| CERT017 | According to the terms of this GL policy, does the additional insured have primary and noncontributory coverage? |
| AIRP14 | Aircraft owners permitted to perform any repair service of inspection of Aircraft under supervision? |
| EPL69 | Any action where a license was revoked or suspended against any persons? |
| EPL68 | Any action where a license was revoked or suspended against the organization? |
| HOME43 | Any adjacent property hazards or operations? |
| INMRC25 | Any advertising signs away from premises? |
| AIRP13 | Any Aircraft other than Single Engine or Multi-Engine maintained, serviced or repaired by applicant? |
| PUMBR12 | Any aircraft owned, leased, chartered or furnished for regular use? |
| INMRC63 | Any airless spray guns used? |
| LIQ015 | Any alcoholic beverage ever offered free of charge? |
| BOP51 | Any alcoholic beverages sold or consumed on premises? |
| HOFP003 | Any animal(s) on premises? |
| GENRL33 | Any applicant covered by a wage continuation plan? |
| BOP35 | Any area leased in building? |
| INMRC30 | Any asbestos removal done? |
| CONTR29 | Any asbestos removal while working on heating and air-conditioning? |
| CONTR30 | Any asbestos removal while working on plumbing? |
| AUPMA22 | Any auto equipped with electronic equipment permanently installed but not in locations used by the auto manufacturer for such equipment? |
| GENRL14 | Any bankruptcies, tax or credit liens against the applicant in the past 5 years? |
| AVIA05 | Any bankruptcies, tax or credit liens against the applicant in the past 7 years? |
| INMRC57 | Any basement work? |
| INMRC29 | Any boiler work done? |
| HOME39 | Any broken, cracked, or missing windows? |
| PUMBR07 | Any business and/or professional activities included in the primary policies? |
| HOME26 | Any business conducted at any other location? |
| GENRL20 | Any Business conducted on premises? (Including day/child care) |
| GENRL39 | Any catastrophes exposure? |
| DO04 | Any changes in the Board of Directors or senior management in the last 3 years? |
| DO05 | Any changes to the outside financial auditor in the last 3 years? |
| AIRC14 | Any charters or rentals for more than seven consecutive days? |
| EPL80 | Any closings, reductions, mergers, acquisitions last 24 months? |
| CPR45 | Any cooking operations? |
| CUMBR02 | Any coverage provided under agency's policy? |
| CPR46 | Any cutting / welding? |
| CGL31 | Any demolition exposure contemplated? |
| INMRC23 | Any demolition or wrecking work? |
| EPL67 | Any discriminatory practice violation or litigation against any persons? |
| EPL66 | Any discriminatory practice violation or litigation against the organization? |
| HOME80 | Any dogs or other animal(s) on premises? |
| AUPFL01 | Any driver 55 or older complete an approved motor vehicle accident prevention course? |
| AUTOP06 | Any driver have physical/mental impairment? |
| AUTOP12 | Any driver have physical impairment that would affect the ability to drive? |
| AUTOP05 | Any drivers license been suspended/revoked? |
| AUTOB08 | Any drivers not covered by Workers Compensation? |
| CUMBR30 | Any drivers with convctions for moving traffic violations within the past 3 years? |
| INMRC21 | Any drivers with convictions for moving traffic violations? |
| AUTOB09 | Any drivers with moving violations? |
| AUTOP13 | Any driver undergoing a course of medical treatment for a physical or mental impairment that would affect the ability to drive? |
| RR002 | Any emergency communication plan established between railroad and contractor? |
| CRIM18 | Any employee(s) been cancelled for crime coverage by any insurer? |
| PUMBR11 | Any employees? |
| CRIM15 | Any employees leased from others? If yes, give number and explain in remarks. |
| CRIM14 | Any employees leased to others? If yes, give number and explain in remarks. |
| CRIM16 | Any employees perform money investing or trading? |
| CRIM17 | Any employees receive or issue warehouse receipts? |
| BOP22 | Any employees under 16 or over 60 years of age? |
| WORK12 | Any employees with physical handicaps? |
| INMRC44 | Any encapsulation or removal of asbestos? |
| CONTR33 | Any epoxies used? |
| CONTR27 | Any excavation involving basements? |
| CONTR26 | Any excavation involving septic systems? |
| CONTR25 | Any excavation involving sewers? |
| CONTR24 | Any excavation involving water lines? |
| BOATP09 | Any existing damage to the boat? |
| AUTOP01 | Any existing damage to vehicle? (Include damaged glass) |
| CRIM21 | Any exposure from loss to guest property? |
| GENRL41 | Any exposure to flammables, explosives, chemicals? |
| CGL23 | Any exposure to radioactive/nuclear materials? |
| INMRC62 | Any exterior spray painting? |
| HOME01 | Any farming or other business conducted on premises? (including day/child care) |
| AUTOP07 | Any financial responsibility filing? |
| HOME58 | Any fire code violations in the last specified period of time? |
| CPR70 | Any firing of tobacco? |
| CPR08 | Any flammable products utilized or any supplemental heating devices? |
| CPR48 | Any flammables in use? |
| HOME03 | Any flooding, brush, forest fire hazard, landslide, etc.? |
| GENRL52 | Any foreign operations, foreign products distributed in USA, or US products sold/distributed in foreign countries? |
| PUMBR05 | Any full-time employees? |
| HOME64 | Any full time residence employees? |
| INMRC48 | Any grading of land or excavation work done? |
| WORK11 | Any group transportation provided? |
| INMRC36 | Any gutting of interior load bearing walls? |
| CPR69 | Any hay or straw storage? |
| CPR49 | Any hazardous operations? |
| AUTOB01 | Any Hold Harmless Agreement? |
| AUTOP04 | Any household member in military service? |
| INMRC65 | Any installation of high pressure systems, caustics, flammables, gases or chemicals? |
| INMRC43 | Any insulation removal? |
| HOME11 | Any lead paint hazard? |
| INMRC64 | Any lead paint removal done? |
| CPR04 | Any manufacturing on the property? |
| INMRC67 | Any mechanical contracting operations? |
| CGL22 | Any medical facilities provided or medical professionals employed or contracted? |
| BOP53 | Any mercantile occupancies? |
| INMRC55 | Any mix-in-transit? |
| AUPCA01 | Any motorcycles to be insured? |
| AGLIA14 | Any Non-owned horses on any insured premises? |
| PUMBR06 | Any non-owned property exceeding $1,000 in value, in your care, custody or control? |
| GLAS003 | Any obstruction or unusual settings? |
| INMRC27 | Any operation or owned, leased or rented property not covered by this policy? |
| CGL24 | Any operations sold, acquired or discontinued in the last five (5) years? |
| BOATP07 | Any operator had an accident/conviction during the last specified number of years? |
| AUTOP03 | Any other auto insurance in household? (Include any provided by employer) |
| BOP29 | Any other improvements done? |
| GENRL22 | Any other insurance with this company? |
| SPEC001 | Any other insurance with this company or being submitted? |
| AUTOP02 | Any other losses incurred (not shown in Accident/Convictions area)? |
| BOP20 | Any other on or off premises exposure not listed? |
| GENRL23 | Any other residence owned, occupied or rented? |
| DFIRE02 | Any other structure being insured? |
| CONTR28 | Any other types of excavation not otherwise classified? |
| CONTR34 | Any other types of exposures? |
| INMRC60 | Any painting of tanks, water or gas? |
| INMRC61 | Any painting or bridges or towers? |
| CGL27 | Any parking facilities owned/rented? |
| AGLIA02 | Any part of farm used or leased for organized recreational use? |
| BOP62 | Any past, present or planned future work on tract housing, including apartments, condominiums or townhomes? |
| GENRL07 | Any past losses or claims relating to sexual abuse or molestation allegations, discrimination or negligent hiring? |
| PUMBR09 | Any pending litigation, court proceedings or judgements? |
| PILOT02 | Any physical impairments or limitations or waivers on Medical Certificate? |
| GLAS002 | Any plates fixed, glued or in angle settings? |
| GENRL06 | Any policy or coverage declined, cancelled or non-renewed during the mandated number of years? |
| AGLIA21 | Any premises rented to others for hunting at no charge? |
| AGLIA22 | Any premises rented to others for hunting for a fee? |
| CPR92 | Any prior insurance? |
| GENRL70 | Any prior sinkhole losses? |
| GARAG15 | Any private protection systems? (Fences, dogs, alarms, guards)? |
| INMRC28 | Any product manufactured or sold under the applicant's name? |
| HOME19 | Any products directly imported or exported outside the U.S., Puerto Rico or Canada? |
| HOME30 | Any products repackaged, modified, or mixed? |
| INMRC05 | Any property in basement? |
| INMRP01 | Any protective devices/systems in use? |
| PUMBR02 | Any real estate, vehicles, watercraft or aircraft that is owned, hired, leased or regularly used that is not covered by primary policies? |
| PUMBR01 | Any real estate, vehicles, watercraft or aircraft used commercially or for business purposes? |
| CPR11 | Any real estate tax or other liens or judgements affecting the property including foreclosure? |
| INMRC66 | Any refrigeration systems installed? |
| INMRC35 | Any renovation work done? |
| HOME02 | Any residence employees? |
| INMRC54 | Any retaining walls built? |
| INMRC33 | Any roofing done? |
| INMRC59 | Any scaffolding used? |
| WORK42 | Any seasonal employees? |
| INMRC69 | Any septic tank installation? |
| INMRC34 | Any shop work done? |
| GLAS014 | Any signs off premises or not attached to building? |
| BOATP08 | Any sleeping facilities? |
| INMRC41 | Any snowplowing? |
| HOTEL24 | Any special facilities or amities offered Including but not limited to: Day care, fitness, swimming, horses, scuba, fishing, boating, ballooning, etc.? |
| BOP04 | Any specialized equipment, such as medical equipment or other, valued over $100,000? |
| INMRC49 | Any spraying of bushes, lawns, etc. with pesticides, herbicides or fertilizers? |
| CPR47 | Any spray painting? |
| CGL30 | Any structural alterations contemplated? |
| MHOME01 | Any supplemental heating? |
| RR001 | Any temporary grade crossing utilized? |
| INMRC50 | Any tree trimming work done? |
| GENRL62 | Any uncorrected fire and/or safety violations? |
| GENRL09 | Any uncorrected fire code violations? |
| INMRC37 | Any underground cable work? |
| WORK44 | Any undisputed and unpaid workers compensation premium due from you or any commonly managed or owned enterprises? If yes, explain including entity name(s) and policy number(s). |
| CUMBR06 | Any units not insured by underlying policies? |
| CPR10 | Any unrepaired damage? |
| AGLIA09 | Any unusual hazards such as (but not limited to) dump pits, silage pits, gravel pits, rock quarries, sump holes, ponds, lakes or reservoirs? |
| HOME20 | Any used items sold? |
| AIRC15 | Any use of jets, helicopters or aircraft over eight-place including crew? |
| AUTOB07 | Any vehicles customized, altered or with special equipment? |
| AUTOB03 | Any Vehicles owned but not scheduled on this application? |
| AUTOB02 | Any Vehicles used by Family Members? |
| TRANS01 | Any waterborne shipments to be covered? |
| CGL26 | Any watercraft, docks, floats owned, hired or leased? |
| HOME41 | Any water or flooding hazards or exposures? |
| CONTR31 | Any work above two stories while painting? |
| CONTR32 | Any work above two stories while roofing? |
| INMRC58 | Any work done above 2 stories? |
| CONTR03 | Any work done afloat? |
| INMRC51 | Any work done during "off-season" months? |
| CONTR08 | Any work done in or around Airport Construction or Repair? |
| CONTR10 | Any work done in or around Burglar Alarm Design, Install or Repair? |
| CONTR35 | Any work done in or around Dam, Bridge or River Related Construction? |
| CONTR06 | Any work done in or around Explosive Environments (Paints, Solvents, etc.)? |
| CONTR09 | Any work done in or around Fire Alarm or Automatic Sprinkler Design, Install Repair? |
| CONTR19 | Any work done in or around Hazardous Material Abatement? |
| CONTR11 | Any work done in or around High Voltage (over 480 volts) or High Amperage? |
| CONTR15 | Any work done in or around Hospitals? |
| CONTR21 | Any work done in or around Hot or Live Wires? |
| CONTR07 | Any work done in or around Installation of Emergency Back-up Equipment? |
| CONTR22 | Any work done in or around Land Fills? |
| CONTR12 | Any work done in or around Major Electrical Control Panels? |
| CONTR20 | Any work done in or around Nuclear Power Plants? |
| CONTR13 | Any work done in or around Oil or Gas Refineries? |
| CONTR14 | Any work done in or around Petrochemical Plants? |
| CONTR18 | Any work done in or around Power Lines? |
| CONTR16 | Any work done in or around Power Plants? |
| CONTR23 | Any work done in or around Swimming Pools? |
| CONTR17 | Any work done in or around Traffic Signals? |
| INMRC38 | Any work done in streets or roads? |
| BOP01 | Any Workers Compensation carried? |
| INMRC56 | Any work involving load-bearing walls? |
| WORK45 | Any work performed on barges, vessels, docks or bridge over water? |
| BOP21 | Any work performed underground or above 15 feet? |
| GENRL01 | App. Own Majority Int./Operate business not insured, here? |
| AUPWI06 | Applicant's motor vehicle lawfully parked? |
| EO01 | Applicant derived from predecessor firm? |
| AUPWI07 | Applicant reimbursed by or on behalf of person responsible for accident or has judgment against such person? |
| AUPWI08 | Applicant struck in rear by another auto, applicant not convicted of a violation? |
| LIQ007 | Are actions taken if an employee is found selling/serving alcohol to a minor? |
| RESTA11 | Are adequate emergency exits provided and equipped with panic hardware? |
| LIQ005 | Are age limits posted? |
| PROP20 | Are all accessible areas secured and all exposed glass areas properly boarded on the exterior by 3/8" plywood securely fastened to the building? |
| MHOME16 | Are all additions to mobile home (including carport, added rooms, etc.) tied down? |
| RESTA18 | Are all Alcohol Servers currently TIPS® or TAM® certified? |
| EPL108 | Are all applicant locations compliant with the Americans with Disabilities Act (ADA)? |
| GARAG019 | Are all convictions are over 3 yrs old? |
| FIDUC08 | Are all defined benefit plans adequately funded in accordance with ERISA or any applicable similar common or statutory law of the US, Canada, or any state or other jurisdiction anywhere in the world, as attested to by an actuary? |
| PROF001 | Are all employees licensed as required by law? |
| EPL103 | Are all employees subject to these tests and examinations? |
| HOTEL21 | Are all entrances locked or monitored at night? |
| BAM03 | Are all equipment instrumentation and controls in accordance with manufacturers specifications? |
| HOME16 | Are all exterior doors equipped with deadbolt locks or comparable slider locks? |
| CRIM07 | Are all locations audited? |
| CYBR57 | Are all mission/business critical systems and data information assets backed up and stored at another location? |
| CRIM06 | Are all officers and employees required to take annual vacations of at least five consecutive business days? |
| WORK90 | Are all of your Employees Residents of the controlling state? |
| PROF006 | Are all prescriptions checked against the original order when the merchandise is delivered? |
| HOTEL06 | Are all rooms equipped with smoke detectors? |
| HOTEL07 | Are all rooms equipped with sprinklers? |
| FIDL01 | Are all staff required to take two weeks uninterrupted holiday each year? |
| CPR82 | Are all the doors and windows locked? |
| BOP45 | Are all units are sprinklered? |
| AUTOB17 | Are all vehicles to be included in this policy part of a fleet? |
| FIDL02 | Are all wages/salaries independently checked against personnel records? |
| RESTA29 | Are ammonia sensing devices in each refrigerated space? |
| EDP30 | Are anti-viral safeguards in effect? |
| AGLIA25 | Are any "Hold Harmless" or "Indemnifying" Agreements in effect? |
| HANG04 | Are any aircraft of others taxied, towed or moved by applicant? |
| AGMOR14 | Are any animals not observed and cared for on a daily basis? |
| HOME55 | Are any buildings in need of painting? |
| AGLIA06 | Are Any Contract or Service Operations Performed for Others such as Snow Removal, Tilling, Excavating, or Ditching? |
| BOATC05 | Are any crew members onboard the vessel? |
| HOME40 | Are any gutters or downspouts in poor condition? |
| AUPMA02 | Are any listed operators included on another policy or do they have their own MA personal automobile policy? |
| AGLIA67 | Are any livestock present on premises or are any livestock anticipated during the year? |
| GLAS013 | Are any locations with glass or signs vacant? |
| DO19 | Are any of the Applicants Securities, or those of its Subsidiaries Publicly Traded or Subject to Public Reporting under the Securities Exchange Commission Act of 1934? |
| AUTOP23 | Are any of the vehicles titled/registered in the name of a Trust? |
| EO33 | Are any of your products used in the aircraft, space, medical, robotics, pollution or environmental industries? |
| AUPWI04 | Are any other vehicles owned by any member of household? |
| INMRC22 | Are any overage, shortage or damage claims pending? |
| DO11 | Are any persons or entities proposed for this insurance cognizant of any fact, circumstance, act, error, omission, or situation which he/she/it has reason to suppose might afford grounds for any claim such as would fall within the scope of the proposed insurance? |
| DO13 | Are any persons or entities proposed for this insurance cognizant of any inquiry, investigation or communication which he/she/it has reason to suppose might give rise to a claim such as would fall within the scope of the proposed insurance? If there are any exceptions, please attach complete details. |
| AGLIA08 | Are Any Portions of the Farm Rented or Leased or Used by Any Other Individual, Corporation or Interest for Other than Farming? |
| AGLIA68 | Are any premises used by others for hunting, fishing or other recreational activities? |
| AGLIA20 | Are any premises used for hunting purposes? If yes, by whom and is there a fee involved? |
| AGLIA74 | Are any premises used for hunting purposes by owners? |
| CPR93 | Are any real estate taxes delinquent? |
| GENRL46 | Are any rental properties without working smoke detectors? If yes, explain. |
| PROF019 | Are any services provided to animals belonging to zoos, circuses, carnivals, rodeos, theatrical or other show enterprises? |
| PROF018 | Are any services provided to animals used or bred for professional racing, show or delivery services? |
| CPR27 | Are any taxes unpaid or overdue for the specified period of time? |
| CUMBR07 | Are any vehicles leased or rented to others? |
| MTRTK01 | Are any vehicles operated for the applicant by others? |
| AIRP20 | Are any vehicles operated off airport? |
| AGLIA64 | Are any wood or coal fired stoves used in any buildings? |
| BOP10 | Are athletic teams sponsored? |
| LIQ008 | Are background checks done on employees? |
| HOTEL15 | Are balcony platforms and railings regularly inspected for structural integrity and strength? |
| CRIM03 | Are bank accounts reconciled by someone not authorized to deposit or withdraw? |
| INMRC02 | Are billed and unbilled records kept separate? |
| BAM04 | Are chlorofluorcarbon (CFC) rerfrigertants used in the machinery to cool any part of the premises or process? If yes, explain. |
| HOTEL25 | Are cleaning solvents in locked cabinets or stored out of reach of children? |
| LIQ019 | Are clients / guests allowed to mix their own drinks? |
| CYBR107 | Are computer service providers required by contract to indemnify the Applicant for harm arising from a breach of the provider’s security? |
| FLOOD04 | Are contents household personal property? |
| CRIM28 | Are credit checks secured for employees with access to financial transactions? |
| EQ003 | Are cripple walls braced with plywood or equivalent? |
| CYBR72 | Are critical operations of the insured outsourced? If Yes, what are the legal names of the three largest outsource providers? |
| CYBR101 | Are critical patches installed within thirty (30) days of release? |
| PROF015 | Are customers required to proof-read before printing takes place? |
| CGL06 | Are day-care facilities operated or controlled? |
| CUMBR22 | Are defense costs a separate limit? |
| CUMBR23 | Are defense costs unlimited? |
| CUMBR21 | Are defense Costs within aggregate limits? |
| CRIM42 | Are departments supervised by someone not authorized to pay bills? |
| CRIM40 | Are detailed records of bank deposits maintained? |
| INMRC20 | Are drivers compensated per trip? |
| EDP31 | Are duplicates of software maintained? |
| CRIM41 | Are duties segregated? |
| FIDL07 | Are duties segregated so that no individual can control monthly statements to customers independent of employees receiving payments from commencement to completion? |
| FIDL06 | Are duties segregated so that no individual can control the authorization of capital expenditures from commencement to completion? |
| FIDL05 | Are duties segregated so that no individual can control the investment in and custody of securities from commencement to completion? |
| FIDL04 | Are duties segregated so that no individual can control the issuing of funds transfer instructions from commencement to completion? |
| FIDL03 | Are duties segregated so that no individual can control the signing of checks from commencement to completion? |
| HOME60 | Are electrical cords, extension cords in good condition? |
| RESTA07 | Are employees given liquor training? |
| HOTEL17 | Are employees trained in first aid? |
| EPL105 | Are employment contracts created and reviewed by outside counsel? |
| BAM01 | Are equipment maintenance, overhaul, monitoring, disassembly and repair conducted according to manufacturers' instructions? |
| INMRC39 | Are excavations marked and guarded at end of day? |
| EPL107 | Are exit interviews documented? |
| CUMBR04 | Are explosives, caustics, flammables or other dangerous cargo hauled? |
| RESTA19 | Are facilities available for use or rent for private parties, receptions, banquets or similar affairs? |
| CPR66 | Are Fire Protection/Smoke detection devices, required by law, installed and workable? |
| HOTEL09 | Are fire safety messages posted in all rooms? |
| FLOOD29 | Are flood openings engineered? |
| PROF011 | Are food or drug labels printed? |
| CUMBR17 | Are foreign products distributed in the Unites States (USA)? |
| BOATC06 | Are full time crew members onboard the vessel? |
| PROP13 | Are gutters routinely cleaned out? |
| CRIM39 | Are hard copies of funds transfer confirmations received and reconciled? |
| PROF008 | Are hearing aids or optical goods manufactured or delivered only as a result of a prescription from a physician, audiologist or optometrist? |
| AUTOB04 | Are ICC, PUC or other filings required? |
| WORK77 | Are increased limits of liability required? |
| CERT023 | Are insured vs. insured suits (cross liability in the ISO CGL policy) excluded or restricted (other than named insured vs. named insured)? |
| HOTEL19 | Are laundry facilities provided? |
| AGLIA39 | Are livestock milked? If yes, indicate type of livestock and number of head milked. |
| AGLIA66 | Are livestock near any public road or highway? |
| PROF010 | Are lottery, gaming or raffle tickets printed? |
| CRIM31 | Are managers provided with names and salaries of all assigned employees? |
| BOP33 | Are materials stored in open yard? |
| CUMBR16 | Are missiles, engines, guidance systems, frames or any other product used/installed in aircraft? |
| PROF013 | Are money orders, securities, or travelers checks printed? |
| PROP26 | Are mortgage payments overdue by the specificed period of time or more? |
| LIQ002 | Are operations on or near college campus? |
| CGL44 | Are other risk factors considered as a measure of the exposure that the policy represents? Please describe the risk factor and its relative exposure amount/value. |
| HOME52 | Are other structures in good condition? |
| GENRL13 | Are overages, shortages and damage claims pending? |
| MHOME18 | Are over the roof tie downs visible? |
| BOATC07 | Are part time crew members onboard the vessel? |
| CUMBR05 | Are passengers carried for a fee? |
| LIQ016 | Are patrons allowed to bring alcohol on premises? |
| CYBR32 | Are penetration tests conducted on the applicant's network at least annually? |
| FIDUC16 | Are plan benefits provided by insurance? (e.g., annuity, medical policy, etc.) |
| HOTEL29 | Are preparation and sanitation procedures followed to prevent food borne illness? |
| INMRC68 | Are proper written procedures in place with respect to "sweating" of pipes? |
| PROF007 | Are records of all tests performed, prescriptions filled and customer's acceptance of merchandise kept on computer or in a fire-resistant cabinet? |
| EO16 | Are redundant systems or warnings built into your product to prevent or warn against the product's failure? |
| CRIM22 | Are references of all new hires checked with respect to employment history? |
| MHOME07 | Are roads unpaved in the moble home park? |
| AIRP01 | Are runways lighted? |
| BOP54 | Are safety rules are posted in the area? |
| CRIM05 | Are securities subject to joint control of two or more responsible employees? |
| INJW001 | Are showcases equipped with locks? |
| INJW002 | Are show cases kept locked during business hours except when the contents are actually being removed or replaced? |
| INJW003 | Are showcase tops secured? |
| HOFP001 | Are sidewalks, steps and driveway free from trip, slip and fall hazards? |
| AGLIA48 | Are signed releases obtained? |
| CYBR76 | Are significant changes in the nature or size of the Applicant’s business anticipated over the next twelve (12) months? Or have there been any such changes within the past twelve (12) months? |
| CGL41 | Are social events sponsored? |
| CRIM29 | Are social security numbers verified? |
| PROF020 | Are solvents and/or other pollutants disposed of? |
| HOME59 | Are space heaters, kerosene heaters vented and away from furniture? |
| CERT014 | Are specific operations excluded or restricted (GL policy) by building height? |
| CERT015 | Are specific operations excluded or restricted (GL policy) by classifications? |
| CERT016 | Are specific operations excluded or restricted (GL policy) by designated work? |
| CERT012 | Are specific operations excluded or restricted (GL policy) by location? |
| CERT013 | Are specific operations excluded or restricted (GL policy) by type of construction? |
| SFH01 | Are stove pipe connections securely fastened to each other with screws at each connection? |
| BOP15 | Are subcontractors allowed to work without providing you with a certificate of insurance? |
| INMRC24 | Are subcontractors allowed to work without providing you with a certificate of insurance? |
| WORK43 | Are subcontractors used? (If yes, give % of work subcontracted) |
| CRIM48 | Are suspicious transactions reviewed and investigated? |
| CYBR97 | Are tapes or other portable media containing backup materials encrypted? |
| CYBR98 | Are tapes or other portable media stored offsite using secured transportation and secured storage facilities? |
| PROP27 | Are tax liens against this property or business taxes unpaid or overdue for the specified period of time? |
| WIND13 | Are tenant contents to be covered? |
| MHOME24 | Are tension heads used in tie downs? |
| EPL102 | Are testing / examinations done after an offer of employment? |
| EPL101 | Are testing / examinations done pre-employment? |
| HOTEL18 | Are the elevators and/or escalators inspected regularly? |
| AGLIA07 | Are the Farm Premises Open to the Public for Activities such as, Road Side Stands, "U-Pick", recreational, "Rent-a-Garden", auction, sales, show, food, or beverage service, hay rides, fishing, kennels, animal boarding, or Christmas tree sales uses? |
| BOP57 | Are the floors, stairs, sidewalks and parking areas in average condition? |
| BOP56 | Are the floors, stairs, sidewalks and parking areas in good condition? |
| HOTEL04 | Are the insured's heating, refrigeration and air conditioning systems regularly checked? |
| HOWC003 | Are the living quarters separate, with separate entrances? |
| CPR39 | Are the outbuildings in good condition? |
| WORK49 | Are the payroll amounts listed above lower than those appearing on your most recent policy or audit? |
| SFH32 | Are the pipe and chimney cleaned annually? |
| DO31 | Are there additional coverages attached? |
| BOATP11 | Are there any additional owners of the boat who are not listed as the named insured? |
| MHOME21 | Are there any additions to the mobile home? |
| AGMOR07 | Are there any animals that are not wormed on a regular schedule? |
| AGLIA34 | Are there any attractive nuisances? If yes, explain. |
| CPR81 | Are there any broken windows? |
| AGLIA77 | Are there any burglar and / or fire alarms? |
| BOP60 | Are there any business operations on the premises? |
| AGLIA44 | Are there any business or professions conducted on the insured premises that are not listed on this application? If yes, explain. |
| EO36 | Are there any changes in the nature of services provided or the size of the applicant's revenue base anticipated during the next 18 months? |
| GENRL69 | Are there any conditions on the policy that could impact the risk underwriting premium? If yes, provide details. |
| AGLIA35 | Are there any creeks, rivers, or other bodies of water on the premises you own, rent, lease, or do work on? |
| PROP28 | Are there any current violations of fire, safety, health, building or construction codes at any listed locations? |
| AUIN002 | Are there any damaged or missing parts of the vehicle? |
| RESTA04 | Are there any deliveries? |
| CPR60 | Are there any dogs on the premises? |
| AGLIA62 | Are there any elevators on the premises? |
| HOTEL22 | Are there any facilities that will draw crowds to the upper floors? |
| AGLIA27 | Are there any government statutes, standards, or regulations (federal, provincial, municipal) for the protection of the environment with which to your knowledge you do not comply? |
| GENRL71 | Are there any known sinkholes within the stipulated distance of any locations? |
| CUMBR34 | Are there any Light Trucks/Vans? |
| CGL40 | Are there any lodging operations including apartments? |
| AGLIA28 | Are there any manure lagoons on the property? If yes. List type of lagoon and explain how manure is disposed of. |
| CUMBR35 | Are there any Medium Trucks/Vans? |
| HOME35 | Are there any mortgage payments delinquent? |
| BOATP12 | Are there any non-household members that have regular access to any watercraft insured under this policy? |
| AIRP02 | Are there any obstructions to the approach? |
| HOME36 | Are there any other buildings on the premises? |
| RESTA05 | Are there any other on or off premises exposures not previously listed? |
| FIDUC23 | Are there any outstanding delinquent contributions? |
| FIDUC09 | Are there any overdue employer contributions for any plan, or has any plan requested or contemplated filing a request for a waiver of contributions? |
| GLAS001 | Are there any partial or complete painted plates? |
| AGLIA36 | Are there any pressurized tanks? If yes, explain. |
| CPR14 | Are there any prior losses or occurrences that may give rise to claims for the mandated number of years? |
| CUMBR33 | Are there any Private Passenger Autos? |
| DRIVE12 | Are there any restrictions other than glasses? |
| HOME70 | Are there any roomers or boarders residing on the premises? |
| DO29 | Are there any Shareholders who own 5% or more of the common stock of the company? |
| BOP48 | Are there any skylights located on the roof? |
| BOP18 | Are there automatic gas or electric shut offs for cooking? |
| RESTA06 | Are there bouncers or doormen? |
| CPR50 | Are there firewalls? |
| LIQ018 | Are there formal procedures for preventing a noticeably intoxicated person from driving? |
| FIDL11 | Are there internal audits or internal control procedures in Canada? |
| FIDL12 | Are there internal audits or internal control procedures in Foreign countries? |
| FIDL10 | Are there internal audits or internal control procedures in USA? |
| CUMBR26 | Are there liability claims exceeding $10,000 or occurrences that may give rise to claims, during the last 5 years? |
| RESTA03 | Are there lodging operations other than apartments? |
| CPR43 | Are there more than three dwellings insured on this property? |
| CPR38 | Are there outbuildings? |
| LIQ010 | Are there procedures for handling violent or disruptive patrons? |
| LIQ025 | Are there pyrotechnics? |
| SFH31 | Are there separate liners for other appliances? |
| DO30 | Are there Shared Limits? |
| BOP55 | Are there smoke/fire alarms in all units? |
| CGL35 | Are there smoke dampers on each HVAC? |
| HOTEL08 | Are there special smoke or fire alarm devices in rooms for hearing impaired guests? |
| HOTEL11 | Are there sufficient and well-illuminated fire exists? |
| LIQ012 | Are there wine/beer sales only? |
| AIRC01 | Are the runways paved? |
| AGLIA13 | Are these the only premises which the applicant or spouse owns, rents, or operates as a farm or ranch or maintains as a residence, other than business property? |
| MHOME22 | Are the wheels removed? |
| MHOME25 | Are tie downs factory installed? |
| PROF012 | Are transportation, admission or special event tickets printed? |
| MHOME14 | Are turnbuckles ending with jaws properly secured? |
| MHOME19 | Are turnbuckles used in tie downs? |
| LIQ004 | Are underage patrons allowed on premises? |
| CUMBR18 | Are Unites States (USA) products sold or distributed in foreign countries? |
| CYBR92 | Are users able to store data to the hard drive of portable computers or portable media devices such as USB drives? |
| INMRC40 | Are utilities staked before the start of every dig? |
| GENRL10 | Are vehicles equipped with theft alarms? |
| GARAG07 | Are vehicles furnished for group or organizations? |
| GENRL12 | Are vehicles left loaded overnight? |
| GENRL11 | Are vehicles left unlocked and unattended? |
| CYBR102 | Are virus signatures updated Automatically? |
| CYBR104 | Are virus signatures updated Monthly? |
| CYBR105 | Are virus signatures updated on some basis other than automatically, weekly, or monthly? If yes, please describe the frequency. |
| CYBR103 | Are virus signatures updated Weekly? |
| CRIM13 | Are volunteers used? If yes, how many? |
| HOME42 | Are walks, steps, porches or railings cracked, raised or in need of repair? |
| EO39 | Are written contracts with clients are used in all cases? |
| EO40 | Are written contracts with clients sometimes used? |
| INMRC72 | Are written procedures in place to assure that an opening in the roof will never be left unattended and will be properly covered and anchored before leaving the jobsite? |
| AIRC21 | Are you a member of any other State Agricultural Aviation Association? |
| AIRC22 | Are you a member of the National Agricultural Aviation Association? |
| AIRC20 | Are you a member of your State Agricultural Aviation Association? |
| WORK01 | Are you currently in the process of liquidation or termination of this business? |
| WIND12 | Are you eligible for the plan because the premium for all offers of coverage made by authorized insurers is more than the specified percentage higher than the premium for comparable coverage from the plan? |
| WIND11 | Are you eligible for the plan because you are unaware of any offer of coverage from an authorized insurer? |
| WORK75 | Are you in Chapter 11 Bankruptcy? |
| HOME68 | Are you indebted to an insurance agent, broker or company? |
| BOP02 | Are you involved in manufacturing, mixing relabeling or repacking of products? |
| EO23 | Are you named as an additional insured on the contractor's policy? |
| AGLIA53 | Are you named as an additional insured on the policy(s) of independent trainers or instructors operating on your premises who carry their own insurance? |
