Volume 73

January 2013

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PRODUCER'S COMMERCIAL LINES RISK EVALUATION SYSTEM

Client / Agent Coverage Agreement

Category: Eating and Drinking Places Risk: Restaurants

Instructions:

Agent: The coverages listed below are suggested for consideration for eating or drinking places. After evaluating each of the listed coverages, check the recommended blank by those that apply specifically to this client. Make sure both the exposure and the coverage are explained to the client. Each coverage and option is explained in the Definitions section of this program.

Client: For each of the coverages that the agent has recommended, initial whether you have chosen to accept or reject that coverage in the blanks provided.

CLIENT / AGENT COVERAGE AGREEMENT

         

PROPERTY COVERAGES

       

Recommend

Accept

Reject

Not Applicable

Building and Personal Property Coverage Form

       

Building

______

______

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Business Personal Property

______

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Personal Property of Others

______

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Improvements and Betterments

______

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Condominium Coverage Form

       

Condo-Unit Owners Coverage

______

______

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Commercial Output Policy

______

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Building and Personal Property Coinsurance

Percentages    None 80% 90% 100%

______

______

______

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Bldg               ____ ____ ____ ____

______

______

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BPP               ____ ____ ____ ____

______

______

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PPO               ____ ____ ____ ____

______

______

______

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I & B               ____ ____ ____ ____

______

______

______

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Alternatives to Coinsurance

Agreed Value

______

______

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Functional Replacement Cost

______

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Peak Season

______

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Reporting Form

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Other ________________________

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Optional Property Coverages

Boiler and Machinery

______

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Legal Liability

______

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Optional Property Endorsements

       

Additional Debris Removal

______

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Ordinance or Law

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Outdoor Trees, Shrubs and Plants Enhancement

______

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Replacement Cost Valuation

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Spoilage

______

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Utility Services-Direct Damage

______

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Other Property Options

       

______________________________________

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______________________________________

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______________________________________

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TIME ELEMENT COVERAGES

       

Recommend

Accept

Reject

Not Applicable

Business Income With Extra Expense
Coinsurance Percentage ___

______

______

______

______

Business Income Without Extra Expense
Coinsurance Percentage ___

______

______

______

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Extra Expense

______

______

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Leasehold Interest

______

______

______

______

           

Alternatives to Coinsurance

Agreed Value

______

______

______

______

Maximum Period of Indemnity

______

______

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Monthly Limit of Indemnity

______

______

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Premium Adjustment

______

______

______

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Optional Time Element Endorsements

       

Business Income from Dependent Properties

______

______

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Ordinance or Law Increased Period of Restoration

______

______

______

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Utility Services

______

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______

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Other Time Element Coverages

       

______________________________________

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______________________________________

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______________________________________

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PROPERTY AND TIME ELEMENT CAUSES OF LOSS

       

Recommend

Accept

Reject

Not Applicable

                    Bldg BPP PPO BI   EE

       

Basic          ____ ____ ____ ___ ____

______

______

______

______

Broad          ____ ____ ____ ___ ____

______

______

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Special       ____ ____ ____ ___ ____

______

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Earthquake ____ ____ ____ ___ ____

______

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Flood          ____ ____ ____ ___ ____

______

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______

           

Other Cause of Loss Endorsements

       

______________________________________

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______________________________________

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______________________________________

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INLAND MARINE COVERAGES

       

Recommend

Accept

Reject

Not Applicable

Accounts Receivable

______

______

______

______

Bailees Customer

______

______

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Builders Risk

______

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Commercial Articles

______

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Difference In Conditions – DIC

______

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Electronic Data Processing

______

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Fine Arts

______

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Goods in Transit

______

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Signs (Neon and Electric)

______

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Valuable Papers and Records

______

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______

           

Other Inland Marine Coverages

       

______________________________________

______

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______________________________________

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______________________________________

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CRIME COVERAGES

       

Recommend

Accept

Reject

Not Applicable

Money, Securities and Other Property

       

Employee Dishonesty Coverage

______

______

______

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   Including Customer's Goods

______

______

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Computer Fraud Coverage

______

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Extortion Coverage

______

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Forgery or Alterations Coverage

______

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Lessees of Safe Deposit Boxes Coverage
(Securities and Other Property only)

______

______

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______

           

Money and/or Securities Only

       

Theft, Disappearance and Destruction

______

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Robbery and Safe Burglary

______

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Securities Deposited With Others Coverage

______

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Property other than Money and Securities

       

Premises Burglary

______

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Premises Theft

______

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Robbery and Safe Burglary

______

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Other Crime Coverages

       

______________________________________

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______________________________________

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______________________________________

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LIABILITY COVERAGES

       

Recommend

Accept

Reject

Not Applicable

Commercial General Liability

       

   Occurrence Basis

______

______

______

______

   Claims- Made Basis

______

______

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______

           

Optional Liability Coverages

       

Directors and Officers

______

______

______

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Employee Benefits

______

______

______

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Employment- Related Practices

______

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Liquor

______

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Owners and Contractors Protective

______

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Railroad Protective

______

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Special Events

______

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Other Liability Coverages

       

______________________________________

______

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______________________________________

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______________________________________

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COMMERCIAL AUTO COVERAGES

       

Recommend

Accept

Reject

Not Applicable

Liability

______

______

______

______

Physical Damage

______

______

______

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Uninsured Motorists

______

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Underinsured Motorist

______

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Hired Cars

______

______

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Non-Ownership Auto

______

______

______

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P.I.P./No-Fault

______

______

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Garagekeepers

______

______

______

______

           

Other Auto Coverages

       

______________________________________

______

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______________________________________

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______________________________________

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WORKERS COMPENSATION COVERAGES

       

Recommend

Accept

Reject

Not Applicable

Workers Compensation and Employers Liability

______

______

______

______

Stop Gap or Employers Liability Coverage

______

______

______

______

Federal Employers Liability Act

______

______

______

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Longshore and Harbor Workers Coverage

______

______

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Voluntary Compensation

______

______

______

______

           

Other Workers Compensation Endorsements

       

______________________________________

______

______

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______________________________________

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______________________________________

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EXCESS LIABILITY COVERAGES

       

Recommend

Accept

Reject

Not Applicable

Umbrella Policy

______

______

______

______

Excess Liability Policy

______

______

______

______

           

AVIATION COVERAGES

       

Aircraft Policy

______

______

______

______

Passenger Liability

______

______

______

______

           

SPECIALTY COVERAGES

       

Environmental Impairment Liability Policy

______

______

______

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Fiduciary Liability Insurance

______

______

______

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International/Foreign Operations Insurance

______

______

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Rain or Weather Insurance

______

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Terrorism Insurance

______

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Underground Storage Tank Liability – UST

______

______

______

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Other ____________________________________

______

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______

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BONDS

       

Bid Bond

______

______

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Contract Bond

______

______

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License Bond

______

______

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Other _________________________________

______

______

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______

           

Other Options

       

______________________________________

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______________________________________

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Comments

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

I certify that I have reviewed my coverage needs in accordance with this checklist with my agent and I have accepted or rejected the recommended coverages as indicated by my initials in the spaces above.

___________________________________ Signature of Client ______________________ Date

_____________________________________________ Title

I certify that I have reviewed the coverages outlined in this checklist with my client and that the initials of the client indicate the acceptance or rejection of the coverages recommended.


___________________________________ Signature of Agent _______________________ Date