Inland Marine
Occupancy
Check box if you need to correct the address:
*
Incorrect
{"Incorrect":["89","90","322"]}
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
{" No":["324"]}
What rating basis were you unable to obtain?
*
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:
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-- Please Select--
Owner
Bookkeeper
Manager
Assistant Manager
Tenant
Other
{" Other":["328"]}
What was the other title?
*
What date was the interview conducted?
*
January
February
March
April
May
June
July
August
September
October
November
December
Month
01
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31
Day
2006
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1961
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1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
Year
Was the agent contacted for assistance?
*
Yes
No
{" No":["331"],"Yes":["332"]}
You must contact the agent for assistance.
How many attempts were made to contact the insured and/or the agent?
*
-- Please Select--
1
2
3
4
5
6
7
8
9
10
Type of Business
What type of business is on the property?
*
-- Please Select--
Aircraft hangar
Airport terminal
Apartments 4-1000 units
Auditorium
Auto mini lube
Auto Sales/Showroom
Auto salvage
Auto service center
Auto service repair
Bank
Bar/Tavern
Beauty salon/Barber shop
Bowling alley
Bus terminal
Car wash
Caterer
Church
Cold storage facility
Community center
Condominium
Convenience store
Country club
Daycare center
Department store
Discount store
Duplex/Triplex 2-3 units
Fast food restaurant
Funeral home
Heavy manufacturing
HOA homeowner association
Hotel/Motel
Laundromat/Dry cleaning
Light manufacturing
Marina
Medical office
Mini storage warehouse
Mobile home park
Movie theater
Nursing home/Retirement home
Office
Open pavilion
Parking garage
POA property owner association
Post office
Prison
Private club
Restaurant
Restroom building
Retail store
School
Self-storage warehouse
Shopping center strip
Single family dwelling
Social club
Strip center
Supermarket/Grocery
Surgical center
Townhomes
Vacant building
Warehouse
{"Aircraft hangar":["337","349"]," Airport terminal":["337","349","340","370"]," Auditorium":["337","349","340","370"]," Auto mini lube":["337","349","340","370"]," Auto Sales/Showroom":["337","349","340","370"]," Auto salvage":["337","349","340","370"]," Auto service center":["337","349","340","370"]," Auto service repair":["337","349","340","370"]," Bank":["337","349","340","370"]," Bar/Tavern":["337","349","340","370"]," Beauty salon/Barber shop":["337","349","340","370"]," Bowling alley":["334","337","349","340","370"]," Bus terminal":["337","349","340","370"]," Car wash":["337","349","340","370"]," Caterer":["334","337","349","340","370"]," Church":["335","365","337","349"]," Cold storage facility":["337","349","340","370"]," Community center":["334","337","349"]," Condominium":["340","370"]," Convenience store":["337","349","340","370"]," Country club":["337","349","340","370","334"]," Daycare center":["337","349","340","370"]," Department store":["337","349","340","370"]," Discount store":["337","349","340","370"]," Fast food restaurant":["337","349","340","370"]," Funeral home":["337","349","340","370"]," Heavy manufacturing":["337","349","340","370"]," HOA homeowner association":["337","349"]," Hotel/Motel":["340","370"]," Laundromat/Dry cleaning":["337","349","340","370"]," Light manufacturing":["337","349","340","370"]," Marina":["337","349","340","370"]," Medical office":["334","337","349","340","370"]," Mini storage warehouse":["337","349"]," Mobile home park":["337","349"]," Movie theater":["334","337","349","340","370"]," Nursing home/Retirement home":["337","349","340","370"]," Office":["334","337","349","340","370"]," Open pavilion":["337","349"]," Parking garage":["337","349"]," POA property owner association":["337","349"]," Post office":["337","349"]," Prison":["334","337","349"]," Private club":["334","337","349","340","370"]," Restaurant":["337","349","340","370"]," Restroom building":["337","349"]," Retail store":["334","337","349","340","370"]," School":["334","337","349","340","370"]," Self-storage warehouse":["337","349"]," Shopping center strip":["334","337","349","340","370"]," Social club":["334","337","349","340","370"]," Strip center":["334","337","349","340","370"]," Supermarket/Grocery":["334","337","349","340","370"]," Surgical center":["337","349","340","370"]," Townhomes":["337","349","340","370"]," Vacant building":["340","370"]," Warehouse":["337","349","340","370"]}
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
{"Building owner only":["341","350","352","373"]," Building owner and occupies the building":["341","350","351","352","373"]," Tenant":["341","376"]}
Number of owners?
*
-- Please Select--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Approximately what percentage does the building owner occupy?