| HOME14 | Are you or any resident a professional entertainer, athlete, media personality, state or federal political figure? |
| EPL85 | Are you requesting coverage for employees? |
| EPL86 | Are you requesting coverage for leased employees? |
| WORK29 | Are you seeking to cover the leased workers? |
| SFH02 | Ashes disposed of in a metal container? |
| WORK19 | Can each driver's state of majority driving time be established through verifiable records or logs? |
| WORK34 | Can each driver's state of majority driving time be estimated through verifiable records or logs? Is this a replacement? |
| INMRC04 | Can papers be replaced? |
| PRE09 | Can products be tracked back to source and destination? |
| RESTA31 | Can refrigerated spaces be isolated from one to another in the event of an ammonia leak? |
| DRIVE07 | Can the driver hear normal conversation? |
| CYBR45 | Computer attacks? If the applicant has had any computer security incidents during the past two (2) years (incident refers to any unauthorized access, __ or other computer incidents); complete the following: |
| HOME65 | Coverage desired for any outboard motor(s) or watercraft? |
| CUMBR14 | Coverage provided for doctors/nurses? |
| AUPWI10 | Damaged by hit and run driver and accident reported to the policy within 24 hours from time of accident? |
| GLAS012 | Did agent inspect signs or glass? |
| INMRP06 | Did any loss occur during the last mandated number of years? |
| HOME73 | Did applicant ever have coverage with association on this property? |
| HOME74 | Did the applicant ever have coverage on this property with another company? |
| EO35 | Did the applicant purchase another business, was the purchase an "asset purchase" or did the applicant also buy or accept any liabilities? |
| AUTOP16 | Did the child passenger restraint system (child seat) sustain a loss at the time of the accident? |
| EPL50 | Did you consult an outside law firm when last revising your employee handbook? |
| WORK55 | Did you include the payroll on the application for coverage of owner-operators who you have no Workers Compensation Certificates of Insurance on file? |
| WORK48 | Did you purchase the business, or any part of it, from someone else? |
| WORK16 | Do/have past, present or discontinued operations involve(d) storing, treating, discharging, applying, disposing, or transporting of hazardous material? |
| CGL32 | Do/have you ever sold, manufactured, installed, serviced or repaired any product containing asbestos? |
| BOP52 | Do alcohol sales exceed 15% of gross sales? |
| DFIRE06 | Do all drains and gutters function properly? |
| EO32 | Do all of your contracts include the Conditions of Product Acceptance clause? |
| EO29 | Do all of your contracts include the Disclaimer of Warranties clause? |
| EO28 | Do all of your contracts include the Force Majeure clause? |
| EO30 | Do all of your contracts include the Limitation of Liabilities clause? |
| EO31 | Do all of your contracts include the Limitation of Liabilities for Consequential Damages clause? |
| DO28 | Do all shareholders that own 5% or more of the voting shares, either directly or beneficially have a representative on the board of directors? |
| WORK91 | Do any Employees, at any time, work outside the controlling state? |
| PROF003 | Do any employees work for others in addition to the applicant? |
| AGMOR17 | Do any horses have any conformation problems, defects or ailments, illness or disease, lameness, injury or physical disability, including but not limited to: OCD, neurological disorders, navicular disease and/or degenerative joint disease? Provide full particulars of any past or present conditions. |
| EO08 | Do any of the applicant's contracts contain warranties or guarantees? |
| CONTR04 | Do any operations include blasting or utilize, or store explosive material? |
| WORK89 | Do any other clients of labor contractor have current coverage through the bureau? |
| WORK83 | Do any principal owners of the labor contractor have any ownership interest in any other business entities, in any jurisdiction? |
| TRKRS05 | Do any vehicles have special equipment mounted or attached? |
| EO07 | Do Applicant contracts contain hold harmless or indemnity agreements which inure to applicant's benefit? |
| CUMBR15 | Do current or past products, or their components, contain hazardous materials that may require special disposal methods? |
| INMRC12 | Do drivers receive regular physicals? |
| LIQ006 | Do employees check identification of patrons prior to serving or selling alcohol? |
| WORK09 | Do employees predominantly work from home? |
| GARAG12 | Do employees regularly use their own autos on company business? |
| WORK10 | Do employees travel out of state? |
| FLOOD31 | Does a building permit exist for the property? |
| RESTA23 | Does a contingency plan exist in the event there is a loss of refrigeration? |
| INMRC26 | Does an employee of the applicant have direct oversight of each jobsite in progress? |
| CGL38 | Does an outside contractor provide security? |
| EO38 | Does any director, officer, employee or partner of the applicant serve on the board of directors of any client of the applicant? |
| CGL21 | Does any named insured sell to other named insured? |
| AGLIA37 | Does any named or additional insured have other liability coverage? If yes, explain. |
| AGMOR02 | Does anyone other than you have an insurable interest in any animals listed? |
| BOP14 | Does any operation involve excavation, tunneling, underground work or earth moving? |
| CYBR51 | Does any person __ have any prior knowledge of facts, __ which he or she has reason to believe may give rise to any claim __ within the scope of the proposed coverage? (If "yes", provide an attached explanation) |
| FIDUC02 | Does any plan employ the investment, trustee, actuarial, legal, administrative or benefits consulting services of any outside providers? |
| FIDUC03 | Does any plan hold any contract with a guaranteed return (including Guaranteed Investment Contracts (GICs), Guaranteed Annuity Contracts (GACs) or Bank Investment Contracts (BICs)? |
| PUMBR08 | Does any primary policy have reduced limits of liability or eliminated coverage for specific exposures? |
| AGLIA03 | Does Applicant Build, Repair or Design Machinery, Equipment or Systems for Anyone at a Charge or Fee? |
| DO01 | Does applicant carry D&O coverage? |
| WORK61 | Does applicant consent and agree to receive electronically transmitted information issued by NCCI? |
| WORK62 | Does applicant consent and agree to receive electronically transmitted information issued by the assigned carrier? |
| GARAG10 | Does applicant dismantle autos or have salvage operation? |
| BOP13 | Does applicant draw plans, designs or specifications for others? |
| GARAG09 | Does applicant drive-away or haul-away vehicles from factory distributing point or other dealers? |
| PROF009 | Does applicant employ optometrists or opticians? |
| FIDUC15 | Does applicant handle any investment decisions in-house? |
| AGLIA05 | Does Applicant Handle any Product, such as Seed, Fertilizer, Sprays, etc. for Resale? |
| GARAG06 | Does applicant handle butane, propane or other gases? |
| INMRC15 | Does applicant haul any dangerous, caustic, radioactive or flammable cargo? |
| INMRC18 | Does applicant haul for other truckers? |
| INMRC16 | Does applicant haul target commodities (e.g. stereos, televisions, pharmaceuticals, liquor, meat, seafood, etc)? |
| INMRC11 | Does applicant have a driver recruiting method? |
| BOP03 | Does applicant have a heating or processing boiler? |
| AGLIA79 | Does applicant have any other business or other non-farm activities on or off premises, such as dude ranch, bed & breakfast or resort facility? |
| AGLIA24 | Does applicant have any potentially dangerous animals or exotic pets? |
| EO13 | Does applicant have any professional or trade association memberships? |
| CRIM19 | Does applicant have any written agreements with clients? |
| GENRL60 | Does applicant have a qualifying companion policy with the carrier? |
| INMRC14 | Does applicant have a specific driver recruiting method? |
| HOME66 | Does applicant have national flood insurance? |
| GENRL64 | Does applicant have other business ventures for which coverage is not requested? |
| TRKRS06 | Does applicant have tow trucks or perform towing? |
| INMRC17 | Does applicant hire equipment from others? |
| CGL43 | Does applicant hire others to operate drones? If yes, describe use. |
| CGL12 | Does applicant install, service or demonstrate products? |
| LIQ009 | Does applicant keep a gun on premises? |
| BOP16 | Does applicant lease equipment to others with or without operators? |
| AGLIA23 | Does Applicant Maintain a Non-farm office or Private school in an Insured Building? |
| AGLIA17 | Does Applicant maintain any Vacation or Seasonal Premises? |
| AGLIA04 | Does Applicant Mix, Process, Slaughter, Butcher or Otherwise Prepare for Any "End Consumer" His or Any Other Grower's Product? |
| INMRC10 | Does applicant obtain MVR verification for drivers? |
| INMRC13 | Does applicant obtain MVR verification on drivers? |
| LIQ017 | Does applicant offer special promotions? |
| GENRL24 | Does applicant or any tenant have any animals or exotic pets? |
| WORK07 | Does applicant own, operate or lease aircraft or watercraft? |
| CUMBR10 | Does applicant own, rent or otherwise use cranes? |
| CUMBR03 | Does applicant own/lease/operate aircraft? |
| CGL42 | Does applicant own/lease/operate any drones? If yes, describe use. |
| HOME05 | Does applicant own any recreational vehicles (snowmobiles, dune buggies, mini bikes, ATVs, etc.)? |
| GENRL44 | Does applicant own any watercraft? |
| CUMBR20 | Does applicant own or lease watercraft? |
| CUMBR31 | Does applicant own or manage any other properties? |
| TRKRS01 | Does applicant own or operate equipment not listed here? |
| GARAG05 | Does applicant own or sponsor a car for racing? |
| GARAG13 | Does applicant park customer's vehicles on public streets or off premises? |
| GARAG17 | Does applicant perform road emergency services? |
| GARAG08 | Does applicant perform spray painting or welding? |
| GARAG02 | Does Applicant pick-up or deliver customer's cars? |
| AGLIA42 | Does applicant process or manufacture any of their own products? If yes, explain. |
| TRKRS02 | Does applicant pull double or triple trailers? |
| AGLIA40 | Does applicant raise or board livestock? If yes then explain. |
| EO03 | Does Applicant render any professional services to owned or affiliated entities? |
| GARAG01 | Does Applicant rent, lease or loan vehicles to others? |
| TRKRS04 | Does applicant rent or lease vehicles or equipment to others with or without operators? |
| GENRL18 | Does applicant serve on any boards for remuneration? |
| PROF005 | Does applicant specialize in cremation services? |
| CRIM20 | Does applicant transfer any funds via phone or fax? |
| PRLI01 | Does applicant use airport premises? |
| AIRP12 | Does applicant use contracts for hangaring and tie down service, etc.? |
| GARAG11 | Does applicant use tow trucks? |
| GLAS005 | Does applicant wish to insure lettering on glass? |
| GLAS004 | Does applicant wish to insure tape on glass? |
| CRIM32 | Does audit department have a program to detect ghost employees? |
| CRIM02 | Does audit include inventory? |
| EO44 | Does both in-house and outside legal counsel reviews all legal contracts? |
| FLOOD27 | Does building have any additions or extensions? |
| BOP24 | Does building have a sprinkler? |
| WORK86 | Does client lease entire workforce from this labor contractor? |
| AGCY02 | Does every employee in your agency have a work station with access to e-mail? |
| AGCY03 | Does every employee in your agency have a work station with access to the agency automation system? |
| AGCY01 | Does every employee in your agency have a work station with access to the internet? |
| HOTEL28 | Does food preparation involve cooking? |
| CYBR16 | Does general counsel approve all licensing and/or consent agreements to use the intellectual property of another? |
| GLAS011 | Does glass or signs have scratches, cracks or defects? |
| EO41 | Does in-house and/or outside legal counsel review all contracts utilized? |
| EO42 | Does in-house counsel review all legal contracts? |
| AGLIA15 | Does insured own, board, race, breed or rent horses? |
| EO25 | Does legal counsel review and approve all contracts, advertising and promotional materials, and brochures? |
| AGLIA72 | Does machinery or equipment owned or operated by the applicant not conform to applicable safety regulations? |
| GENRL66 | Does Named Insured(s) claim that each named insured is entitled to exemption? |
| AGLIA45 | Does named insured have operational control over the premises? If no, then explain |
| EO43 | Does outside counsel reviews all legal contracts? |
| MHOME02 | Does park have a resident manager? |
| MHOME03 | Does park have limited access? |
| MHOME05 | Does park have subdivisions? |
| GARAG03 | Does pick-up or delivery exceed 50 miles? |
| CRIM23 | Does premises have double cylinder door locks? |
| HOTEL32 | Does re-heating of pre-cooked food occur at the establishment? |
| INMRC32 | Does spray booth meet NFPA standards? |
| HOME63 | Does the additional insured(s) occupy separate unit(s) in the dwelling? |
| AIRC03 | Does the aircraft have other than a standard airworthiness certificate in full force and effect? |
| AIRP05 | Does the airport employ medical personnel? |
| AIRP06 | Does the airport maintain a bird strike prevention program? |
| AIRP03 | Does the airport maintain an air crash emergency plan? |
| AIRP04 | Does the airport maintain an anti-terrorist plan? |
| AGMOR01 | Does the amount of insurance applied for, on any specific animal, exceed the purchase price of that animal? |
| EPL03 | Does the applicant, its subsidiaries, or any Director, Officer or Employee of the Applicant and its Subsidiaries know of any act, error or omission, which could give rise to a claim under this policy? |
| CYBR19 | Does the applicant's web site(s) include a forum (such as bulletin board or comment posting area) that includes communications from third parties? |
| CYBR05 | Does the applicant's web site(s) include copyrighted material owned by another party? |
| CYBR09 | Does the applicant's web site use the content of another web site and surround with frames? |
| CYBR79 | Does the Applicant accept credit cards for goods sold or services rendered? |
| CYBR07 | Does the applicant allow placement of another vendor's hypertext link on its web site? |
| EO47 | Does the applicant always uses a written contract with subcontractors? |
| EPL29 | Does the Applicant and its Subsidiaries distribute an Employee Handbook to all Employees? |
| EPL24 | Does the applicant and its subsidiaries have a Human Resource or Personnel Department? If yes, how many staff members? |
| EPL26 | Does the Applicant and its Subsidiaries have a Human Resources Manual(s) or equivalent Written Management Guidelines? |
| EPL35 | Does the Applicant and its Subsidiaries have an Implemented Anti-Discrimination and Anti-Sexual Harassment Procedure (including guidelines for handling/reporting complaints)? |
| EPL36 | Does the Applicant and its Subsidiaries provide Formal Training for Staff on Discrimination and Sexual Harassment? |
| EPL32 | Does the Applicant and its Subsidiaries provide Regular Written Performance Appraisals to Employees? |
| EPL17 | Does the applicant anticipate any plant, facility, branch, office or department closing, consolidation, reorganization or layoff within the next 24 months? If yes, provide details. |
| CYBR01 | Does the applicant anticipate establishing or entering into any related or unrelated ventures which are a material change in operations in the next twelve (12) months? |
| CYBR02 | Does the applicant anticipate providing any new e-commerce products or services in the next twelve (12) months? |
| WORK65 | Does the applicant anticipate the number of employees increasing during the course of the policy term? |
| TRANS02 | Does the Applicant Back Haul Property of Others? |
| CYBR129 | Does the applicant collect, process, store or transfer Government Classified Information (GCI)? If yes, please indicate the number of such records. |
| CYBR128 | Does the applicant collect, process, store or transfer Personal Credit Information (PCI)? If yes, please indicate the number of such records. |
| CYBR127 | Does the applicant collect, process, store or transfer Personal Information (PI)? If yes, please indicate the number of such records. |
| CYBR22 | Does the applicant collect, receive, transmit, or store confidential customer information (e.g., social security number, drivers' license number, bank account number, credit or debit card number, etc.)? |
| CYBR53 | Does the Applicant comply with its relevant Payment Card Industry Data Security Standard obligations? |
| EPL93 | Does the applicant conduct any testing? |
| EPL99 | Does the applicant conduct background checks? |
| EPL94 | Does the applicant conduct drug / alcohol screening? |
| EPL95 | Does the applicant conduct physical examination testing? |
| EPL98 | Does the applicant conduct polygraph testing? |
| EPL96 | Does the applicant conduct psychological testing? |
| EPL97 | Does the applicant conduct skills testing? |
| EPL100 | Does the applicant conduct testing other than those listed? |
| CYBR85 | Does the Applicant conduct training annually for every employee user of the information systems in security issues and procedures for data handling, email usage, internet usage, end-user device usage, phishing, and other social media threats? |
| CYBR122 | Does the Applicant currently have insurance in place covering media, privacy or network security exposures? If yes, please provide the Insurer Name, Limits, Deductible, Policy Period, Premium, and Retroactive Date (if any). |
