• Johnston Meier Insurance Commercial, Risk Survey

    Johnston Meier Insurance Commercial, Risk Survey

    Applicant Info:
  • Date Completed:
     - -
    2 digit month, 2 digit day, 4 digit year
  •  -
  • Add contractor supplement?
    • Electrical Contractor Supplement: 
    • Emergency Equipment Installation (Hospital/medical equipment)
    • Alarm System Installation/repair
    • Exterior work over 4 stories in height
    • Industrial Work

    • ** End Of Electrical Supplement **

    • Plumbing/Heating Contractors Supplement: 
    • Boiler Work
    • Are employees ticketed
    • Do you work with propane, butane, LPG (Liquefied Petroleum Gas)
    • If yes are you ticketed
    • Any Industrial work
    • Do you install sprinkler systems

    • ** End Of Plumber Supplement **

    • Excavation Contractors Supplement 
    • Any Tunneling, subway work, sewers or road Construction
    • Any Gas , Hydro or communication line work?
    • Any work on Oil Fields or Oil Patch sites
    • Any work on logging sites, lumbering premises, or rural areas
    • Any Tree removal

    • ** End Of Contractors Supplement **

    • Crane Operators Questionnaire Supplement 

    • ** End Of Crane Operators Supplement **

    • Collapse Stopper 
    • Claims/Losses?*
    • Has the applicant ever been refused Insurance Coverage?*
    • Expiry Date:
       - -
      2 digit month, 2 digit day, 4 digit year
    • Upload a File
      Cancelof
  • Johnston Meier Insurance Commercial Risk Survey

    Johnston Meier Insurance Commercial Risk Survey

    Building Information/Coverages Required
  • Does client require Commercial Building Insurance*
    • Open Commercial Building Supplement 
    • If building location is the same as applicant, click to auto-fill.
    • Building Construction:*
    • View Online Construction Code Description
    • ISO Construction Code Descriptions
    • Is building over 25 years old?*
    • If building is over 25 years old, have any of the following updates been done?*
    • Heating by:*
    • Sprinkler System:*
    • Sprinkler System for partial or entire building:*
    • Fire Extinguishers:
    • Extinguishers Found On Premises:
    • View Fire Class Colour Code:
    • View Fire Class Colour Code:
    • Alarm:

    • Building Ownership/Type

    • Compound Description:

    • ** End Of Commercial Building Supplement **

    • Collapse Stop 

    • What Coverages Are Required:

    • Crime
    • Crime Coverage 

    • ** End Of Crime Coverage Application **

    • Collapse Stop 
    • Professional Liability*
    • Errors And Omission Coverage 
    • Additional Coverages

    • The Applicant__________________________________

    • Autofill Applicant Info
    • Is there more than one legal entity?
    •  -
    • Date operations began:
       - -
      2 digit month, 2 digit day, 4 digit year
    • Upload a File
      Cancelof

    • Gross Annual Revenue

    • Does the applicant provide services outside of Canada?
    • Does the applicant belong to any related association:
    • Has the Applicant ever been investigated by or suspended from practice by any governing body of their profession?
    • Is any legislation currently in force governing the practice of the Applicant?

    • Insurance Coverage_____________________________

    • Has the Applicant ever previously purchased professional liability or errors and omissions insurance?
    • If yes please provide the following details for the last three years:
      Rows
    • With respect to above, please indicate if such coverage was offered on occurrence basis, or claims-made basis?
    • If claims-made, what was the retroactive date of the policy?
       - -
      2 digit month, 2 digit day, 4 digit year
    • Has insurance coverage ever been declined or cancelled or the renewal thereof been refused?

    • Loss Experience________________________________

    • In the past, has the Applicant or any of their employees ever been the recipient of any allegations of professional negligence in writing or verbally?
    • Is the Applicant or any of their employees aware of any facts, circumstances or situations which may reasonably give rise to a claim, other than as advised above?

    • Limits Requested_______________________________

    • Rows

    • ** End Of E&O Coverage Application **

    • Collapse Stop 
    •  
    • Should be Empty: