AND EQUIPMENT TOTAL: $ $

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2. List all Mobile/Contractor’s Equipment to be insured: (i.e. Grooming machines, bulldozers, loaders,snowmobiles, portable air compressors, etc.). Licensed Vehicles must be insured under anautomobile policy.

Item # Year Description Serial Number Value (Actual Cash Value)

MOBILE EQUIPMENT TOTAL: $

3. List all Lifts (and lift huts) to be insured.

Item # Year Description HP Value (Replacement

Cost) OR

Value (Actual Cash

Value)

LIFTS TOTAL: $$

GRAND TOTAL: $

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4. List all Miscellaneous Equipment to be insured (snowmaking equipment, generators, etc)

Item # Employee Name Description of Property Replacement Cost

MISC. EQUIPMENT TOTAL: $

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Solid Fuel Questionnaire

CLIENT NAME: POLICY #

Please attach a picture of the unit, flue pipe and chimney showing as much as possible of each.

Address of premises where unit is installed:

Which building is the heating unit located:

HEATING UNIT:

1. Type of unit:

2. Date of installation:

3. Was the unit installed by a WETT* certified technician: Yes No

If yes, please provide their name:

And certification number:

4. Which room is the unit located in:

OR Is the stove located in an outbuilding: Yes No

5. What certification logo is printed on the label:

ULC CSA W/H ITS None Other:

6. What is the make and model of the unit:

7. What type of fuel is used: Wood Pellet Other:

8. What quantity of fuel is used per year:

9. How often is the chimney cleaned: Twice per year Once a year Other:

10. Is the chimney cleaned by a WETT* certified chimney sweep: Yes No N/A

11. If the unit is a Pellet Stove does the vent extend 5ft vertically and 2ft horizontally from the wall:

Yes No N/A

12. If it is a Fireplace Insert, does the chimney have a metal liner from the top of the stove to the top of the

chimney:

Yes No N/A

13. If the unit is an Outdoor Furnace, how far is it from the nearest building: N/A

14. If the unit is an Outdoor Furnace, what type of liquid is used in the boiler: N/A

*WETT provides training and certification for people who are involved in the installation, inspection andmaintenance of “solid fuel” heating appliances. For more information, go to www.wettinc.ca

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Personal Information Commercial Client Agreement

BETWEEN: R.L. Gougeon Limited/Gougeon Insurance Brokers West Ltd. (the "Broker ")

AND

(the "Client")

The parties acknowledge that the Broker is being retained by the Client to acquire or renew a policy or policies of insurance for the Client, under which certain individuals, including the Client's employees, servants, agents and representatives may be insured (hereinafter called "insured individuals"). Accordingly, each of the parties may need to collect, use and disclose the personal information of such insured individuals.

FOR GOOD AND VALUABLE CONSIDERATION, the receipt and sufficiency of which is hereby acknowledged, each of the parties hereto agrees to collect, use and disclose the personal information of such insured individuals in a manner that a reasonable person would consider appropriate in the circumstances. Each of the parties further agrees to safeguard the security of such personal information in a manner appropriate to the sensitivity of that information.

FOR THE SAID CONSIDERATION, the Client further covenants and warrants that the Client has obtained the appropriate consent from such insured individuals to disclose their personal information to the Broker.

Date:

per:

(Client)

Print Name

(Authorized signing officer)