BOP Insurance Policy

	Location 1
Annual Revenue $
Occupied Area (SQ FT):
Open to Public Area (SQ FT):
Total Building Area (SQ FT):
Any Area Leased to Others? Yes or No

	Location 2
Annual Revenue $
Occupied Area (SQ FT):
Open to Public Area (SQ FT):
Total Building Area (SQ FT):
Any Area Leased to Others? Yes or No

	Location 3
Annual Revenue $
Occupied Area (SQ FT):
Open to Public Area (SQ FT):
Total Building Area (SQ FT):
Any Area Leased to Others? Yes or No

NATURE OF BUSINESS

What is the nature of the business?

RESTAURANT SECTION

Hours of Operation

# Of Days Per Week

Is Applicant Seasonal?

Distance To Nearest Body of Water

Kitchen Fire Protection?

U.L. Approved Automatic Extinguishing System Under Semiannual Contract

Above System Covering All Cooking Surfaces?

System Name?

System

Automatic Gas or Electric Shut Offs For Cooking?

Hood and Filters Cleaned Weekly By Staff

Hoods & Ducts Maintenance Contract Schedule. # Per Month

# of Fire Extinguishers

Tag Dates

Apartments

Is there an on sight manager

Hours Available

Are units available for daily or weekly rental

Age of building

# of Buildings

# of Stories

# of Families

% Occupied

Is there an elevator on the premises?

Is elevator maintenance agreement in force?

Construction last updated

Roof

Wiring

If over 10 years provide details

If aluminum wiring, have all outlets been pigatied and checked by a licesned electrical contractor within the past 5 years?

Numbers of years owned

Condition of property

Surrounding Area

Occupancy

Security

Are sliding glass doors equipped with additional locks?

Do entry doors have peepholes and keyless deadbolts?

Are there any securtiy guards on premises?

If yes, please provide full details including whether armed or unarmed, off-duty police, independent firm (which provides certificates?) or employees and if there is any non-cash compensation:

Are there fences and/or gates surrounding the property?

Are criminal checks done on employees?

Are criminal checks done on prospective tenants?

Have there been any previous incidents of physical or sexual assault?

Retail Opperations

Does the insured have employees who perform pick-up or delivery?

If yes, what is the maximum pick-up or delivery radius?

How many delivery vehicles, including employee owned, are used in the class related to Stores - Wholesale?

Does the insured participate in any program where they are notified if one of their drivers receives a vehicle violation?

Does the insured have any repacking or assembly operations ?

What is the maximum weight of any single product?

Store Hours:

Monday 12:00am to 11:00pm 24 HoursTuesday 12:00am to 11:00pm 24 HoursWednesday 12:00am to 11:00pm 24 HoursThursday 12:00am to 11:00pm 24 HoursFriday 12:00am to 11:00pm 24 HoursSaturday 12:00am to 11:00pm 24 HoursSUnday 12:00am to 11:00pm 24 Hours

Does the insured sell any of the following:

GunsPoisonous reptiles or exotic animalsRent or sell adult videos or booksExercise/Sports Equipment weighing more than 50 lbsSpas or Furniture weighing more than 50 lbs

Has insured experienced a robbery or attempted robbery in the past 4 years?

If yes, How many?

What type of Retail Store does the insured operate:

Manufacturers

If any products become component parts of another company's products, supply details and include end use applications. If sold to be repacked under another name, supply the eventual name and potential customers:

Are any new products to be introduced/manufactured during next year?

If yes, describe product and expected sales:

Do you manufature products for any of the following industries?

If yes, Describe

Top five customers:

	List best customers
Customer #1
Customer #2
Customer #3
Customer #4
Customer #5

What Products are Manufactured, Sold, Or Distributed

	Product Type:	Total Sales:	Estimated Sales:	Percentage of Sale Outside the US:
1
2
3
4
5

How can your products be identified from those of your competitors?

Do you agree to hold all distributors, dealers and suppliers harmless against claims or suits for bodily injury and property damage in connection with your products?

Are any products sold or components used by you manufactured by foreign manufacturers

If yes, provide details with percent of cost of goods sold:

Are batch/product records, serial numbers or copies of guarantee/warranties maintained to trace products?

If yes, provide details including how long records are maintained:

Are products identified to ensure traceability to date and place of manufacturing?

Are the critical components identified and traceable to the original source?

Are the raw materials traceable back to the original source?

Does any manufacturer provide you protection for any products that you distribute?

If yes, which products and provide details:

Have you merged with or acquired any companies in the last three years?

If yes, provide details and advise how past liabilities were handled in the acquisition:

Do you have a formal quality control program?

if ye, provide details. If no, how do you assure the quality of your products?

What Products are Manufactured, Sold, Or Distributed

	Product Type:	Total Sales:	Estimated Sales:	Percentage of Sale Outside the US:
1
2
3
4
5

In What Geographic Area/States are These Products Sold?

	Percentage of Sales: %
States/Geographic Areas:

Foreign Countries:

	Percentage of Sales
Foreign Countries

Do you have a formalized recall program?

If yes, please attach a copy.

Browse Files

If no, do you have an informal plan?

Has any product ever been recalled?

Date of recall:

By what agency?

Product involved:

Reason for recall and how discovered:

What was the remedy for the problem?

Were federal/state authorities notified?

If yes, on what date?

ARe there any present situations which might give rise to an incident causing a product recall

If yes, which products and provide details:

Have you been cited by any regulatory agency for violations from business activity involving your product?

If yes, which products and provide details:

Does any manufacturer provide you protection for any products that you distribute?

If yes, which products and provide details:

Lessor's Risk Only Supplemental Application

List all names of tenants, or attach list:

What is the area of all building to be covered per questions #2 about (square footage)

Nail solo, SQF 1000Restaurant, SQF 2000Office, SQF 1000Other

Does the property have a parking lot or garage?

If yes, what is the area of the lot/garage (square footage):

Who is responsible for the care and maintenance of the property? (Buildings, sidewalks, and parking lots) check one:

INSURIANCE REQUIERMENNTS:

Are all tenants required to carry their own Commercial General Liability coverage?

If yes, what limits are required?

Are all tenants required to name the insured as Additional Insured on their CGL policies?

Does insured collect Certificates of Insurance on an annual basis from all tenants?

NOTE: SUBMITTING COPIES OF THESE CERTIFICATES MAY QUALIFY FOR PREMIUM CREDITS

Do lease agreement contain Hold Harmless wording in insured's favor?

Are any security guards employed by insured?

If yes, are they armed?

Are there any Underground Storage Tanks on the property?

If yes, what do they contain?

Any of the following? Please describe all answers in detail below.

If yes to any above, please describe:

PROPERTY SECTION

Premises Information

	Location 1	Location 2	Location 3
Building
Business Personal Property
Business Income

Building

Construction Type

Siding

Distance to Fire Hydrant

Distance to Fire Station

Fire District

# Stories

# Basm'ts

Yr Built

Total Area

Improvements

Wiring

Heating

Roofing

Plumbing Yr

Roof Type, Condition, and Age

Other Occupancies

Primary Heat

BoilerSolid FuelOther

If boiler, is insurance placed elsewhere?

Alarms

Smoke Detectors?

If Yes:

Fire Alarm?

If Yes:

Burglar Alarm

If Yes:

Surveillance Cameras

If Yes:

Is there a Central Monitor?

Archived for? (# of months)

Sprinkler System

If Yes:

Volunteer Fire Department

Distance to Hydrant and Fire Dept

COMMERCIAL GENERAL LIABILITY SECTION

General Aggregate:

Limit Applies Per:

Products & Completed Operations Aggregate:

Personal and Advertising Injury:

Each Occurance:

Damage to Rented Premises: (each occurance)

Medical Expenses: (any one person)

Employee Benefits:

	Product Description	Annual Gross Sales	Payroll
Loc 1
Loc 2
Loc 3

	Date of Loss	Line	Type of Claim	Date of Claim	Amount Paid	Amount Reserved	Subro- gation Y/N	Open Y/N
1
2
3
4
5

Business Owner Policy Application