PROPERTY – BUILDING
Premises #_______ Building # _______
Location address:
____________________________________________________________________________________
____________________________________________________________________________________
Does the applicant own the building? ___ Yes ___ No
If no, answer the following:
Who owns the building?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Is the applicant contractually obligated to insure
the building? ___ Yes ___ No
If yes, attach a copy of the contract.
If the building sustains a major loss, would the applicant replace it
with the same type of
structure? ___ Yes ___ No
If no, what would the applicant do?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
If the building sustains a major loss, what new building codes would be
imposed on the applicant in order to rebuild?
____________________________________________________________________________________
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Describe any barriers that would prevent the fire department from
responding to a fire at the applicant’s building in a timely manner. These
could include locked gates, railroad crossings, and congested or narrow roads.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Describe any barriers or bottlenecks that would prevent the efficient
evacuation of the building.
____________________________________________________________________________________
____________________________________________________________________________________
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How many fire extinguishers and smoke alarms are on premises?
____Fire extinguishers ____Smoke alarms
When was the building built? _____
When were the following systems last updated?
______Heating ______ Electrical ______ Roof ______ Plumbing
Have there been any additions to the building? ___ Yes ___ No
If yes, describe the addition including its date of completion.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
PROPERTY – BUSINESS PERSONAL PROPERTY
Premises # _______ Building # _______
Location address:
____________________________________________________________________________________
____________________________________________________________________________________
Describe the business personal property.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Do the applicant’s business personal property values fluctuate? ___ Yes
___ No
If yes, is the fluctuation ___Monthly ____Seasonal (from_________ to
_________)
Is the business personal property:
Highly flammable: ___ Yes ___ No
Susceptible to severe damage from: ___Smoke ___
Heat ___ Water ___ Temperature
Do any of the other occupancies in this building pose a catastrophe or
other hazard to the applicant (explosion, fire, chemical, other)? ___ Yes ___
No
If yes, describe.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Would business personal property be damaged if the outside heat, light
or power failed? ___ Yes ___ No
If yes, answer the following:
Describe what would be damaged and how quickly.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
How is the heat, light or power transmitted to the
applicant?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Will alarms sound or other notification be made if
power fails or shuts off? ___ Yes ___ No
Are backup generators available? ___ Yes ___ No
Are detailed records kept of all inventory, machinery, fixtures or
equipment including purchase date and price? ___ Yes ___ No
Are all items labeled and assigned inventory numbers? ___ Yes ___ No
Is rack storage used? ___ Yes ___ No
If yes, what is the height of the rack storage? ________________
Are 'in-rack' sprinklers installed? ___ Yes ___ No
Are fork lifts used to handle merchandise? ___ Yes ___ No
Is yes, answer the following:
How many of each type of forklift is used:
____ Electric ____ Gas ____ Battery
Is there training before employees can drive the
fork lift? ___ Yes ___ No
How wide are aisles? _______
Are there written investigations for all fork lift
accidents? ___ Yes ___ No
Does the warehouseman have guidelines as to what may not be stored? ___
Yes ___ No
If yes, indicate which of the following MAY NOT be stored:
|
___
Explosives
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___
Perishables
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___
Living items (plants, pets, etc.)
|
|
___
Weapons and ammunition
|
___
Vehicles
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___
Aerosols
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___
Chemicals-corrosive/toxic
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___
Paints/varnishes/paint thinners
|
|
|
___
Other
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|
|
Describe other.
____________________________________________________________________________________
____________________________________________________________________________________
BURGLAR ALARM
Describe any burglary exposures beyond what is usual to this type of
business.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Describe any special features to the burglary alarm or safe or vault
systems that are not noted elsewhere.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
IMPROVEMENTS AND BETTERMENTS
Is the applicant a tenant? ___ Yes ___ No
If yes, answer the following.
Describe all I & B added by the applicant or
for which the applicant is paying that cannot be removed.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
What is the term of the applicant’s lease?
________________________________________________
What is the applicant’s lease renewal option term?
_________________________________________
INLAND MARINE – BAILEE CUSTOMERS
Describe all property of others that is in the applicant’s custody or
control either at the applicant’s premises or at other processors for storage,
sale, processing, service or consignment.
Location Description
Value
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
How is property of others received, marked and tracked so that they are
returned to the rightful owner?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Does the applicant send customer’s property to another processor? ___
Yes ___ No
If yes, describe how the customer’s property is marked, tracked and
returned to the applicant’s premises.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Describe the applicant’s processing and the method used to continually
identify the customer’s property.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
How is property of others returned to the customer and how is ownership
verified?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Are all items subject to a warehouse operator's lien? ___ Yes ___ No
Note: If yes, coverage should be purchased using a
Warehouse Legal Liability policy.