| EO37 | Does the applicant currently or plan to provide services to any governmental entities? |
| CYBR136 | Does the Applicant dispose of old computers and media safely? (This includes electronically wiping hard drives, mobile phones, tablets, USB devices, offline media, etc. or physically destroying old computers and media.) |
| CYBR75 | Does the Applicant distribute any products on a wholesale basis? |
| CYBR61 | Does the Applicant distribute its products or services by means of the Internet? |
| EPL30 | Does the Applicant document the receipt of the employee handbook by each employee? |
| BOATP05 | Does the applicant employ a paid crew? |
| CYBR133 | Does the Applicant enable web and email filters to block malware infected email, malware attachments within email, unapproved or inappropriate websites, and blacklisted websites? |
| CYBR93 | Does the Applicant encrypt data stored on laptop computers and portable media? |
| CYBR100 | Does the Applicant enforce a software update process including installation of software “patches”? |
| EO06 | Does the Applicant ever assume liability of others in its contracts? |
| EPL57 | Does the Applicant give authority to fire employees? If yes, please name. |
| EPL56 | Does the Applicant give authority to hire employees? If yes, please name. |
| CYBR87 | Does the Applicant have a business continuity plan? |
| CYBR31 | Does the applicant have a computer security breach incident response plan (irp)? |
| BOP58 | Does the applicant have a contract for security? |
| EDP14 | Does the applicant have a dedicated line to protect the hardware from power line problems? |
| CYBR86 | Does the Applicant have a disaster recovery plan? |
| EO51 | Does the applicant have a formalized training program for newly hired employees? |
| EPL19 | Does the applicant have a formal out-placement program that assists former employees in obtaining alternative employement? |
| CYBR29 | Does the applicant have a laptop security policy? |
| EDP12 | Does the applicant have a line conditioner to protect the hardware from power line problems? |
| CYBR91 | Does the Applicant have and enforce policies concerning when internal and external communication should be encrypted? |
| EPL27 | Does the Applicant have an employee handbook? If "Yes", indicate the date it was last revised. |
| CYBR138 | Does the Applicant have an incident response plan for network intrusions and virus incidents with written procedures, defined roles, training, communications, and management oversight? |
| EDP11 | Does the applicant have an uninterruptible power source to protect the hardware from power line problems? |
| EPL89 | Does the applicant have any employees located outside the primary state of operations, including outside of the United States? |
| INTL001 | Does the Applicant have any Foreign Subsidiaries? |
| AVIA09 | Does the applicant have any owned, subsidiary, affiliated, managed, or controlled companies? |
| EDP13 | Does the applicant have a power suppressor voltage regulator to protect the hardware from power line problems? |
| CYBR24 | Does the applicant have a privacy policy posted on all of their web site? |
| CYBR113 | Does the Applicant have a procedure for responding to allegations that content created, displayed or published by the Applicant is libelous, infringing, or in violation of a third party’s privacy rights? |
| CYBR114 | Does the Applicant have a process to review all content prior to posting on the Insured’s Internet Site or on social media web pages created and maintained by or on behalf of the Insured? |
| CYBR20 | Does the applicant have a process to screen postings by third parties? |
| CYBR88 | Does the Applicant have a program in place to test or audit security controls on an annual or more frequent basis? |
| EPL90 | Does the applicant have a tracking system that monitors the overtime, vacation and sick pay hours of non-exempt employees? |
| CYBR108 | Does the Applicant have a website or social media web pages on which any content can be posted? |
| CYBR111 | Does the Applicant have a website or social media web pages on which information created by the Applicant can be posted? |
| CYBR109 | Does the Applicant have a website or social media web pages on which licensed third party content can be posted? |
| CYBR112 | Does the Applicant have a website or social media web pages on which streaming video or music content can be posted? |
| CYBR110 | Does the Applicant have a website or social media web pages on which unlicensed third party content (e.g. - Blog/Message Boards/ Customer Reviews) can be posted? |
| CYBR63 | Does the Applicant have a worldwide ranking (for example, Alexa Ranking) for its website as an indicator of website traffic. If Yes, please provide the ranking source and ranking. |
| CYBR54 | Does the Applicant have a written corporate privacy policy? If yes, please attach a copy of the privacy policy to this application. |
| EO50 | Does the applicant have a written procedural manual for employees to follow? |
| PROF014 | Does the applicant have a written quality control program? |
| EPL73 | Does the applicant have employees who work at customer locations or perform a majority of their functions off-site? If yes, please provide approximate number of employees, and services performed/provided. |
| EPL72 | Does the applicant have established policies or procedures for responding to complaints of harassment, discrimination, or civil rights violations from its customers, clients, vendors, the general public or other third parties? If yes, please include a copy. |
| EPL71 | Does the applicant have established policies or procedures outlining employee conduct when dealing with customers, clients, vendors, the general public or other third parties, including non-discrimination and non-harassment statements? If yes, please include a copy. |
| CYBR56 | Does the Applicant have firewalls protecting its data? |
| CYBR21 | Does the applicant have procedures in place to ensure compliance with privacy legislation ___ with respect to the protection of confidential information? |
| EO52 | Does the applicant have promotional literature or marketing materials? |
| GENRL45 | Does the applicant have recreational vehicles or all terrain vehicles? |
| GENRL35 | Does the applicant have subsidiaries? If yes, explain. |
| CYBR137 | Does the Applicant have the ability to remotely wipe portable devices (such as mobile phones and tablets) if they are lost, stolen, or misplaced? |
| EPL37 | Does the applicant have written procedures in place regarding EEO Statements? If yes, indicate the date it was last revised. |
| EPL38 | Does the applicant have written procedures in place regarding termination? |
| EPL31 | Does the Applicant have written procedures in place that are distributed to each employee, if the Applicant does not have an employee handbook? |
| MTRTK05 | Does the applicant hire owner operators? |
| HOTEL01 | Does the applicant host business meetings, conferences or trade shows? |
| CYBR28 | Does the applicant maintain an information systems security policy? |
| CYBR62 | Does the Applicant maintain or support an Internet website? |
| CYBR134 | Does the Applicant monitor for and alert when there is unusual user behavior, data exfiltration, or content transfers? |
| EPL20 | Does the applicant offer enhanced severance agreements in return for a release from future litigation? |
| DO22 | Does the Applicant or any of its Subsidiaries Act as a General Partner in any Partnership? |
| DO35 | Does the applicant or any of its subsidiaries act as a general partner in any partnership or are involved in any joint ventures? |
| EPL16 | Does the applicant or any of its subsidiaries anticipate any Employee Layoffs or Early Retirements in the next 12 months? If yes, what percentage of the total workforce will be affected? |
| EPL12 | Does the applicant or any of its Subsidiaries have any leased employees or independent contractors for whom it provides Indemnification to the same extent as regular F/T or P/T employees? |
| CYBR140 | Does the Applicant or other proposed insured, or any director, officer or employee of the Applicant or other proposed insured have knowledge of or information regarding any fact, circumstance, situation, event or transaction which may give rise to a claim or loss or obligation to provide breach notification under the proposed insurance? (New buyer only) |
| AGLIA75 | Does the applicant or spouse own, rent or operate as a farm, ranch or residence any premises other than those described in the premises information section? |
| CYBR36 | Does the applicant outsource infrastructure operations? |
| CYBR60 | Does the Applicant outsource the handling of any Personally Identifiable Information? |
| CYBR14 | Does the applicant own a federally registered trademark in the applicant's domain name? |
| AIRC04 | Does the applicant own any other aircraft not listed? |
| BOP11 | Does the applicant own or operate any other business? |
| AIRP19 | Does the applicant participate in the National Air Transportation Association (NATA) Safety First program? |
| AIRP18 | Does the applicant perform aircraft painting? |
| AIRP15 | Does the applicant perform engine overhauls? |
| AGPP03 | Does the applicant perform maintenance on equipment? |
| AIRP17 | Does the applicant perform major airframe structural repairs? |
| AIRP16 | Does the applicant perform propeller overhauls? |
| CYBR132 | Does the Applicant prevent its employees from downloading and installing software onto their work computers and mobile devices? |
| CYBR59 | Does the Applicant protect all Personally Identifiable Information through encryption? |
| DO27 | Does the applicant provide any consulting and/or professional services? |
| EPL74 | Does the applicant provide formal diversity or cultural sensitivity training for all of its employees? If yes, explain. |
| EPL28 | Does the Applicant provide formal training for its supervisors in administering performance reviews? |
| CYBR03 | Does the applicant provide technology services or products (e.g. data processing, data storage, data hosting services) to third parties? If yes, describe the specific services. |
| CYBR84 | Does the Applicant publish and distribute written computer and information systems policies and procedures to its employees? |
| CYBR135 | Does the Applicant reduce the chance of spoofed emails by implementing SPF (sender policy framework) or DMARC? |
| EO04 | Does the Applicant render professional services not previously described, which the applicant does not wish to insure? |
| CPR67 | Does the applicant request the reason(s) they are being offered insurance through the plan? |
| CYBR106 | Does the Applicant require computer service providers who may have access to confidential information or personally identifiable information to demonstrate adequate security policies and procedures? |
| EPL92 | Does the applicant require employment terminations to be reviewed by outside legal counsel? |
| EPL82 | Does the applicant require employment terminations to be reviewed by the legal department? |
| EPL70 | Does the Applicant require mandatory arbitration of employment-related Claims? If no, does the Applicant have a program of voluntary arbitration? |
| CYBR38 | Does the applicant require resolution of non-compliance issues within a stipulated time period? |
| EO45 | Does the applicant require subcontractors to carry their own E & O Insurance? |
| CYBR130 | Does the Applicant require the use of multifactor authentication for all critical network devices? |
| CYBR81 | Does the Applicant require third parties with which it shares personally identifiable information or confidential information to indemnify the Applicant for legal liability arising out of the release of such information due to the fault or negligence of the third party? |
| HOME79 | Does the applicant reside in or occupy any other premises? |
| CYBR80 | Does the Applicant restrict employee access to personally identifiable information on a business need-to-know basis? |
| CYBR23 | Does the applicant sell, share or otherwise disclose this personal information to third parties? |
| EO48 | Does the applicant sometimes uses a written contract with subcontractors? |
| CYBR30 | Does the applicant store sensitive data on web servers? |
| CYBR89 | Does the Applicant terminate all associated computer access and user accounts as part of the regular exit process when any employee, contractor, partner, or other third-party leaves the company? |
| CYBR131 | Does the Applicant track, control, and correct the ongoing operational use of ports, protocols, and services on networked devices in order to minimize windows of vulnerability available to attackers? |
| MTRTK06 | Does the applicant trip lease to others? |
| CYBR58 | Does the Applicant use anti-virus, spyware and malware protection software? |
| EPL39 | Does the applicant use any tests to screen applicants or employees for continued employment or promotion? |
| EO46 | Does the applicant use a written contract with subcontractors? |
| CYBR12 | Does the applicant use metatags to control its web site positioning and description in search engine results? |
| CYBR35 | Does the applicant use the services of an application service provider (asp)? |
| CYBR37 | Does the applicant use the services of a third party for off-site backup and/or archiving of electronic data? |
| CYBR95 | Does the Applicant utilize an Online Backup Service for backing up and storage of computer system data? |
| EPL45 | Does the applicant utilize any form of alternative dispute resolution (ADR) or have an arbitration policy? If yes, explain. |
| CYBR33 | Does the applicant utilize firewalls, anti-intrusion and anti-virus software / programs? |
| CYBR96 | Does the Applicant utilize some Other method for backing up and storage of computer system data? |
| CYBR94 | Does the Applicant utilize Tapes or Other Media for backing up and storage of computer system data? |
| EO05 | Does the Applicant utilize written contracts with its clients? |
| PROF017 | Does the applicant write documents? |
| FLOOD08 | Does the area below elevated floor contain machinery and equipment? |
| FLOOD28 | Does the area below the elevated floor contain elevators? |
| WIND06 | Does the building comply with ANSI/ASCE code 7-88? |
| CPR03 | Does the building have a soft story? |
| CGL09 | Does the business' promotional literature make any representation about the safety or security of the premises? |
| HOTEL03 | Does the business contract with a pest control service? |
| HOME22 | Does the business involve demonstration of any products? |
| HOME28 | Does the business involve the use or storage of petroleum-based products, paint, fertilizer, pesticides or other hazardous material or pollutants? |
| DRIVE01 | Does the car have special controls? |
| SFH34 | Does the chimney have a clay liner? |
| EDP24 | Does The Computer room have a raised pedestal floor? |
| FLOOD18 | Does the condition of 2 federal disaster payments, each more than $1000 arise from one or more occurrences exist? |
| FLOOD16 | Does the condition of 2 loss payments, each more than $1,000 arise from one or more occurrences exist? |
| FLOOD19 | Does the condition of 3 federal disaster payments, regardless of amount arise from one or more occurrences exist? |
| FLOOD17 | Does the condition of 3 or more loss payments, regardless of amount arise from one or more occurrences exist? |
| FLOOD20 | Does the condition of one flood insurance claim payment and one disaster relief payment (including loans and grants), each more than $1000 arise from one or more occurrences exist? |
| DRIVE05 | Does the driver have a pacemaker? |
| DRIVE06 | Does the driver use a hearing aid? |
| EPL34 | Does the Employee Handbook have a Written Anti-Discrimination and Anti-Sexual Harassment Statement? |
| EPL33 | Does the Employee Handbook provide Information on the Family Medical Leave Act and the Americans with Disabilities (ADA) Act? |
| WORK92 | Does the employer elect to provide coverage for farm laborers? |
| WORK93 | Does the executive officer have at least Five (5)% ownership interest in a Subchapter C Corporation as defined by the Tax Reform Code? |
| WORK94 | Does the executive officer serve voluntarily and without remuneration in a non-profit corporation? |
| CERT021 | Does the GL policy (including endorsments) not cover the additional insured for claims involving injury to employees of the named insured or subcontractors (not workers compensation)? |
| EPL59 | Does the Human Resource Department or outside legal counsel conduct a pre-termination review of the personnel file? |
| RESTA09 | Does the inn owner reside elsewhere; or, is the inn operated by someone other than the owner? |
| HOTEL26 | Does the inn owner reside elsewhere; or is the inn operated by someone other than the owner? |
| RESTA10 | Does the inn provide guests with any sports equipment, including boats, bicycles, motorcycles, or horses? |
| HOTEL20 | Does the insured allow guests to store valuables in the hotel safe? |
| EPL49 | Does the insured conduct an orientation for all newly hired employees? |
| EPL62 | Does the insured conduct exit interviews with each terminated employee? |
| EPL47 | Does the insured confirm all offers of employment in writing? |
| WORK74 | Does the insured elect to be excluded from the list of employers in the assigned risk plan? |
| WORK97 | Does the insured elect to be excluded from the list of employers in the Tennessee assigned risk plan? |
| EPL63 | Does the insured enter into employment contracts with any employees? If yes, please provide the current applicable number of contracts and amounts. |
| EPL25 | Does the Insured have a Human Resources representative in each location in which it does business? If "No", how is this function handled? |
| EPL44 | Does the insured have an "At Will" provision in the employment application? |
| EPL61 | Does the insured have an established severance plan, policy or practice? |
