CONTRACTUAL EXPOSURES
Does the applicant lease the
premises? ___ Yes ___ No
If yes, answer the following:
Does the lease
include a written waiver-of-rights provision for damage to property? ___ Yes
___ No
Does the lease
include a written waiver of subrogation? ___ Yes ___ No
Does the lease
include a written hold harmless agreement? ___ Yes ___ No
Does the lease
clearly delineate maintenance responsibilities? ___ Yes ___ No
Indicate under which of the
following agreements the applicant has assumed liability of others:
|
___ Lease agreements for real
estate
|
___ Lease agreements for signs,
refrigerators, etc.
|
|
___ Sidetrack agreements
|
___ Contracts for electric power,
steam, etc.
|
|
___ Easement agreements
|
___ Elevator maintenance
|
|
___ Other contracts such as
construction, installation,
compliance certificates, etc.
|
|
Attach
a copy of each contract and/or agreement indicated above.
Is the applicant’s insurance policy
required to be primary under any of the indicated contracts? ___ Yes ___ No
What are the applicant's procedures
to ensure that it is an additional insured on the subcontractor's policy?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Do any current contracts contain
requirements that list specific endorsements or insurance coverage wording? ___
Yes ___ No
If yes, attach a copy of the
contract(s).
SUBCONTRACTORS
Does the applicant regularly use
subcontractors? ___ Yes ___ No
If yes, answer the following:
Describe the type
of work the subcontractors perform.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Describe procedures
used to monitor timely receipt of certificates of insurance from
subcontractors.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Does the
applicant have a written contract with each subcontractor? ___ Yes ___ No
If yes, attach a
copy of each contract.
If no, describe
the terms and agreements between the applicant and the subcontractor.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
What are the
subcontractors' required insurance limits? $___________
What is the
percentage of work subcontracted: ____%
