New PLC Contractor Application - PLC of the Northeast

Phone

This field is for validation purposes and should be left unchanged.

Company Name(Required)

Contact Name(Required)

First Last

State(Required)

Mailing Address(Required)

Street Address City ZIP / Postal Code

Phone(Required)

Cell:(Required)

Email(Required)

Additional Emails for weekly email:

Website

Best Contact Method:(Required)

text

phone

mail

1. Is your company responsible for the execution of all phases of your harvesting operation from stump to roadside?(Required)

The undersigned, on behalf of the above-named company (applicant), herby applies for membership in the PLC of the Northeast. As a condition of membership, I agree that: – The burden of proof for eligibility rests with the applicant and all questions must be completed.

Yes

2. Do you have a Federal Tax ID #?(Required)

Yes

3. Do you have an Unemployment Insurance Account Number?(Required)

Yes

4. Do you have a current Workers’ Compensation Policy?(Required)

* PLC policy is that Members must have a current workers comp. insurance policy. However, affiliated sole proprietor applicants may also qualify for membership if they do not have a current policy by being Master Logger Certified® company. (Your insurance agent will have all of the information below)

Yes

Workers Compensation Insurance Agency:(Required)

If not listed, please add under other.

Cass Insurance

Chalmers Insurance

Clark Insurance

Cross Insurance

F.A. Peabody Insurance

Readfield Insurance

United Insurance

Unknown

Other

Workers Compensation Insurance Underwriter:

If not listed, please add under other.

Workers compensation modifier number rating:

A number between .25 and 2.

If you do not know your workers compensation modifier number, may we contact your agent to get the information?

Not Applicable

Yes

5. Do you have a current General Liability (GL) Insurance Policy?(Required)

Yes

General Liability Insurance Agency:(Required)

If not listed, please add under other.

Cass Insurance

Chalmers Insurance

Clark Insurance

Cross Insurance

F.A. Peabody Insurance

Readfield Insurance

United Insurance

Unknown

Other

General Liability Insurance Underwriter:

If not listed, please add under other.

Acadia

Acuity

Other

Training/Certification & Safety

6. Current number of full-time employees:(Required)

Current number of part-time employees:(Required)

7. Do your employees participate in a logger training program?(Required)

Check all that apply.

Northeast Professional Logger (PLC)

Certified Logging Professional

Qualified Logging Professional

Vermont Logger Education to Advance Professionalism

New York Logger Trained

Other

Is your company certified by the Master Logger Certification Program®?(Required)

Yes

In Process

8. Do you have a written safety program on file?(Required)

(PLC members and Master Logger Certified Companies must have a written safety program on file as a condition of membership. The PLC will provide sample safety plans to assist with this process.)

Yes

9. Do you have ongoing workplace safety inspections?(Required)

Quarterly or Annually

Yes

10. Has your company violated the standards of the State Forest Practices Act or had civil violations (i.e. timber theft or trespass) within the past five years?(Required)

Yes

If yes, please explain.(Required)

11. During the past 12 months, have there been any significant changes in your company?(Required)

Yes

If yes, please explain.(Required)

Acadia Dividend & Logger Code of Practice

12. Would your company like to participate in the 2026 PLC/Acadia Insurance Dividend Group? (*participation in the Dividend Group is subject to underwriting approval by Acadia Insurance)(Required)

Yes (Type Name Below)

Acadia Confidentiality Waiver- As a condition of participation in the PLC/Acadia Insurance Dividend Group, Acadia Insurance requires the PLC to obtain a signed confidentiality waiver from each participating company.

On behalf of (“Company”), as a member of the PLC/Acadia Insurance Dividend Program, I hereby authorize Acadia Insurance and/or its appointed agents to release information relating to my insurance policies with Acadia Insurance, including but not limited to premiums and loss history, to the Executive Director of the PLC. The Executive Director of the PLC will keep this information confidential and will not share company specific information with the Executive Board, Full Board, or individual members of the PLC. I acknowledge and agree that the fore- going authorization will remain valid as long as the Company remains a member of the PLC and the PLC/Acadia Insurance Dividend program, unless expressly revoked in writing to Acadia Insurance and the PLC. The undersigned certifies that he/she is duly authorized to sign this authorization on behalf of the Company. Signature required to participate in the dividend program.

13. Loggers Code of Practice: (All PLC members must sign)(Required)

As a professional contractor and member of the PLC, our company meets or exceeds the following standards: 1. Promote ethical conduct in all aspects of my work. 2. Strive to meet high standards for harvesting practices that are consistent with the principles of sustainable forestry. 3. Operate responsibly in every phase of my business. 4. Respect private landowner rights and work to meet their objectives when they align with sustainable forestry principles and applicable laws. 5. Educate and inform landowners, loggers, and others about the importance of responsible forestry practices. 6. Participate in recognized certification programs that demonstrate compliance with industry standards. 7. Pursue continuous improvement through training, innovation, employee programs, and other means of professional development. 8. Comply with all federal, state, and local laws and regulations, as well as industry standards and guidelines. 9. Maintain safe harvest operations in accordance with Occupational Safety and Health Administration (OSHA) requirements, including safety planning and implementation. 10. Operate profitably and responsibly as a member of the business community, ensuring fair and lawful practices with employees, vendors, and partners. 11. Foster positive relationships with landowners, procurement personnel, mill representatives, and the public. 12. Promote a positive image of the industry by working with peers, trade associations, and other groups to elevate standards across the profession. 13. Uphold the integrity of the logging profession through responsible actions and commitment to high standards.

Company data – please check any that apply:

Please provide a short overview of your operation and the types of work you perform.

Type of harvesting operation:

Whole Tree

Cut to length

Conventional

How many of each crew do you have?

Type of buncher:

rubber tires

tracked