| EPL58 | Does the insured have an internal grievance procedure? |
| LLOYDS01 | Does the insured have any exports? |
| LLOYDS02 | Does the insured have any US exports? |
| HOTEL23 | Does the insured have a policy of providing alternate accommodations? |
| EPL42 | Does the insured have a Progressive Disciplinary Program? |
| EPL43 | Does the insured have a standard employment application for all applicants? |
| AGLIA38 | Does the Insured have rental properties? If yes, explain. Include number of properties and units at each property. |
| AUDIT07 | Does the Insured operate in more than one state? |
| AGLIA76 | Does the insured plan any construction or renovation work to be done on the premises in the next specified period of time? |
| EPL60 | Does the insured provide outplacement services for terminated employees? |
| EPL46 | Does the insured require that all applicants sign the application? |
| EPL41 | Does the insured train Employees in Anti-Harassment and Anti-Discrimination? |
| EPL40 | Does the insured train supervisors and managers on human resources issues, interviewing practices, performance appraisals, discipline and harassment issues at least annually? If yes, indicate the date it was last revised. |
| AUDIT05 | Does the Insured use a Temporary Agency to complete a project? |
| AUDIT06 | Does the Insured use Casual Labor to complete a project? |
| AUDIT01 | Does the Insured use Direct Employees to complete a project? |
| AUDIT04 | Does the Insured use Independent Contractors to complete a project? |
| AUDIT03 | Does the Insured use Leased Employees to complete a project? |
| AUDIT08 | Does the Insured use outside salespersons to market or sell the products and/or services? |
| AUDIT02 | Does the Insured use Subcontractors to complete a project? |
| AUTC009 | Does the insured wish to not provide information regarding their race or national origin? |
| WORK88 | Does the labor contractor have any outstanding premium due on any worker's compensation policy? |
| BOP39 | Does the operation have hours after 9:00 P.M. and/or 24 hour operations? |
| HOWC004 | Does the other co-owner have a Homeowners policy that provides building coverage? |
| SFH27 | Does the pipe assembly from the wall pass through a thimble collar or opening at least 12 inches larger diameter than stove pipe? |
| SFH25 | Does the pipe assembly have hangers if there is a horizontal run over five feet? |
| SFH29 | Does the pipe assembly not pass through concealed spaces? |
| EPL55 | Does the Policyholder use an outside legal counsel for employment advice and/or defense? If yes, please name. |
| AUPFL02 | Does the policy include specifically insured or identified motor vehicle(s) registered or principally garaged in Florida? |
| AUPTX01 | Does the policy only cover household residents who are specifically named on the policy (acceptance of named driver option)? |
| FIN05 | Does the policy provision prohibit cancellation? |
| FIN04 | Does the policy require more than ten (10) days to cancel? |
| EDP10 | Does the premises have a burglar alarm? |
| PROP06 | Does the premises have a fireplace? |
| PROP05 | Does the premises have central air conditioning? |
| CGL33 | Does the premises have fire protection in each unit/division? |
| SURTY01 | Does the principal have any bankruptcies? |
| SURTY02 | Does the principal own real estate? |
| WORK81 | Does the producer acknowledge the signature to the application is an original signature and agree to maintain a copy of the completed application with the applicant's signature for no less than the specified number of years? |
| WORK80 | Does the producer certify that they have read the specified section(s) of the application with the applicant prior to his/her signing? |
| WORK63 | Does the producer consent and agree to receive electronically transmitted information issued by NCCI ? |
| WORK64 | Does the producer consent and agree to receive electronically transmitted information issued by the assigned carrier? |
| DFIRE04 | Does the property exhibit any evidence of roof, ceiling, wall, window, or plumbing leaks? |
| DFIRE08 | Does the property have any broken glass? |
| RESTA21 | Does the refrigeration system utilized have any spare capacity? |
| CYBR117 | Does the review include screening the content for Copyrighting infringement? |
| CYBR116 | Does the review include screening the content for Disparagement Issues? |
| CYBR119 | Does the review include screening the content for Invasion of Privacy? |
| CYBR118 | Does the review include screening the content for Trademark infringement? |
| CPR94 | Does the risk at the location have a soft storey? |
| BOP46 | Does the safe have a key lock? |
| SFH03 | Does the smoke pipe fit snug into the chimney opening? |
| SFH14 | Does the stove installation and use conform to all of its manufacturers specifications and local fire codes? |
| SFH13 | Does the stove pipe pass through any interior combustible wall, ceiling, closet, or concealed area? |
| PROP07 | Does the structure have a finished basement or attic? |
| GENRL48 | Does the swimming pool have a slide? |
| CUMBR27 | Does the umbrella policy provide coverage in excess of the limits of the uninsured/underinsured vehicle coverage in the primary auto insurance? |
| CUMBR27 | Does the umbrella policy provide coverage in excess of the limits of the uninsured/underinsured vehicle coverage in the primary auto insurance? |
| AUTOB16 | Does the vehicle have physical damage coverages only? |
| BOATC02 | Does the watercraft have a captain? |
| BOATC03 | Does the watercraft have a full time captain? |
| BOATC04 | Does the watercraft have a part time captain? |
| CERT001 | Does the workers compensation and employers liability policy exclude any proprietor, partner, executive officer, or member? |
| WORK33 | Does this business or any owners, individually or in combination with other owners, own > 50% of any other business operated at any time during the mandated number of years prior to this application? |
| WORK32 | Does this business own a majority interest in another entity, which in turn owns a majority interest in any entity that operated at any time during the mandated number of years prior to this application? |
| AH001 | Does this policy have any allowable/eligible complainants? If yes, what is the maximum number of allowable/eligible complainants on this policy, expressed as a number of individuals? |
| AGCY04 | Does your agency input policy and transactional detail for only specific types of business? |
| AGCY05 | Does your agency plan on changing your agency automation system vendor within the next year? |
| EPL77 | Does your application contain an equal opportunity employment statement? |
| EPL76 | Does your application include authorization to check references and criminal conviction records? |
| HOME23 | Does your company maintain or support an internet website? |
| HOME85 | Does your company maintain or support an internet website? |
| HOTEL12 | Do fire exists have emergency lighting? |
| HOTEL13 | Do hallways have emergency lighting? |
| AGLIA51 | Do independent trainers or instructors operate on your premises? |
| AGLIA52 | Do independent trainers or instructors operating on your premises carry their own insurance? |
| HOTEL14 | Do individual guest rooms have balconies? |
| CRIM46 | Do internal audit procedures include computer operations? |
| AUTOB06 | Do Operations involve transporting hazardous materials? |
| INMRC19 | Do other truckers operate under the permit of the applicant? (Percentage of total number of vehicles so operated) |
| PRE06 | Do Products Carry a Company Name or Trademark? |
| PRE07 | Do Products Carry a Part Number? |
| PRE08 | Do Products Carry a Production Batch Number? |
| RESTA27 | Do refrigerated spaces have temperature alarms (high / low) installed? |
| HOTEL16 | Do security personnel carry guns? |
| CUMBR11 | Do subcontractors carry coverages or limits less than applicant? |
| MTRTK02 | Do terminals have fire protection (sprinklers, hoses, etc.)? |
| MTRTK03 | Do terminals have security systems (guards, alarms, fences, lights, dogs, etc.)? |
| BOP61 | Do the insured's activities include other than religious services? |
| FIDUC20 | Do the plans conform to the standards of eligibility, participation, vesting, funding and other provisions of the Employee Retirement Income Security Act (ERISA), the Pension Protection Act of 2006, or similar foreign laws, if applicable? |
| CYBR13 | Do these metatags use competitor names, trademarks, or other identifiers that could be construed as infringing the intellectual property of another or create initial interest confusion? (185 characters) |
| BOP47 | Do the windows contain bars? |
| LIQ003 | Do the written policies include policies and procedures regarding non-service to minors and intoxicated persons? |
| CYBR04 | Do third parties rely on the availabilty of the applicant's web site(s) in order to transact business? |
| WORK30 | Do trucking classifications apply? |
| MHOME20 | Do turnbuckles end with open hook? |
| EPL104 | Do written performance evaluations include standard rating categories? |
| WORK46 | Do you, or companies with whom you have contracts, use any owner-operators? |
| AIRC06 | Do you anticipate aircraft to be operated outside the contiguous United States? |
| EO14 | Do you conduct formal inspections of requirements, design code, and test plans? |
| AGLIA47 | Do you conduct or sponsor any horse events on premises such as shows or rodeos? |
| EPL75 | Do you currently carry EPLI insurance? |
| HOME21 | Do you distribute your products or services by means of the internet? |
| AGLIA46 | Do you employ any children? If so, how many and what ages? |
| AGLIA26 | Do you employ any migrant workers? If yes, explain. |
| WORK96 | Do you employ drivers? |
| WORK13 | Do you employ part time or seasonal labor? |
| WORK06 | Do you employ subcontractors, owner-operators, and/or independent contractors? |
| PUMBR03 | Do you engage in any type of farming operation? |
| EO24 | Do you ever agree to hold harmless any dealers for claims arising out of their products? |
| EO21 | Do you ever agree to hold harmless any suppliers for claims arising out of their products? |
| AGLIA30 | Do you ever use or store polychlorinated biphenyls (PCB's)? (Other than those in transformers in current use)? |
| INMRC53 | Do you excavate also? |
| EO17 | Do you have a formal product recall plan? |
| WORK20 | Do you have a franchise or licensing agreement? If yes, provide details of the agreement. |
| EDP02 | Do you have an arrangement for the use of other equipment? |
| EPL78 | Do you have an employment opportunity statement? |
| LLOYDS05 | Do you have any foreign operations? |
| LLOYDS06 | Do you have any operations based in the US? |
| EDP05 | Do you have a service maintenance contract with a manufacturer or other service contractor? |
| AGMOR09 | Do you have a veterinarian group or veterinary group that you use consistently? |
| EO18 | Do you have contingency plans to service a customer who has had a critical failure of your product or service? |
| WORK31 | Do you have operations in states other than the controlling state? |
| INMRC07 | Do you have property on consignment? If Yes, please describe. |
| WORK15 | Do you have safety programs? |
| WORK54 | Do you have Workers Compensation Certificates of Insurance on file for each owner-operator? |
| PUMBR04 | Do you hold any non-compensated positions? |
| CGL04 | Do you lease employees to or from other employers? |
| WORK21 | Do you lease workers from a labor contractor? If yes, refer to WCIP instructions. |
| WORK22 | Do you lease workers to a client company? |
| MP003 | Do you maintain a separate policy for professional liability? |
| EO19 | Do you normally install and service your products? |
| BOP40 | Do you obtain and verify certificates of insurance from subcontractors, manufacturers and / or suppliers? |
| LIQ021 | Do you or employees provide transportation to apparently intoxicated patrons? |
| WORK28 | Do you or your employees regularly operate from a base terminal(s) which is (are) used to load, unload, store or transfer freight? If yes, please provide a list of terminal addresses. |
| WORK95 | Do you or your employees spend a majority of driving time in a certain state? |
| WORK57 | Do you own goods that are being hauled? |
| PILOT01 | Do you participate in FAA Pilot Proficiency Award Program? |
| EPL79 | Do you post all notices required by law? |
| AGLIA49 | Do you post rules and/or warning signs? |
| AUPMA01 | Do you presently owe any motor vehicle premium, payable in the last twelve months? |
| AGLIA31 | Do you process or sell any chemicals (fertilizers, pesticides, etc.) or store chemicals for other than your own use? |
| AGLIA59 | Do you provide riding for the handicapped? |
| EO20 | Do you provide service and repair of products other than your own? |
| WORK26 | Do you provide temporary labor services to other employers? |
| CONTR05 | Do your contractors carry coverages or limits less than yours? |
| INMRC06 | Do you rent property to others? If Yes, please describe. |
| AGLIA58 | Do you repair riding equipment for others? |
| EO22 | Do you require anyone to whom you contract work to have products and E&O coverage? |
| HANG01 | Do you require hangar tenants to carry insurance? |
| WORK14 | Do you require pre-employment physicals? |
| HANG03 | Do you require tenants to sign hangar agreement holding you harmless for losses not caused by you? |
| EPL83 | Do you require that all employment terminations be reviewed by the human resources department / personnel having human resources responsibilities? |
| EO15 | Do you require your customers to sign off at critical milestones of a project? |
| EO26 | Do you require your customers to sign written agreements that outline the specifications of products and services you will provide? |
| AIRC19 | Do you sell, distribute, or provide any chemicals? |
| AGLIA57 | Do you sell from premises other than your own? |
| AIRC25 | Do you spray over any residential (or populated) areas? |
| AIRC18 | Do you spray - Picloram formulations (i.e. Tordon, Grazon, etc.)? |
| AIRC26 | Do you spray right-of-ways? |
| LIQ020 | Do you subscribe to a taxi or other serving providing transportation home to apparently intoxicated patrons? |
| WORK70 | Do you supply employees on a regular basis? |
| AGLIA60 | Do you transport horses for others? |
| WORK53 | Do you use any owner-operators? |
| WORK04 | Do you use privately owned or leased aircraft in the operation of the business? |
| AUTOP21 | Do you wish to purchase additional uninsured motorists coverage? |
| AUTOP22 | Do you wish to purchase optional underinsured motorists coverage? |
| PROP29 | During the last 10 years, has anyone with a financial interest in this property including the mortgagee_had any fire or explosion losses exceeding $1,000 on this or any other property? |
| EPL07 | During the last 5 years, has the company only, excluding those actions naming the company, and the Directors and Officers described, been named as a party in any civil or criminal action, administrative, arbitration, regulatory or investigative proceeding, or received any demands involving alleged violations of Federal or state anti-trust or fair trade laws or regulations? If yes, explain. |
| EPL05 | During the last 5 years, has the company only, excluding those actions naming the company, and the Directors and Officers described, been named as a party in any civil or criminal action, administrative, arbitration, regulatory or investigative proceeding, or received any demands involving alleged violations of Federal or State copyright or patent laws or regulations? If yes, explain. |
| EPL06 | During the last 5 years, has the company only, excluding those actions naming the company, and the Directors and Officers described, been named as a party in any civil or criminal action, administrative, arbitration, regulatory or investigative proceeding, or received any demands involving alleged violations of Federal or state security laws or regulations? If yes, explain. |
| EPL08 | During the last 5 years, has the company only, excluding those actions naming the company, and the Directors and Officers described, been named as a party in any civil or criminal action, administrative, arbitration, regulatory or investigative proceeding, or received any other written demands for money or services? If yes, explain. |
| EPL04 | During the last 5 years, have the company and the Directors and Officers been named together as parties in any other civil or criminal action, administrative, arbitration, regulatory or investigation proceeding, or received any other written demands for money or services? If yes, explain. |
| AUPMA18 | During the last 6 years have you or any listed operator been assigned to an alcohol education program? |
| AUPMA20 | During the last 6 years have you or any listed operator been convicted of vehicular homicide, auto related fraud, auto theft, or driving under the influence of alcohol or drugs? |
| AUPMA17 | During the last 6 years have you or any listed operator been involved in any motor vehicle accident or been found guilty of any moving violation? |
| AUPMA19 | During the last 6 years have you or any listed operator had two or more total fire or total theft losses? |
| AUPMA21 | During the last 6 years have you or any listed operator received payment from an insurance company for any collision or comprehensive loss including fire, theft, vandalism, malicious mischief, or glass? |
| GENRL08 | During the last specified number of years, has any applicant been convicted of any degree of the crime of arson? |
| GENRL61 | During the last specified number of years, has any applicant been indicted for or convicted of any degree of the crime of fraud, bribery, arson or any other arson-related crime in connection with this or any other property? |
