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Cannabis Operations (Not Finished)

Type of operation? (Please check all that apply): *
- Distributor
- Extraction
- Greenhouse grower
- Guided marijuana tours
- Indoor grower
- Lab/Testing
- Manufacturer
- Medical Dispensary
- Other (Please describe)
- Outdoor grower (No structure)
- Processor (Bud and more)
- Processor (Usable bud only)
- Recreational
- Retailer/Dispensary
Describe other type of operation: *
Any in-home cannabis operations? (Check all that apply): *
- Cultivation
- Dispensing
- None
- Other (Please describe)
- Processing
Describe other in-home operation: *
All required state and local license and permits maintained? *
- Yes
- No
How is insured licensed? (City permit # and/or state license #): *
Ever been denied or suspended licensing? *
- Yes
- No
Explain denial/suspension of license: *
In compliance with all local and state laws, regarding the cultivation, manufacturing, dispensary &/or control of marijuana or marijuana-containing products? *
- Yes
- No
Explain non-compliance: *
Is a member of any cannabis/marijuana trade associations? *
- Yes
- No
Describe members: *
Years of experience in the med/rec marijuana industry? *
Does insured own any other business? *
- Yes
- No
Is the location fully owned and operating? *
- Yes
- No
Year the business started? *
Hours of operation? *
Date of location opening and fully operational? *
- Month
- Day
- Year
Type of neighborhood? *
- Industrial
- Residential
- Rural
Is it a drug-free workplace? *
- Yes
- No
Number of employees at this location? *
Background check for employees? *
- Yes
- No
Does the business operate in shifts? *
- Yes
- No
Describe shifts (How many, night shifts, what kinds of job duties are performed at night?): *
Are volunteers or non-paid workers used? *
- Yes
- No
Are temporary staffing workers or leased employees used? *
- Yes
- No
Is insured a farm labor contractor providing employees to cannabis operations other than cultivation? *
- Yes
- No
Any claims or losses within the past 3 years? *
- Yes
- No
Description of losses and claims within the past 3 years: *
Building/Protection
Building square feet occupied by the insured: *
% of building occupied by the insured? *
Type of building construction: *
- Masonry/Non-combustible
- Joisted Masonry
- Frame
Year built: *
Is part of the building residential? *
- Yes
- No
Any known building updates? *
- Wiring
- Heating/HVAC
- Plumbing
- Roof
- None
Is the building sprinkled? *
- Yes
- No
Sprinkler coverage: *
- Full
- Partial
Does the building have an active Central Station Fire Alarm? *
- Yes
- No
Central Station Burglar Alarm? *
- Yes
- No
24/7 interior and exterior video surveillance (14 days of recording)? *
- Yes
- No
Motion detectors? *
- Yes
- No
All entryways, doors and windows are locked, secured and protected by alarm during non-business hours? *
- Yes
- No
Buzz-in system at entryway? *
- Yes
- No
Hold-up button/Panic button? *
- Yes
- No
Security guards on site? *
- Yes
- No
Are they contracted? *
- Yes
- No
Any armed guards? *
- Yes
- No
Are they bonded? *
- Yes
- No
Retail/Dispensary
EDIBLE - sell/dispense infused medical marijuana edible products containing THC or other active cannabinoids (CBD)? (e.g. Baked goods, candies, other food or drink items, tinctured, capsules, etc.)... *
- Yes
- No
If yes, fully describe: *
TOPICAL - sell/dispense topical medical marijuana products containing THC or other active cannabinoids? (e.g. Oils, creams lotions, etc.): *
- Yes
- No
If yes, fully describe: *
VAPORIZERS - sell/dispense medical marijuana oil cartridges or medical marijuana concentrates intended to be used with vaporizers or vapor pens: *
- Yes
- No
If yes, fully describe: *
FDA Violation - sell/distribute or otherwise market cannabis-related products that are in violation of FDA regulations prohibiting the marketing of CBA products claiming to prevent, diagnose, treat... *
- Yes
- No
If yes, fully describe: *
SIGNAGE - if operation is as a retail store or dispensary offering cannabis-related products, is there signage advertising the same? (If yes, provide a photo.): *
- Yes
- No
ANIMAL FOOD - Any sales of animal food or feed to which THC or CBD has been added? *
- Yes
- No
If yes, fully describe: *
DIETARY - Are any THC and CBD marketed, sold and/or distributed as DIETARY supplements? *
- Yes
- No
MMIC - Are MEDICINAL products only sold to patients having a current, qualified physician's script or valid medical marijuana identification card (MMIC)? *
- Yes
- No
MINORS - Is access for minors controlled? *
- Yes
- No
If yes, fully describe: *
Room/Lounge - Are smoking/vape rooms offered? *
- Yes
- No
Does all advertising of cannabis-related products contain the required consumption warning? *