*
-- Please Select--
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Does the owner have a tenant or tenants in the building?
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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
What is the tenant square footage?
*
Is the property vacant or partially vacant?
*
Yes
No
{"Yes":["356","357"]}
What percentage of the building(s) is vacant?
*
-- Please Select--
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
What are the insured's plans for the vacant property?
*
Business Operations
Description of business operations:
*
What type of business ownership?
*
-- Please Select--
Corporation
Partnership
Individual
Franchise
Non-profit
Insured's years of experience at this type of business?
*
-- Please Select--
Less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 years
Over 20 years
How long has insured been at this location?
*
-- Please Select--
Less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 years
Over 20 years
Does insured have other locations?
*
Yes
No
{"Yes":["363"]}
How many other locations (including this location)?
*
-- Please Select--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Over 20
What type of neighborhood?
*
-- Please Select--
Residential
Rural
Commercial
Commercial and residential
Industrial
Losses
Has there been any losses in the last 5 years?
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Yes
No
{"Yes":["368","369"]}
Describe in detail the loss (This must be more than just an answer of "Hail"):
*
Date of last loss:
*
January
February
March
April
May
June
July
August
September
October
November
December
Month
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
Year
Hours of Operation
How many days a week are they open?
*
-- Please Select--
1 day
2 days
3 days
4 days
5 days
6 days
7 days
Varies per tenant
{"1 day":["371"]," 2 days":["371"]," 3 days":["371"]," 4 days":["371"]," 5 days":["371"]," 6 days":["371"]," 7 days":["371"]," Varies per tenant":["371"]}
Average opening time?
*
-- Please Select--
1 am
2 am
3 am
4 am
5 am
6 am
7 am
8 am
9 am
10 am
11 am
12 noon
1 pm
2 pm
3 pm
4 pm
5 pm
6 pm
7 pm
8 pm
9 pm
10 pm
11 pm
12 midnight
24 hours
{"1 am":["372"]," 2 am":["372"]," 3 am":["372"]," 4 am":["372"]," 5 am":["372"]," 6 am":["372"]," 7 am":["372"]," 8 am":["372"]," 9 am":["372"]," 10 am":["372"]," 11 am":["372"]," 12 noon":["372"]," 1 pm":["372"]," 2 pm":["372"]," 3 pm":["372"]," 4 pm":["372"]," 5 pm":["372"]," 6 pm":["372"]," 7 pm":["372"]," 8 pm":["372"]," 9 pm":["372"]," 10 pm":["372"]," 11 pm":["372"]," 12 midnight":["372"]}
Average closing time?
*
-- Please Select--
1 am
2 am
3 am
4 am
5 am
6 am
7 am
8 am
9 am
10 am
11 am
12 noon
1 pm
2 pm
3 pm
4 pm
5 pm
6 pm
7 pm
8 pm
9 pm
10 pm
11 pm
12 midnight
Contents
Does the owner have any contents in the building?
*
Yes
No
{"Yes":["374","375"]}
Describe the building owner's contents:
*
What is the content value? (In dollars):
*
Does the tenant have any contents in the building?
*
Yes
No
{"Yes":["377","378"]}
Describe the building tenant's contents:
*
What is the tenant content value? (In dollars):
*
Additional Notes
Additional Notes:
*
Inland Marine
Type of operation
*
-- Please Select--
Contractor equipment
Electronic data processing equipment
Cargo coverage for property in transit
Clothing
{"Contractor equipment":["381","383","384","385","387","389","391","392","394","395","396","397","398","399"]," Cargo coverage for property in transit":["382","400","401","402","404","405","406","407"]}
Equipment Information
Did you attach a list of equipment with make, model, and s/n?
*
Yes
No
Where is the equipment stored at night?
*
-- Please Select--
On the jobsite
Company shop building(s)
Company fenced in storage lot
Barn
Garage
Depends on jobsite location
Canopy/Awning
What type of protection do they have?
*
-- Please Select--
Fencing
Security guards
Security lights
Security cameras
None
Other
{" Other":["386"]}
Describe the other type of protection:
*
Are keys removed from all equipment when not in use?
*
Yes
No
{"Yes":["388"]}
Where are the keys kept?
*
Does the equipment have electronic GPS tracking devices?
*
Yes
No
{"Yes":["390"]}
List all equipment that has a GPS tracker on it:
*
How is the equipment transported to a jobsite?
*
-- Please Select--
Truck and trailer
Farm use only
Driven
Not transported
Stationary equipment
Is equipment leased to others?
*
Yes
No
{"Yes":["393"]}
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
{" Other":["403"]}
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