| DO34 | During the last specified number of years, has the applicant completed or agreed to, or is contemplating within the next 12 months; a merger, acquisition or consolidation with another entity? |
| DO33 | During the last specified number of years, has the applicant or any director, officer, members of the board of managers or any other proposed insured been involved in any claims, lawsuits or administrative proceedings? |
| FIDUC29 | During the last specified number of years has the applicant or any other proposed insured been involved in any claims, lawsuits or administrative proceedings? |
| CYBR139 | During the past __ years has the Applicant notified consumers or any other third party of a data breach incident involving the Applicant? (Indicate number of years, if any) |
| CYBR125 | During the past 5 years has the Applicant been subject to any government action, investigation or subpoena regarding any alleged violation of a privacy law or regulation? |
| CYBR126 | During the past 5 years has the Applicant experienced an actual or attempted extortion demand with respect to its computer systems? |
| CYBR124 | During the past 5 years has the Applicant received any claims or complaints with respect to privacy, breach of information or network security, unauthorized disclosure of information, or defamation or content infringement? |
| DO02 | During the past five years has this organization been involved in claims or lawsuits, including employment disputes? |
| EO34 | During the past specified number of years, has the applicant's name changed, has the application purchased, merged or consolidated with any other business or has the applicant been purchased? |
| FLOOD14 | During the period of ownership has the property owner received 2 or more flood insurance claim payments of $1000 or more, or 3 or more claim payments, regardless of amount, or 2 or more federal disaster relief payments (including loans and grants) of $1000 or more, or 3 federal disaster relief payments, regardless of amount? |
| INMRC76 | Equipment rented, loaned from other with / without operators. |
| CONTR01 | Equipment rented, loaned to/from others with/without operators? |
| INMRC75 | Equipment rented, loaned to other with / without operators. |
| AGMOR16 | For all quarter horses, appaloosas or paint horses, does any horse have an ancestor known to carry HYPP? |
| CUMBR25 | For Claims made, was "tail" coverage purchased for any previous primary or excess policy? |
| FIDUC19 | For each cash balance plan, was the plan converted from a prior defined benefit (pension) plan? |
| CGL13 | Foreign products, sold, distributed, used as components? |
| AUPMA08 | For motorcycles only, do you want a policy issued to expire at 12:01 AM on January 1st and do not renew? |
| AUPMA09 | For trailer or recreational vehicles, do you want a policy issued to expire at 12:01 AM on December 1st and do not renew? |
| CGL15 | Guarantees, warrantees, hold harmless agreements? |
| HOFP002 | Handrails on your porches/stairways? |
| AUTOB12 | Has agent inspected vehicles? |
| AIRC05 | Has aircraft been equipped with any modifications not provided by the original aircraft manufacturer that alter the flying characteristics? |
| HOME75 | Has an incident report been made against an animal in your care, custody, or control? |
| AGMOR10 | Has any animal been examined or treated by a veterinarian for other than routine care? |
| AGMOR23 | Has any animal been used as a hunter, jumper or eventer, or for racing? |
| AGMOR04 | Has any animal had any insurance not listed in the prior insurance section? |
| AGMOR06 | Has any animal suffered any accident, disease or sickness, had colic/bloat or indigestion, or experienced birthing difficulties? |
| AUTOP10 | Has any applicant or driver had a foreclosure, repossession, bankruptcy, judgment or lien during the past five years? |
| DO18 | Has any Auditor issued a "Going Concern" Opinion for the Applicants or any of its Subsidiaries Financial Statements? |
| PUMBR10 | Has any auto accident or liability loss on any primary or excess policy occurred, regardless of fault during the mandated number of years? |
| CPR64 | Has any building you own or have owned suffered any damage is the specified number of years? |
| CPR21 | Has any carrier cancelled, declined to insure, refused renewal or required policy restitution on similar insurance? |
| AUTOP25 | Has any driver not maintained personal automobile insurance coverage (e.g., due to military deployment) during the insurer’s required experience period? If "Yes," please explain. |
| AUTOP24 | Has any driver satisfying the state-specified age requirement completed an approved motor vehicle accident prevention course? If yes, indicate the driver number(s) from the driver schedule. |
| BAM07 | Has any Equipment Breakdown loss in the last 3 years exceeded $10,000? |
| FIDUC26 | Has any fiduciary been accused, found guilty or held liable for a breach of trust? |
| FIDUC27 | Has any fiduciary been convicted of criminal conduct? |
| AGMOR18 | Has any horse been nerved or received any surgical treatment for lameness? |
| AGMOR21 | Has any horse been treated for hoof problems, founder/laminitis, or rotation of the coffin bone? |
| AGMOR20 | Has any horse received any joint injections, any type of medication, long or short term, or any preventative treatments in the last twelve (12) months? |
| AGMOR19 | Has any horse undergone diagnostic ultrasounds, X-rays or bone scans? |
| PILOT04 | Has any insurance company or underwriter cancelled, or refused to renew any insurance on your behalf? |
| EPL53 | Has any insured been involved in any Investigation by the EEOC, or Similar State or Foreign Agency? |
| EPL109 | Has any insured been involved in any other criminal actions? |
| EPL51 | Has any insured been involved in Civil or Criminal Action or Administrative Proceeding Charging Violation of a Federal, State, or Foreign Employment Law or Regulation? |
| EPL52 | Has any insured been involved in Representative Actions, Class Actions or Derivative Suits in Connection with Employment Issues? |
| AVIA01 | Has any insurer cancelled or non-renewed any aviation insurance for the applicant? |
| DO17 | Has any Insurer Refused, Canceled, Non-Renewed, or stated an intent to Non-Renew your D&O insurance? |
| AUPDE01 | Has any named insured driven without liability insurance during any part of the last six (6) months? |
| WORK71 | Has any owner ever been in business under a different name? |
| FIDUC22 | Has any plan filed for an exemption from a prohibited transaction? |
| FIDUC06 | Has any plan or portion of any plan been spun off (sold), transferred, or terminated? |
| FIDUC04 | Has any plan requested or contemplated filing a request for termination? |
| CUMBR24 | Has any product, work, accident, or location been excluded, uninsured or self-insured from any previous coverage? |
| CGL10 | Has any product, work, accident or location been excluded, uninsured or self-insured from any previous coverage? |
| CYBR123 | Has any professional liability, privacy, network security or media insurance ever been declined or cancelled? |
| BOP44 | Has any proposed insured, or the property sought to be insured, been the subject of any claim or suit with in the last mandated number of years? |
| PRLI03 | Has any subsidiary, affiliated, owned or managed firm, or applicant's products liability ever been self-insured or not insured? |
| INMRC45 | Has applicant applied or installed any exterior insulation or finishing, or any exterior insulation finishing systems (EIFS) related product or materials in the past? |
| LIQ027 | Has applicant carried prior insurance for liquor liability? |
| AIRP11 | Has applicant entered into any agreements assuming liability of others such as lease of premises, fuel supplier, equipment leases, etc.? |
| GENRL59 | Has applicant had a foreclosure, repossession, bankruptcy, or filed for bankruptcy during the mandated time period? |
| GENRL25 | Has applicant had a foreclosure, repossession or bankruptcy during the past five years? |
| GENRL63 | Has applicant had a judgement or lien during the specified number of years? |
| RESTA01 | Has applicant has now, or in the past been involved in bankruptcy, foreclosure, tax lien, business failure, or litigation? |
| HOME67 | Has applicant obtained letter of interim control or letter of compliance for lead paint? |
| CPR44 | Has applicant previously applied or been insured by the state Fair Plan? |
| EO02 | Has Applicant within the past 5 years changed its name, reorganized, acquired or merged with another entity? |
| WIND14 | Has application been previously submitted? |
| CERT005 | Has a request has been submitted to add the certificate holder listed to the policy(ies) listed herein by policy number(s)? |
| BOATC01 | Has a survey of the vessel has been made? |
| RESTA02 | Has business been in operation less than 5 years at this location? If yes, describe prior experience of owner/manager. |
| GENRL40 | Has business been placed in a trust? |
| CPR41 | Has construction been started? |
| AUPMA23 | Has Driver had any accidents/violations/incidents while holding a license which was not issued by the state of Massachusetts? |
| CPR51 | Has electrical system been improved since construction? |
| GLAS016 | Has factory-built insulating glass been tempered? |
| CPR71 | Has FAIR Plan ever refused coverage, cancelled coverage or non-renewed coverage at this location? |
| BOP28 | Has heating been improved since construction? |
| GENRL26 | Has insurance been transferred within agency? |
| AUIN001 | Has insured had previous vehicle theft losses? |
| LIQ001 | Has liquor license ever been non-renewed, cancelled, or revoked? |
| BOP27 | Has plumbing been improved since construction? |
| CPR20 | Has property been properly boarded? |
| CPR72 | Has property to be covered suffered any property damage losses? |
| BOP26 | Has roofing been improved since construction? |
| HOFP004 | Has the animal ever harmed or injured anyone? |
| CYBR44 | Has the applicant __ (3) years put its insurance carrier on notice of any potential __ under its prior insurance program __ under the scope of the proposed coverage? (If "yes", __ explanation.) |
| EO10 | Has the applicant, during the past 5 years been the subject of a professional disciplinary or regulatory proceeding? |
| AUPWI12 | Has the applicant, or anyone who usually drives the applicant's motor vehicle(s), been convicted or forfeited bail at any time during the specified period of time? |
| AUPWI05 | Has the applicant, or anyone who usually drives the applicant's motor vehicle(s), been involved, either as owner or operator, in any motor vehicle accident during the past specified period of time? |
| EPL48 | Has the applicant's employee application been revised? If yes, what was the date of the revision? |
| CYBR121 | Has the Applicant acquired any trademarks from others in the past three (3) years? |
| AVIA03 | Has the applicant been indicted or convicted of a felony? |
| CYBR15 | Has the applicant conducted a trademark search to determine whether their domain name infringes a trademark held by a third party? |
| CYBR65 | Has the Applicant designated a Chief Data Officer? If Yes, please provide the CDO's name. If No, please provide the name and position of the person responsible for data issues. |
| CYBR66 | Has the Applicant designated a Chief Digital Officer? If Yes, please provide the CDO's name. If No, please provide the name and position of the person responsible for digital technology. |
| CYBR68 | Has the Applicant designated a Chief Privacy Officer? If Yes, please provide the CPO's name. If No, please provide the name and position of the person responsible for privacy issues. |
| CYBR67 | Has the Applicant designated a Chief Security Officer? If Yes, please provide the CSO's name. If No, please provide the name and position of the person responsible for computer security. |
| EO11 | Has the applicant during the past 5 years been the subject of any claim, lawsuit or proceeding relative to professional services the applicant renders, regardless if insured? |
| EPL65 | Has the Applicant ever been the Subject of an OFCCP Investigation which Resulted in a Violation? If yes, submit a copy of the investigation report along with this application, and explain what corrective actions your company has taken. |
| EO54 | Has the applicant ever sued a client to collect its fees? |
| CYBR50 | Has the applicant experienced a security breach that required notification of customers or other third parties? |
| HOME69 | Has the applicant filed a voluntary petition, or been named as the debtor in an involuntary petition, under the US bankruptcy code or is the applicant acting as bankruptcy trustee or performing a similar function? |
| HOME29 | Has the applicant filed for bankruptcy (business or personal) in the last specified number of years? |
| DO26 | Has the applicant had a breach of debt covenant or loan agreement? |
| GENRL55 | Has the applicant had a foreclosure, repossession, bankruptcy, judgement or lien during the last specified number of years? |
| CYBR40 | Has the applicant had an external network security assessment conducted within the last twelve (12) months? |
| CYBR55 | Has the Applicant had an independent audit undertaken of its IT infrastructure? |
| EPL81 | Has the applicant had any actual or attempted merger, acquisition, consolidation or divestment in the past mandated number of years or anticipated in the next mandated number of months? |
| AVIA04 | Has the applicant had any sanctions, violations or suspensions from the FAA or any other regulatory body? |
| CYBR64 | Has the Applicant had past cyber breaches? If Yes, please explain the past cyber breaches and provide the number of breach incidents that have occurred in the past five years. |
| CYBR82 | Has the Applicant implemented an identity theft prevention program (aka FTC “Red Flags” program)? |
| CYBR69 | Has the Applicant integrated any Information Technology systems as a result of any mergers or acquisitions in the last three years? If Yes, please explain. |
| DO06 | Has the applicant in the past 36 months completed or agreed to or is contemplating within the next 12 months a merger, acquisition or consolidation with another entity whose consolidated assets exceed 25% of the applicants consolidated assets? |
| DO08 | Has the applicant in the past 36 months completed or agreed to or is contemplating within the next 12 months any registration for a public offering or any private placement of securities? |
| DO09 | Has the applicant in the past 36 months completed or agreed to or is contemplating within the next 12 months a reorganization or arrangement with creditors under federal or state law? |
| BOATP06 | Has the applicant lived at current address for less than 3 years? |
| CYBR08 | Has the applicant obtained written consent from the other web site's owner to link to their site? |
| EO53 | Has the applicant or any director, officer, employee or partner of the applicant ever been the subject of disciplinary action as a result of professional activities? |
| EPL15 | Has the applicant or any of its subsidiaries had any Employee Layoffs or Early Retirements in the last 12 months? |
| CPR42 | Has the applicant or any other party with interest in this property had any fire losses in excess of $500? |
| CPR13 | Has the applicant or person having financial interest in the property been indicted or convicted for fraud, bribery, arson or any other crime for the purpose of defrauding an insurance company? |
| CPR36 | Has the applicant previously applied to the State Fair Plan for insurance on this property? |
| CYBR06 | Has the applicant received written permission to use the copyrighted material? |
| CYBR120 | Has the Applicant screened all trademarks used by the Applicant for infringement with existing trademarks prior to first use? |
| CYBR77 | Has the Applicant within the past twelve (12) months completed or agreed to, or does it contemplate entering into within the next twelve (12) months, a merger, acquisition, consolidation, whether or not such transactions were or will be completed? |
| VACB01 | Has the building been condemned? |
| BOP42 | Has the building has undergone building updates? |
| CERT004 | Has the certificate holder been added to the policy(ies) herein by policy number(s)? |
| CERT003 | Has the certificate holder been named as a loss payee on the policy? |
| AUPWI02 | Has the driver been licensed for the specified number of years? |
| DRIVE15 | Has the driver been tested for diabetes? |
| DRIVE16 | Has the driver been treated for epilepsy? |
| DRIVE17 | Has the driver been treated for heart disease? |
| DRIVE18 | Has the driver been treated for high blood pressure? |
| DRIVE03 | Has the driver had a heart attack? |
| DRIVE22 | Has the driver had any motor accidents or claims within the specified number of years? Use the <Num> element to specify the number of 'years' that the response applies to. |
| DRIVE23 | Has the driver had any motoring convictions, driving licence endorsements or fixed penalty points within the specified number of years? Use the <Num> element to specify the number of 'years' that the response applies to. |
| DRIVE24 | Has the driver had any non-motoring convictions within the specified number of years? Use the <Num> element to specify the number of 'years' that the response applies to. |
| DRIVE04 | Has the driver had cataracts? |
| DRIVE09 | Has the driver lost an arm or leg? |
| DRIVE08 | Has the driver lost sight in an eye? |
| DRIVE10 | Has the driver lost use of an arm or leg? |
| WORK50 | Has the estimated remuneration, subject to minimums and maximums, of the above-named individuals been included in Premium Calculation Section? |
| WORK02 | Has the firm ever filed for bankruptcy? |
| DRIVE14 | Has the form been signed? |
| AUTOP18 | Has the insured acknowledged that they have read and understand the information on credit reporting? |
