Inland Marine

Inland Marine

Occupancy
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Check box if you need to correct the address: *
- Incorrect
; {"Incorrect":["89","90","322"]}
Corrected Address
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How did you obtain the corrected address? *

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Address: *
- Street address
- Street address 2
- - City
  - State / Province
- - zip code
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Were you able to verify all the rating basis the customer requested? *
- Yes
- No
; {" No":["324"]}
What rating basis were you unable to obtain? *

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Was an interview conducted? *
- Yes
- No
; {"Yes":["326","327","329"]," No":["330"]}
Person interviewed (must be first and last name): *

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Position and/or title: *

; {" Other":["328"]}
What was the other title? *

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What date was the interview conducted? *
- Month
- Day
- Year
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Was the agent contacted for assistance? *
- Yes
- No
; {" No":["331"],"Yes":["332"]}
You must contact the agent for assistance.
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How many attempts were made to contact the insured and/or the agent? *

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Type of Business
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What type of business is on the property? *

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Select all supplement forms that apply to this business: *
- None
- Restaurant/Cooking
- Convenience store
- Nightclub
- Laundromat/Dry cleaners
- Daycare
- Playground
- Swimming pool
- Nursing home/Assisted living
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Occupancy Information
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Select all supplement forms that apply to this type of business: *
- None
- Cooking
- Daycare
- Playground
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Building Owner/Tenant
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Is the insured the building/property owner or tenant? *
- Building owner only
- Building owner and occupies the building
- Tenant
; {"Building owner only":["341","350","352","373"]," Building owner and occupies the building":["341","350","351","352","373"]," Tenant":["341","376"]}
Number of owners? *

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Approximately what percentage does the building owner occupy? *

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Does the owner have a tenant or tenants in the building? *
- Yes
- No
; {"Yes":["353","354","355"]," No":["355"]}
Does the owner require the tenant to provide proof of insurance naming the owner as an additional insured on their policy? *
- Yes
- No
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What is the tenant square footage? *

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Is the property vacant or partially vacant? *
- Yes
- No
; {"Yes":["356","357"]}
What percentage of the building(s) is vacant? *

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What are the insured's plans for the vacant property? *

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Business Operations
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Description of business operations: *

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What type of business ownership? *

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Insured's years of experience at this type of business? *

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How long has insured been at this location? *

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Does insured have other locations? *
- Yes
- No
; {"Yes":["363"]}
How many other locations (including this location)? *

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What type of neighborhood? *

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Losses
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Has there been any losses in the last 5 years? *
- Yes
- No
; {"Yes":["368","369"]}
Describe in detail the loss (This must be more than just an answer of "Hail"): *

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Date of last loss: *
- Month
- Day
- Year
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Hours of Operation
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How many days a week are they open? *

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Average opening time? *

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Average closing time? *

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Contents
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Does the owner have any contents in the building? *
- Yes
- No
; {"Yes":["374","375"]}
Describe the building owner's contents: *

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What is the content value? (In dollars): *

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Does the tenant have any contents in the building? *
- Yes
- No
; {"Yes":["377","378"]}
Describe the building tenant's contents: *

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What is the tenant content value? (In dollars): *

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Additional Notes
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Additional Notes: *

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Inland Marine
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Type of operation *

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Equipment Information
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Did you attach a list of equipment with make, model, and s/n? *
- Yes
- No
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Where is the equipment stored at night? *

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What type of protection do they have? *

; {" Other":["386"]}
Describe the other type of protection: *

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Are keys removed from all equipment when not in use? *
- Yes
- No
; {"Yes":["388"]}
Where are the keys kept? *

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Does the equipment have electronic GPS tracking devices? *
- Yes
- No
; {"Yes":["390"]}
List all equipment that has a GPS tracker on it: *

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How is the equipment transported to a jobsite? *

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Is equipment leased to others? *
- Yes
- No
; {"Yes":["393"]}
Does the insured supply the operator for the equipment leased? *
- Yes
- No
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Do company name and ID# appear on the equipment? *
- Yes
- No
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Are all serial numbers recorded and kept on file? *
- Yes
- No
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Who maintains the equipment? *

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Do they have a maintenance agreement? *
- Yes
- No
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Are appropriate fire extinguishers in place? *
- Yes
- No
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Are the fire extinguishers maintained annually by a professional firm? *
- Yes
- No
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Cargo in Transit
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What type of cargo/materials are being transported? *

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Are there any hazardous or flammables being transported? *
- Yes
- No
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How is the cargo being transported by? *
- Insured vehicles
- Private carrier
- Common carrier
- Other
; {" Other":["403"]}
Describe other type of transportation: *

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Approximate distance to destination? (in miles): *

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Approximate value of shipment? (in dollars): *

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Are identifying data or serial numbers kept? *
- Yes
- No
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Does cargo have permanent identification numbers? *
- Yes
- No
;

Occupancy

Corrected Address

You must contact the agent for assistance.

Type of Business

Occupancy Information

Building Owner/Tenant

Business Operations

Losses

Hours of Operation

Contents

Additional Notes

Inland Marine

Equipment Information

Cargo in Transit