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Inland Marine

Occupancy
Check box if you need to correct the address: *
- Incorrect
Corrected Address
How did you obtain the corrected address? *
Address: *
- Street address
- Street address 2
- - City
  - State / Province
- - zip code
Were you able to verify all the rating basis the customer requested? *
- Yes
- No
What rating basis were you unable to obtain? *
Was an interview conducted? *
- Yes
- No
Person interviewed (must be first and last name): *
Position and/or title: *
What was the other title? *
What date was the interview conducted? *
- Month
- Day
- Year
Was the agent contacted for assistance? *
- Yes
- No
You must contact the agent for assistance.
How many attempts were made to contact the insured and/or the agent? *
Type of Business
What type of business is on the property? *
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
Occupancy Information
Select all supplement forms that apply to this type of business: *
- None
- Cooking
- Daycare
- Playground
Building Owner/Tenant
Is the insured the building/property owner or tenant? *
- Building owner only
- Building owner and occupies the building
- Tenant
Number of owners? *
Approximately what percentage does the building owner occupy? *
Does the owner have a tenant or tenants in the building? *
- Yes
- No
Does the owner require the tenant to provide proof of insurance naming the owner as an additional insured on their policy? *
- Yes
- No
What is the tenant square footage? *
Is the property vacant or partially vacant? *
- Yes
- No
What percentage of the building(s) is vacant? *
What are the insured's plans for the vacant property? *
Business Operations
Description of business operations: *
What type of business ownership? *
Insured's years of experience at this type of business? *
How long has insured been at this location? *
Does insured have other locations? *
- Yes
- No
How many other locations (including this location)? *
What type of neighborhood? *
Losses
Has there been any losses in the last 5 years? *
- Yes
- No
Describe in detail the loss (This must be more than just an answer of "Hail"): *
Date of last loss: *
- Month
- Day
- Year
Hours of Operation
How many days a week are they open? *
Average opening time? *
Average closing time? *
Contents
Does the owner have any contents in the building? *
- Yes
- No
Describe the building owner's contents: *
What is the content value? (In dollars): *
Does the tenant have any contents in the building? *
- Yes
- No
Describe the building tenant's contents: *
What is the tenant content value? (In dollars): *
Additional Notes
Additional Notes: *
Inland Marine
Type of operation *
Equipment Information
Did you attach a list of equipment with make, model, and s/n? *
- Yes
- No
Where is the equipment stored at night? *
What type of protection do they have? *
Describe the other type of protection: *
Are keys removed from all equipment when not in use? *
- Yes
- No
Where are the keys kept? *
Does the equipment have electronic GPS tracking devices? *
- Yes
- No
List all equipment that has a GPS tracker on it: *
How is the equipment transported to a jobsite? *
Is equipment leased to others? *
- Yes
- No
Does the insured supply the operator for the equipment leased? *
- Yes
- No
Do company name and ID# appear on the equipment? *
- Yes
- No
Are all serial numbers recorded and kept on file? *
- Yes
- No
Who maintains the equipment? *
Do they have a maintenance agreement? *
- Yes
- No
Are appropriate fire extinguishers in place? *
- Yes
- No
Are the fire extinguishers maintained annually by a professional firm? *
- Yes
- No
Cargo in Transit
What type of cargo/materials are being transported? *
Are there any hazardous or flammables being transported? *
- Yes
- No
How is the cargo being transported by? *
- Insured vehicles
- Private carrier
- Common carrier
- Other
Describe other type of transportation: *
Approximate distance to destination? (in miles): *
Approximate value of shipment? (in dollars): *
Are identifying data or serial numbers kept? *
- Yes
- No
Does cargo have permanent identification numbers? *
- Yes
- No

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Confirmation Msg	Inland Marine

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