| AUPSD01 | Has the insured acknowledged this policy has permissive drop down coverage? |
| GENRL68 | Has the Insured been the subject of any sanctions checks undertaken by the Coverholder? |
| EPL18 | Has the insured had a reduction in work force in the last three years? If yes, explain. |
| AUTC007 | Has the insured selected the minimum uninsured motorists conversion coverage limits? |
| AUTC003 | Has the insured selected the minimum uninsured motorists limits? |
| AUTC005 | Has the insured selected uninsured motorists conversion coverage limits double their bodily injury limits? |
| AUTC006 | Has the insured selected uninsured motorists conversion coverage limits equal to their bodily injury limits? |
| AUTC008 | Has the insured selected uninsured motorists conversion coverage limits other than the standard limits offered? |
| AUTC001 | Has the insured selected uninsured motorists limits double their bodily injury limits? |
| AUTC002 | Has the insured selected uninsured motorists limits equal to their bodily injury limits? |
| AUTC004 | Has the insured selected uninsured motorists limits other than the standard limits offered? |
| WORK82 | Has the labor contractor operated under any other name, in any jurisdiction, in the past specified number of years? |
| AUTOP19 | Has the named insured has selected uninsured motorists limits lower than their bodily injury limits? |
| AUTOP17 | Has the named insured requested renewal notices to be sent by electronic mail? |
| AUTOP20 | Has the named insured selected Uninsured Motorist limit(s) equal to their Bodily Injury Liability limits or Combined Single Limit for liability coverage? |
| AUPNJ01 | Has the physical damage inspection been waived? |
| DO23 | Has the Policyholder changed independent auditors in the past 3 years? If yes, please explain. |
| DO16 | Has the Policyholder or any Director, Officer or other proposed Insured been Involved in Any of the Following: Antitrust, copyright, or patent litigation; civil or criminal action or administrative proceeding charging violation of a federal, state, or foreign security law or regulation; any other criminal actions; representative actions, class actions, or derivative suits; Investigation by the SEC, or similar foreign agency? |
| DO14 | Has the Policyholder or any Insured Individual given written notice under the provisions of any prior or current insurance policy of specific facts or circumstances which might give rise to a Claim being made against any Insured for any proposed insurance hereunder? |
| EPL09 | Has the policyholder or any insured individual given written notice under the provisions of any prior or current insurance policy or specific facts or circumstances which might give rise to a claim being made against any insured for any proposed insurance hereunder? If yes, explain. |
| DO21 | Has the policy holder or organization or applicant in the past 36 months completed or agreed to or does it contemplate within the next 12 months any registration for a public offering or private placement of securities? |
| CYBR25 | Has the privacy policy been reviewed and approved by general counsel? |
| BOP43 | Has the property been the subject of any health or safety investigation or citation from any governmental authorities in the specified number of years? |
| CPR74 | Has the property ever been condemned or ordered uninhabitable by any authority? |
| DO03 | Has the proposed insured been involved in any litigation with respect to: employment practices (including EEOC actions), Directors And Officers, Errors And Omissions or anti-trust violations? |
| FIDUC10 | Has there been, or is there now pending, any claim(s) against any proposed insured arising out of any plan? |
| WORK98 | Has there been a change in majority ownership? |
| WORK99 | Has there been a change in operations? |
| WORK23 | Has there been a name change, consolidation, merger or ownership change during the mandated number of years? |
| FIDUC28 | Has there been any assessment of fees, fines or penalties under any voluntary compliance resolution program or similar voluntary settlement program administered by the IRS, DOL or other government authority against any plan? |
| INMRC03 | Has there been flooding at any location? |
| BAM06 | Has there been more than one Equipment Breakdown loss in the last 3 years? |
| FIDUC13 | Has there been or there now pending any inquiry, investigation or communication which could give rise to a claim under this policy? |
| WORK24 | Has there been previous workers compensation coverage in any other state? |
| WORK25 | Has there been previous workers compensation coverage in this state? |
| AGLIA41 | Has there ever been an incidence of escape of livestock? If yes, explain. |
| GENRL37 | Has the risk been inspected for the Building Class Effectiveness Grade? |
| EPL11 | Has the turnover percentage for employment been increasing over the last three years? |
| WIND09 | Has the year built been verified? |
| PRE05 | Has this product ever been recalled? |
| BOP25 | Has wiring been improved since construction? |
| FLOOD36 | Has work been carried out to the property to protect against flooding? |
| MP001 | Has your certification / license in any state ever been (voluntarily or otherwise) suspended, denied, revoked, restricted or limited in any way? |
| MP007 | Has your professional liability insurance ever been cancelled, suspended, non-renewed, declined or issued only on special terms? |
| RESTA12 | Have adequate smoke alarms been installed? |
| AGMOR08 | Have all animals received all appropriate inoculations within the last year? |
| PRLI04 | Have any aircraft products ever been subject to a manufacturers factory service bulletin or advisory? |
| PRLI05 | Have any aircraft products ever been subject to an airworthiness directive? |
| PRLI06 | Have any aircraft products ever been subject to an emergency airworthiness directive? |
| PRLI09 | Have any aircraft products ever been subject to a recall by a governmental agency? |
| PRLI07 | Have any aircraft products ever been subject to a recall by any applicant? |
| PRLI08 | Have any aircraft products ever been subject to a recall by any other firm? |
| CGL07 | Have any crimes occurred or been attempted on your premises within the last three years? |
| EO55 | Have any errors or omissions claims or incidents been made against the applicant or any of its past or present personnel or any predecessor company within the last specified number of years? |
| MP005 | Have any fee or professional relation complaints been registered against you with your professional association(s), hospital(s) or any state licensing authority? |
| CUMBR32 | Have any liability claims been made in the past 5 years, whether insured or not? |
| DO15 | Have any Loss Payments been Made on Behalf of the Proposed Policyholder or any Insured Individual under any Similar Policy? |
| EPL10 | Have any loss payments been made on behalf of the proposed policyholder or any insured individual under any similar policy? If yes, explain. |
| CYBR49 | Have any of the computer attacks resulted in unauthorized access to, or corruption or erasure of data? |
| AIRC24 | Have any of your pilots been cited or fined? |
| FIDUC24 | Have any plans experienced any event reportable to the Pension Benefit Guaranty Corporation (PBGC)? |
| CPR26 | Have any utilities been disconnected and/or account(s) unpaid in the specified period of time? |
| EO09 | Have applicant's contracts been reviewed by a qualified law firm in the applicant's field? |
| EPL02 | Have claims been made against any person(s) or entities proposed for this insurance (including Loss Payment and Defense Costs)? If yes, explain. |
| WORK69 | Have payrolls for officers, partners, LLC members, or spouse been included in determining the estimated annual premium? |
| FIDUC21 | Have the plans been reviewed to assure that there are no violations of prohibited transactions and party-in-interest rules? |
| DO12 | Have there been, or are there now any Pending Claim(s), against the Applicant or its Subsidiaries, Arising Out Of: (1) any Director, Officer, Employee or Entity Liability Matter; or (2) any Matter Claimed against any Person Proposed for Insurance in His/Her Capacity as a Director, Officer or Employee? |
| AGLIA43 | Have there been any claims for milk contamination? If yes, explain. |
| PRLI02 | Have there been any incidents in past which could result in a claim? |
| RESTA08 | Have there been any liquor board violations? |
| FIDUC17 | Have there been any merger of plans in the past specified number of years? |
| AGLIA29 | Have there been any pollution/environmental occurrences or complaints? |
| INMRC08 | Have you been involved with the application or installation of material that is directly in contact with EIFS, such as windows, doors, paint caulk or flasing materials? |
| WORK05 | Have you ever been cancelled? |
| MP006 | Have you ever been charged with or convicted of a criminal offense? |
| PILOT05 | Have you ever been convicted of driving a motor vehicle under the influence of alcohol or narcotics, or of reckless driving? |
| PILOT06 | Have you ever been convicted of or are you under indictment in a legal action involving drugs or narcotics? |
| MP004 | Have you ever been diagnosed with or professionally advised to seek treatment for alcohol / drug abuse or addiction, mental illness or chronic physical illness? |
| MP002 | Have you ever been insured by mutual assurance or medical assurance for professional liability? |
| PILOT03 | Have you ever had an aircraft accident or incident or been penalized for a FAR violation? |
| AGLIA33 | Have you ever had any complaints regarding overspray, waste run-off or similar damages? If yes then explain. |
| AVIA02 | Have you had any aviation losses? |
| INMRC47 | Have you had any EIFS related losses? |
| HOME81 | Have you had any property losses or any liability claims brought against you in the past specified number of years? |
| AIRC23 | Have you had any Workers Compensation claims? |
| GENRL57 | Have you inspected this property in the last mandated time period? |
| AGMOR12 | Have you lost any animals to death in the last three years? |
| WORK67 | Have you or any of your employees reported a workers compensation injury within the last 60 days? |
| WORK27 | Have you received any offers of voluntary coverage? (include multi-line or retrospective rating plan, if applicable) If yes, provide full details including plan terms in the remarks section. |
| CPR01 | Heating boiler on premises? |
| CUMBR13 | Hospital or first aid facility maintained? |
| CYBR43 | If "yes", attach copy of the assessment. |
| CYBR42 | If "yes", have all critical recommendations been complied with? |
| CYBR41 | If "yes", who conducted the assessment? |
| HOME17 | If a financial planner or consultant, do you have discretionary trading authority and/or access to customers data and/or funds? |
| HOME12 | If a fuel tank is on premises, has other insurance been obtained for the tank? |
| CGL03 | If alcohol served, is a charge made or a permit required? |
| HOME76 | If a mobile home, is it permanently anchored to the foundation? |
| PROP32 | If an apartment, are more than 10% of the rental units unoccupied? |
| AUPMA16 | If an auto used in business, is gross vehicle weight 10,000 pounds or more? |
| AUPMA15 | If an auto used in business is a van/pickup, is it used to deliver/transport goods? |
| AIRC13 | If an employee flies their own aircraft on company business, is the applicant listed as an additional insured on the employees' policy? |
| GENRL16 | If a swimming pool is present, is it fenced? |
| AUPMA03 | If a vehicle is a motorcycle, has the principal operator completed an approved motorcycle rider training program? |
| GENRL43 | If building is under construction, is the applicant the general contractor? |
| MHOME12 | If cable used, are loose ends firmly clamped and secure? |
| AGLIA65 | If cattle are present on premises, do you now or have you in the past supplemented cattle feed with bone meal, protein supplements or animal by-products? |
| AGLIA18 | If Dairy Farm, is there any processing of milk? |
| AGLIA19 | If Dairy Farm, is there any retail sales of milk products to public? |
| WORK68 | If eligible persons are excluded, is the appropriate exclusion form attached? |
| PROF004 | If funeral prepayment plans are offered, are funds properly audited, managed and distributed by full-time director? |
| AIRC17 | If insured, as a customer, is included as an additional insured on the charter primary policy, has a certificate of insurance been obtained? |
| AUDIT09 | If Insured uses contractors / subcontractors, are there any helpers? |
| HOME18 | If involved in real estate, do you manage property of others? |
| AGLIA11 | If livestock is kept, are all areas adequately fenced and are fences in a good state of repair? |
| AGLIA12 | If Livestock is kept not fenced is the premises in an open range area? |
| SFH05 | If Masonry, does tile flue lining extend from below the stovepipe entry point to the top of the chimney? |
| MHOME11 | If over the roof tie down are visible, are corner blocks of wood or metal used under strapping cable to prevent sharp bends? |
| HOME82 | If owner occupied, is the unit in which you reside on the residence premises rented or intended for rental at any time during the year? |
| CYBR99 | If stored offsite, are transportation logs maintained? |
| GENRL17 | If swimming pool is present, is there a diving board? |
| INMRC77 | If telephone inquiries are made is a log maintained showing date, time person spoken to plot # and map# referred to? |
| EPL23 | If the applicant is a federal contractor, does the applicant have an Affirmative Action Plan with the Office of Federal Contract Compliance Programs (OFCCP)? |
| CYBR83 | If the Applicant is in the healthcare industry, does the Applicant host, operate, or manage a Healthcare Information Exchange on which other organizations may store personal health information? |
| CPR85 | If the building is being moved, has it been affixed to its permanent foundation? |
| VACB02 | If the building is sprinklered, is the sprinkler system turned off? |
| EDP25 | If the Computer Room has a raised pedastal floor, is the floor construction type combustible? |
| DFIRE07 | If the property is a seasonal or unoccupied dwelling, is the water turned off and plumbing effectively drained when not in use with temperature maintained at a minimum of 50 degrees? |
| PROP02 | If the property is located in a rural fire protection district or in an area protected by a rural fire department, have you paid the appropriate dues or subscription payments? |
| EPL14 | If there are Independent Contractors, are indemnification agreements in effect? |
| EPL13 | If there are Leased Employees, are indemnification agreements in effect? |
| CRIM11 | If there is an internal audit by an internal audit department under the control of an employee who is a public accountant or equivalent, are the reports rendered directly to the proprietor,partners if a partnership of board of directors if a corporation? |
| CPR73 | If there is unrepaired damage, has a contract been signed to complete repairs? |
| CYBR47 | If there were targeted attacks, were the reasons disclosed for these targeted attacks? |
| MHOME13 | If turnbuckles are used, are they forged steel? |
| MHOME15 | If turnbuckles end with open hook, are they closed with twine or wire? |
| PROP11 | If woodburner/space heater is the primary heat type, is heat maintained in dwelling 24 hours a day to prevent freezing pipes? |
| PROP10 | If woodburner/ space heater is used, is it used as a main heat source? |
| PROP12 | If woodburner/ space heater is used, is it used as supplement heat? |
| INMRC46 | If you are a general contractor or subcontractor using subcontractors, have you managed projects or operations using EIFS or EIFS related products as the exterior finish? |
| HANG02 | If you require hangar tenants to carry insurance, does their insurance policy name the owner as an additional insured? |
| CYBR39 | If you responded "yes" to any of the above questions 1 through 5: does the agreement require a level of security commensurate with the applicant's information systems security policy? |
| BOP38 | In addition to your primary nature of business, are you also involved in the mixing of others products? |
| BOP41 | In addition to your primary nature of business are you also involved in the manufacture, relabeling or repackaging of others products? |
| AGLIA01 | Independent contractors hired to perform any farming operations? |
| EO49 | In subcontractor contracts do the subcontractors agree to indemnify the applicant and/or the applicant's clients for damages caused by the subcontractor's negligence? |
| EDP01 | In the event of a major or total loss could you return to operation within one week? |
| FIDUC05 | In the past two years, has there been any amendments to any plan, or has any amendment been contemplated, that has resulted in or may result in any change reduction of benefits, including but not limited to an increase in participants share of costs? |
| AUTOB18 | Is / Are garaging Location(s) within City Limits? |
| CGL01 | Is/has applicant been active in joint ventures? |
| INMRC01 | Is "cycle billing" accounting system used? |
| EDP16 | Is access to the room restricted? |
| RESTA15 | Is a certificate of insurance is required/ maintained for valet parking by a third party? |
| WORK78 | Is a certificate of insurance required? |
| GARAG14 | Is a charge made for parking? (Give locations, # attendants) |
| CRIM34 | Is a complete physical inventory made? (if yes, how often) |
| HOTEL30 | Is a continental breakfast served at the establishment? |
| CRIM44 | Is actual receipt of merchandise verified before payment is made? |
| LIQ022 | Is a dance permit required? |
| PROP03 | Is a deposit enclosed? |
| CPR86 | Is a FAIR Plan vacancy permit endorsement requested? |
| GENRL47 | Is a formal safety program in existence? If yes, explain. |
