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Affidavit Of Financial Responsibility Form - Alaska Department Of Community And Economic Development

State of Alaska

Department of Community and Economic Development

Division of Occupational Licensing

Big Game Guides and Transporter Licensing Section

P.O. Box 110806

Juneau, Alaska 99811-0806

(907) 465-2543

E-mail: license@dced.state.ak.us

AFFIDAVIT OF FINANCIAL RESPONSIBILITY

Will you contract to guide or outfit big game hunts during the licensing period for which you are

applying?

Yes

If "Yes," you must possess and maintain, during the licensing period, assets, general liability

insurance, or a bond totaling at least a minimum of $100,000 that will be available for payment of

a judgement against you resulting from your big game hunting services. (See AS 08.54.680 and

12 AAC 75.220)

If you are providing assets as proof of financial responsibility, you must attach a signed description

of the assets, their fair market value less any liens, identification of any liens against the assets, and

location of the assets.

If you are providing insurance or a bond as proof of financial responsibility, you must provide the

following information:

Check applicable box:

Insurance

Bond

Name of Company Issuing Insurance or Bond

Insurance Policy or Bond Number

Amount of Type of Coverage Supplied by the Insurance or Bond

I certify that if I contract to guide or outfit big game hunts, I will comply with the proof of financial

responsibility requirements in AS 08.54.680 and 12 AAC 75.220.

Applicant Signature

Printed Name

Date:

08-4394f (Rev. 8/00)

Affidavit Of Financial Responsibility Form - Alaska Department Of Community And Economic Development