- Yes
- No
Are consumers of the insured's products made aware that edible cannabis can take significantly longer to affect them than other methods of consumption? *
- Yes
- No
Are warnings included stating the potential adverse health effects associated with use of cannabis products containing THC by pregnant or lactating women? *
- Yes
- No
Approximate annual receipts (In dollars): *
Medical marijuana sales/Total receipts %: *
Recreational marijuana/Total receipts %: *
Average amount of cash on premise at any given time (In dollars): *
Maximum amount of cash on premise at any given time (In dollars): *
Displayed inventory is stored in shatter-proof glass display cases during business hours? *
- Yes
- No
What percentage of your stock is kept out of the safe/vault and on display during business hours? *
Is the grow facility located in the same building as a dispensary? *
- Yes
- No
Describe grow facility location: *
Delivery/Distribution (Testing labs, Warehouse)
Is delivery service offered? *
- Yes
- No
Delivery Details
Is delivery done by employees or is this contracted? *
- Employees
- Contracted
Typically, how many deliveries per week? *
Average trip distance of delivery (In miles): *
Does insured own or lease vehicles? *
- Own
- Rent
- Lease
- Borrow
- Other
Describe other: *
Is there a warehouse for storage of products? *
- Yes
- No
Describe warehouse location: *
Guided Tour
If offering guided marijuana tours, describe the tours including number, type of vehicles and how many passengers: *
Are there separate A/C and air filtration systems for the driver and passenger cabins and with no air flow between the cabins? *
- Yes
- No
Is there parition/eisen-type glass (Strata glass) between the driver and passenger cabins? *
- Yes
- No
If any delivery of cannabis and/or guided marijuana tours, are drivers checked for not being impaired (Under the influence)? *
- Yes
- No
How is smoke prevented from leaking through to the driver? *
Cultivation
Growing hazards include: Egress(maze like grow areas), Lighting (UV and FL ), Plastic dividers/combustible interior finishes, High Electrical Loads, High humidity, Illegal locks/barriers, Carbon monoxide, Carbon dioxide (CO2) enrichment, Fumigation (Pesticides, fungicides).
Does insured use a separate entity to transport the plants? *
- Yes
- No
Describe transportation methods: *
Does insured process the plants to finished products? *
- Yes
- No
Type of lighting: *
- Fluorescent Grow Light
- High Intensity Discharge Grow Light (HID)
- LED Grow Light
Are any metal halide bulbs used in HPS ballast? *
- Yes
- No
Any use of metal halide and HPS bulbs interchangeably in light fixtures? *
- Yes
- No
Processing/Extraction
How are the buds trimmed? *
- Dry
- Wet
- Machine
- Hand
What is the extraction solvent used? *
- Acetone
- Alcohol (Ethanol)
- Butane
- C02
- Hexane
- Isopropyl Alcohol
- Methanol
- Other
- Propane
- Toulene
- Water
Describe other extraction solvent: *
Extraction system used: *
- Open-ended
- Closed loop
Do you have the material safety data sheets (MSDS) for the chemicals used? *
- Yes
- No
For other than approved, unattended processes, is the extraction process continually staffed? *
- Yes
- No
Is all monitoring of the extraction process by staff who are adequately trained in the extraction process and all emergency procedures? *
- Yes
- No
All extraction work carried out in a C1D1 room, if using volatile solvents? *
- Yes
- No
Is the extraction room free of not-in-use LPG containers? *
- Yes
- No
Are all flammables are stored in a UL listed cabinets? *
- Yes
- No
Fume hood present? *
- Yes
- No
Automatic exhaust ventilation system present? *
- Yes
- No
Explosion proof electrical equipment used? *
- Yes
- No
Automatic gas detection system in place? *
- Yes
- No
What type(s) of equipment are used for post-processing and winterization (i.e. the removal of fats) involving the heating or processing of the raw extract? *
Is all equipment used for the extraction of oils from plant material listed and approved for the specific use? *
- Yes
- No
List of manufacturers and models of extraction equipment: *
Are all utensils used in the extraction process non-sparking? *
- Yes
- No
Is testing performed on site? *
- Yes
- No
Describe the testing process (Specifically list any chemicals or solvents that may be used): *
Special Hazards and Controls
What is the quality of the Eisen glass? *
What is the strength of the Eisen glass? *
Do the cooling and heating power of the temperature control units (TCUs) meet the capacity requirements for the size of the application? *
- Yes
- No
Opinion
Opinion of risk: *

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