Museum Insurance Questionnaire

Applicant's Name:

Address:

Mailing Address

Address (cont):

Mailing Address - continued

Contact:

Email

Telephone:

Website

Fax:

Applicant is:

Current Carrier:

Expiration Date:

Limits: ($)

Premium: ($)

Deductible: ($)

GENERAL INFORMATION - Please provide a copy of your newsletter or any brochures.

1. Are you on the National Register of Historic places? If yes, you are not eligible for this program.

2. Please describe your museum facility (collections, activities, special events, snack bar, gift shop, etc.)

3. Do you own the facility?

3a. If no, who is the owner?

3b. Is your location address listed above? If not, please list location(s).

3c. Do you have an emergency plan (tornado, fire, etc.)?

4. What is the square footage of the museum?

5. How many annual visitors?

6. Hours of operation:

7. Is your museum seasonal?

7a. Do you have outdoor displays?

7c. If yes, do you have a caretaker on premises year round?

8. Do you have any high-value or sensitive displays?

8a. Please describe these display(s).

8b. Please describe how these displays are stored (protective glass, controlled temperatures, fire safety, etc.)

9. Do you repair, restore, retouch or conserve collections?

9a. If yes, please describe.

10. Please enter amounts below

Rows	Owned Collections	Loan Collections
Limit of Insurance Desired
Deductible
Total Value
Average Value (Item)
Maximum Value (Item)
Percentage of current collection

11. Owned Collections

Rows	Yes	No
11a. Are permanent collections fully inventoried?
11b. Are all collections catalogued, photographed or videotaped?
11c. Are records stored electronically with an electronic copy stored off site?
11d. Do you have precious metals or gems part of the collection?
11e. Are items stored at least 12 inches off the ground?

11a. Date collection values were last updated.

12. Loaned Collections

Rows	Yes	No
12a. Are written loan agreements obtained for all collections loaned to you?
12b. Do agreements specify who is responsible for damage and insurance?
12c. Do you make a photographic record of objects in loaned collection?
12d. Is valuation agreed for total loss?
12e. Is valuation agreed for partial loss?

13. Please answer the following about collections:

Rows	On Loan From Others	Loaned To Others
13a. Who is responsible for insurance while property is in transit?
13b. Who is responsible for insurance at insured's premises?
13c. Who is responsible for insurance while at loaned premises?
13d. Are packers trained in proper packing methods for valuable items (Yes/No)

14. Please describe security at the museum (guards (armed/unarmed), security system components (fire, burglar, motion detection, glass breakage, door/window sensors, security cameras, etc.)

14a. If central station, name of monitoring company.

14b. If you have security cameras, how many hours do you save the camera recordings?

14c. Can security system operate during power failure?

14d. Are high value displays individually alarmed?

Other

Rows	Building Age	Building Construction	Building Limit ($)	Content Limit ($)
Building 1
Building 2
Building 3

Rows	Year	Make	Model	Value to Insure For ($)
Item 1
Item 2
Item 3

Rows	Vehicle Make	Vehicle Model	Cost New ($)	Year
Vehicle 1
Vehicle 2
Vehicle 3

Rows	Amount ($)
Limit of Liability
Comprehensive Deductible
Collision Deductible

Rows	Yes	No
1a. On prospective employees and volunteers?
1b. On existing employees and volunteers?

Rows	Yes	No
4a. Abuse and Molestation?
4b. How to recognize the signs of abuse?
4c. What to do if an individual reports someone molested him/her?