(July 2024)
This checklist is a starting point. Additional risk specific questions may arise as exposures are developed. This analysis should be combined with exposure analysis checklists for other coverages to develop a complete picture of the insured’s operations.
This checklist is designed to supplement the ACORD application.
Related Article: ISO Products/Completed Operations Liability Coverage Forms ACORD Forms Considerations
A list of endorsements may be helpful as you discuss exposures with your client.
Related Articles:
ISO Products/Completed Operations Liability Coverage Forms Endorsements Checklist
ISO Products/Completed Operations Liability Coverage Forms Available Endorsements and Their Uses
GENERAL
INFORMATION
Legal business name(s)
____________________________________________________________________________________
____________________________________________________________________________________
Mailing address:
____________________________________________________________________________________
____________________________________________________________________________________
Email:
_______________________________________________________________________________
Website:
_____________________________________________________________________________
Type of entity:
___ Individual |
___ Corporation |
___ Sub-S Corp. |
___ Partnership |
___ Joint Venture |
|
___ Not-for-profit |
___ Limited Liability Company |
|
SIC Code(s):
_________________________________________________________________________
NAICS
Code(s):_______________________________________________________________________
Federal ID Number: ____________________________
When did the applicant begin business operations?
___________________________________________
When did the
present management assume control? _________________________________________
How many years’ experience
does the owner have in this type of business? _______________________
How many years’ experience
does the manager have in this type of business? _____________________
Has the applicant ever been involved in a bankruptcy
procedure? ___ Yes ___ No
If yes, explain the type of bankruptcy, the filing
date, and the resolution.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Names of subsidiary companies or joint ventures that
are not part of this application:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Important People |
Name |
Phone Number |
Owner/Principal |
____________________________ |
______________ |
Other Decision Makers |
____________________________ |
______________ |
Plant and Grounds |
____________________________ |
______________ |
Financial |
____________________________ |
______________ |
Legal |
____________________________ |
______________ |
Claims |
____________________________ |
______________ |
The applicant’s primary operations are:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
The applicant’s secondary and/or incidental
operations are:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
The applicant used to be involved in the following
operations, but they have been discontinued:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
The hours of operations are:
_____________________________________________________________
Does the applicant have a safety program? ___ Yes ___
No
If yes, answer the following:
Name of safety director:
_________________________________________________________
Safety director phone
number: __________________________________________________
Safety director email
address:_____________________________________________________
Attach a copy of the
safety program.
Describe all the applicant’s products or services.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
If the product is a component part, describe the
items of which it might become a part.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
If the product or service is defective or used
improperly, describe the possible damage that could occur.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Who draws the
plans, designs, or specifications?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Who is
permitted to alter the plans, designs, or specifications?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Is the
customer consulted and required to sign off prior to alterations? ___ Yes ___ No
Describe
customer acceptance of project procedures and documentation.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Describe the
types of projects completed over the past five years.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________