| CRIM27 | Is a formal training program established and followed? |
| CGL02 | Is alcohol served on premises or at functions off site? |
| CGL39 | Is a legal liability coverage form attached to the risk corresponding property submission? |
| BAM02 | Is all equipement accessible with respect to repair or replacement? |
| BOP05 | Is all equipment inspected annually and well maintained? |
| GLAS007 | Is all exterior glass above second floor? |
| GLAS008 | Is all exterior glass insured? |
| GLAS015 | Is all interior glass above second floor insured? |
| BAM05 | Is all machinery and equipment in good condition? |
| MHOME09 | Is all strapping used in tie down galvanized? |
| MHOME10 | Is all strapping used in tie downs without perforations? |
| CYBR90 | Is all valuable/sensitive data backed-up by the Applicant on a daily basis? |
| BOP12 | Is Aluminum wiring used? |
| RESTA28 | Is ammonia used as a refrigerant? |
| AUPMA14 | Is an auto used in business? |
| AUPMA05 | Is an auto used to transport (to or from work or school) persons employed by you? |
| CRIM45 | Is a numbered purchase order system implemented and followed? |
| LLOYDS03 | Is any % of the insured’s turnover from the US? |
| AGMOR03 | Is any animal leased to others? |
| AGMOR13 | Is any animal on regular medication or supplements? |
| CYBR10 | Is any associated trademark or advertising included? |
| AUPMA07 | Is any auto(s) listed on the application considered to be an antique auto and you wish to purchase coverage parts 7, 8 or 9? |
| AUPMA06 | Is any auto(s) to be insured titled with a salvage title issued by the MA Registry of Motor Vehicles? |
| AUPMA10 | Is any auto equipped with citizens band radio? |
| AUPMA13 | Is any auto equipped with scanning receiver? |
| AUPMA12 | Is any auto equipped with telephone? |
| AUPMA11 | Is any auto equipped with two-way mobile radio? |
| AUPMA04 | Is any auto used to transport (to or from work or school) fellow employees, passengers or students for a fee? |
| FIDUC18 | Is any conversion to a cash balance plan being considered? |
| GLAS009 | Is any glass structural? |
| AGMOR15 | Is any horse not healthy or sound the use intended? |
| EPL54 | Is any insured presently subject to any judicial or administrative order, decree, judgment or conciliation agreement that is employment-related? If yes, explain. |
| AGLIA16 | Is any land held for real estate development or speculation? |
| AGMOR22 | Is any mare in foal? |
| CPR91 | Is any other insurance covering this property presently in force? |
| CPR25 | Is any portion of the building expected to be unoccupied or vacant during the policy period? |
| PROP31 | Is any portion of the building vacant, unoccupied or seasonal? |
| AGPP02 | Is any property kept on a location(s) other than an insured location? |
| INMRP05 | Is any property used professionally/commercially? |
| AGLIA50 | Is any safety program in existence? |
| LLOYDS04 | Is any value of turnover from the US? |
| CPR75 | Is applicant a bank, lender or financial? |
| PROF002 | Is applicant a member of a local or national organization? |
| GENRL53 | Is applicant engaged in any other type of business? |
| GARAG16 | Is applicant involved in any "NON GARAGE" operations? |
| INMRC73 | Is applicant operating equipment not listed here? |
| CYBR27 | Is applicant pci compliant? |
| EO12 | Is applicant presently aware of any facts or circumstances which may give rise to a claim under the subject of insurance? |
| WORK18 | Is applicant related through common management or ownership to any entity not listed here, whether coverage is required or not? If yes, give detailed explanation. |
| CUMBR12 | Is applicant self-insured in any state? |
| WORK59 | Is applicant under exclusive contract with any postal service? |
| WORK58 | Is applicant under exclusive contract with any retail store(s)? |
| BOP06 | Is a property manager employed? |
| CRIM36 | Is a requisition/shipping order required for removal of goods from storeroom/warehouse? |
| CYBR115 | Is a review of all content prior to posting on the Insured’s Internet Site or on social media web pages performed by a qualified attorney? |
| SFH06 | Is ash container placed on a non-flammable surface? |
| CYBR141 | Is at least one complete back-up file generation stored and secured off-site separate from the Applicant’s main operations in a restricted area? |
| CRIM08 | Is audit made in accordance with generally accepted auditing standards and so certified? If no, explain scope of audit. |
| RESTA30 | Is automatic shutoff tied to a sensing system? |
| HOME45 | Is a water supply accessible for fire equipment? |
| INMRP07 | Is bank vault in use? |
| BOP30 | Is basement finished? |
| CERT019 | Is blanket contractual liability located in the insured contract definition removed or restricted? |
| CUMBR09 | Is bridge, dam or marine work performed? |
| FLOOD22 | Is building a business property? |
| FLOOD23 | Is building a rental property? |
| FLOOD26 | Is building a severe repetitive loss property? |
| HOME06 | Is building retrofitted for earthquake? |
| BOP34 | Is building under construction? |
| GENRL27 | Is building undergoing renovation or reconstruction? |
| AGLIA54 | Is buyer allowed to test ride? |
| AGLIA55 | Is buyer allowed to test ride in an arena? |
| AGLIA56 | Is buyer allowed to test ride in an open field? |
| HOME37 | Is chimney(s) in good condition? |
| SFH07 | Is chimney rated for a continuous flue gas temperature of 650 C? |
| WORK87 | Is client contractually affiliated with any other labor contractor? |
| CYBR26 | Is client sensitive information on mobile devices encrypted while in transit and at rest? |
| FLOOD30 | Is condo unit a townhouse/rowhouse? |
| CRIM04 | Is countersignature of checks required? If not, who signs controls? |
| AUTOB13 | Is coverage provided for driving in Canada? |
| AUTOB14 | Is coverage provided for driving in Mexico? |
| AUTOB15 | Is coverage provided for driving in the US? |
| CUMBR36 | Is coverage provided under standard Workers Compensation/Employers Liability forms? |
| WORK56 | Is coverage requested for a sports team? |
| TRKRS03 | Is Coverage Required for Travel in Canada or Mexico? |
| WORK76 | Is coverage required in states other than the controlling state? |
| CRIM30 | Is criminal history checked? |
| BOP07 | Is developer or contractor a board member? |
| RESTA13 | Is documentation kept on each incident of shutting off patrons? |
| CERT008 | Is domestic terrorism excluded? |
| CRIM26 | Is drug testing conducted? |
| INMRC31 | Is dust collection system present? |
| PROP15 | Is dwelling fire coverage requested? |
| DFIRE01 | Is dwelling located on hillside or slope? |
| GENRL65 | Is each Named Insured a resident of the controlling state? |
| CERT022 | Is earth movement, excavation or explosion / collapse / underground property damage excluded or restricted (GL Policy)? |
| HOME32 | Is earthquake coverage provided on the policy? |
| CRIM25 | Is education and training verified? |
| CRIM24 | Is employer history checked? |
| AGLIA61 | Is entire premises occupied year round? |
| AGPP01 | Is equipment well maintained? |
| FIDUC14 | Is ERISA fidelity bond coverage in force with another insurer? If yes, send name and address of insurance co. writing the bond, general counsel, and the law firm for benefits and ERISA litigation matters. Also provide bond limit and premium. |
| AGLIA73 | Is farming the primary source of the insured's income? |
| HOME33 | Is flood coverage provided on the policy? |
| HOTEL27 | Is food prepared? |
| HOTEL33 | Is food service available at the establishment? |
| HOME38 | Is garage in good condition? |
| RESTA14 | Is garage keepers legal liability required and maintained for valet parking on the property? |
| GLAS006 | Is glass protected by wire mesh or U.L.-approved burglary resistant glazing material? |
| CUMBR08 | Is hired and non/owned coverage provided? |
| PROP16 | Is homeowners coverage requested? |
| FLOOD02 | Is home properly anchored? |
| INMRC71 | Is hot tar used? If so, what size are the kettles and is tar heated before traveling to jobsite or upon arrival. |
| CPR02 | Is insurance for the heating boiler placed elsewhere? |
| FLOOD01 | Is insurance required for disaster assistance? |
| AIRC16 | Is insured, as a customer, included as an additional insured on the charter primary policy? |
| FLOOD24 | Is insured a tenant? |
| FLOOD05 | Is insured property owned by a state government? |
| CRIM35 | Is inventory made by persons who do not have custody control? |
| PRE04 | Is it a component or an ingredient of another product? |
| HOME50 | Is it a volunteer fire department? |
| CYBR11 | Is it made clear that the content does not belong to the applicant's business? |
| WORK84 | Is labor contractor duly registered with the State Dept of Labor and Workforce Development? |
| SFH08 | Is metal container equipped with a metal lid? |
| MHOME08 | Is mobile home equipped with factory installed "under the skin" tie down straping? |
| MHOME17 | Is mobile home properly blocked? |
| CYBR52 | Is payment card holder information maintained or stored by the enterprise? If Yes, what is the maximum expected annual number of records of such information? |
| CRIM33 | Is payroll system audited annually? |
| CYBR74 | Is personally identifiable information maintained or stored by the enterprise? If Yes, what is the maximum expected annual number of records of such information? |
| CRIM49 | Is physical access to computer room and equipment restricted to authorized personnel? |
| FIN07 | Is policy financed through other financing programs? |
| EPL21 | Is policy-holder requesting Third Party Claim Coverage? |
| PROP14 | Is property a mobile home? |
| PROP04 | Is Property at Least 50% Occupied? |
| CPR76 | Is property being used for any purpose in violation of federal, state or local law? |
| GENRL58 | Is property currently being purchased, or was it purchased in the past mandated time period? |
| CERT024 | Is property damage to work performed by subcontractors (exception to the damage to your work exclusion in the ISO CGL policy) excluded or restricted? |
| GENRL54 | Is property situated on more than 1 acre? |
| GENRL30 | Is property situated on more than five acres? |
| CPR19 | Is property vacant or unoccupied (fully or partially) and / or under renovations? |
| HOME09 | Is property within 300 feet of commercial or non-residential property? |
| FIDL08 | Is reconciliation of bank statements and client accounts carried out by persons not authorized to deposit/withdraw, issue funds transfers instructions or dispatch accounts to clients? |
| INMRP08 | Is resident vault in use? |
| CRIM43 | Is responsibility for checking merchandise received/controlled by more than one individual? |
| VACB04 | Is scaffolding owned, rented or erected by the applicant? |
| HOTEL31 | Is self service available at the establishment? |
| CYBR73 | Is sensitive personal health information maintained or stored by the enterprise? If Yes, what is the maximum expected annual number of records of such information? |
| INMRC42 | Is shoring work done in accordance with standards? |
| FLOOD25 | Is tenant requesting building coverage? |
| FIN03 | Is the agency shown the issuing agent? |
| WORK51 | Is the agent charging a service fee on the policy? |
| AIRC02 | Is the aircraft equipped with a traffic and/or terrain collision avoidance system? |
| AIRP07 | Is the airport fenced? |
| AVIA06 | Is the airport Fenced? |
| AIRP09 | Is the airport manager an employee of the insured? |
| CYBR70 | Is the Applicant's network segmented into subnetworks (e.g. critical servers segmented from the user, point of sale, printer, wireless, terminal, and/or partners’ networks)? If Yes, please explain. |
| PROF016 | Is the applicant a contract printer for publishers? |
| HOWC001 | Is the applicant a co-owner of the dwelling, as well as an occupant of an apartment in the dwelling? |
| EPL22 | Is the applicant a federal contractor? |
| HOWC009 | Is the applicant an owner-occupant? |
| HOWC008 | Is the applicant an owner of any additional dwelling located in this state that is to be insured under this policy? |
| HOWC010 | Is the applicant an owner of any additional location in this state? |
| HOWC005 | Is the applicant an owner of the dwelling who occupies an apartment in the dwelling? |
| MTRTK04 | Is the applicant an owner operator? |
| HOME62 | Is the applicant applying for immediate coverage? |
| HOME27 | Is the applicant a subsidiary or another entity or does the applicant have subsidiaries? |
| HOWC007 | Is the applicant a tenant of an apartment in a dwelling that is also occupied by an owner? |
| WORK66 | Is the applicant exempt from federal income tax pursuant to s. 501 c (3) of the Internal Revenue Code? |
| CYBR78 | Is the Applicant in compliance with its privacy policy? |
| DO10 | Is the applicant or it subsidiaries involved in any joint ventures or partnerships? |
| PROP25 | Is the applicant other than an individual or a sole proprietorship? |
| EPL84 | Is the applicant requesting coverage for company and directors & officers? |
| EPL87 | Is the applicant requesting coverage for independent contractors? |
| EPL88 | Is the applicant requesting coverage for non-profit outside positions? |
| EPL64 | Is the Applicant required to file an affirmative action plan with the Office of Federal Contract Compliance Programs (OFCCP)? If yes, submit a copy of that plan along with this application, and explain. |
| CPR40 | Is the application for new construction? |
| WORK47 | Is the application for your own employees not subject to a leasing agreement? |
| FLOOD10 | Is the area below the elevated floor enclosed? |
| FLOOD12 | Is the area below the lowest elevated floor finished (20 or more linear feet of finished walls)? |
| CPR31 | Is the Atlantic Ocean within 1 mile? |
| CPR30 | Is the Atlantic Ocean within 300 ft? |
| CPR32 | Is the Atlantic Ocean within 5 miles? |
| EDP28 | Is the below floor protection halon/CO2? |
| EDP29 | Is the below floor protection other? |
| EDP27 | Is the below floor protection smoke detector? |
| BOATP01 | Is the boat chartered to others? |
| BOATP10 | Is the boat used as a primary residence? |
| BOATP02 | Is the boat used commercially or for business purposes? |
| BOATP03 | Is the boat used for racing? |
| BOATP04 | Is the boat used for water-skiing? |
| CPR59 | Is the building accessible by boat only? |
| CPR62 | Is the building awaiting demolition? |
| CPR84 | Is the building being moved onto or away from this location? |
| CPR78 | Is the building being remodeled? |
| FLOOD07 | Is the building elevated (includes crawl space buildings)? |
| CPR15 | Is the building equipped with a restaurant? |
| CPR37 | Is the building escrowed? |
| FLOOD13 | Is the building flood proofed? |
| CPR80 | Is the building for sale or rent? |
| WIND10 | Is the building in a continuing care retirement community? |
| CPR83 | Is the building in good condition? |
| FLOOD15 | Is the building located in a special flood hazard area on a flood boundary map, or on a flood insurance rate map zone A, AE, A1-30, AO, AH, A99, V, VE, V1-30? |
| CPR77 | Is the building open to trespass? |
| GLAS010 | Is the building or area under construction? |
| CPR58 | Is the building over or partly over water? |
| FLOOD03 | Is the building substantially improved? |
| VACB03 | Is the building to be demolished or remodeled? |
| PROP22 | Is the building unoccupied (containing no contents, but not used as a dwelling place by human beings or its customary operations or activities are suspended)? |
| PROP21 | Is the building vacant (containing no contents usual to occupancy)? |
| BOP50 | Is the burglar alarm U.L. approved? |
| WORK03 | Is the business currently in bankruptcy? |
| HOME13 | Is the business run from a distinctly separate area in the residence from household activities? |
| SFH12 | Is the chimney "covered with" or "hidden behind" a combustible wall? |
| SFH30 | Is the chimney built from the ground up? |
| EDP22 | Is the Computer Room protected by CO2? |
| EDP20 | Is the Computer Room protected by Dry Sprinkler System? |
| EDP21 | Is the Computer Room protected by Halon? |
| EDP23 | Is the Computer Room protected by Other? |
| EDP19 | Is the Computer Room protected by Wet Sprinkler? |
| RESTA24 | Is the contingency plan in the event of loss of refrigeration an alternative power source? |
| RESTA25 | Is the contingency plan in the event of loss of refrigeration a temporary storage location? |
| RESTA26 | Is the contingency plan in the event of loss of refrigeration other than the items listed? |
| HOME77 | Is the coverage for personal liability coverage only? |
| CYBR71 | Is the Cyber Liability coverage being written as a standalone policy? If No, please identify whether it is an "Add-on" or is "Included" within another insurance policy. |
| EDP15 | Is the data processing equipment located in a specifically designated room? |
| CPR34 | Is the Delaware Bay within 1 mile? |
| CPR33 | Is the Delaware Bay within 300 ft? |
| CPR35 | Is the Delaware Bay within 5 miles? |
| SFH10 | Is the device free from large cracks and/or broken parts? |
| DRIVE13 | Is the driver's sight corrected by glasses? |
| DRIVE02 | Is the driver colorblind? |
| DRIVE19 | Is the driver taking Medication for Neurological Mental or Emotional Problems? |
| DRIVE20 | Is the driver taking Medication for Neuromuscular Disease? |
| DRIVE21 | Is the driver under physical care? |
| GENRL28 | Is the dwelling/mobile home for sale? |
| EQ002 | Is the dwelling secured to the foundation? |
| FIN08 | Is the earning of premium affected by claims? |
| CPR53 | Is the electrical in poor condition? |
| CPR65 | Is the electrical service at least 60 amps? |
| EPL106 | Is the employee handbook uniform for all locations and subsidiaries? |
| PROP17 | Is the entire building vacant or unoccupied? |
| EDP17 | Is the equipment controlled by a master shutdown switch? |
| EDP06 | Is the equipment shipped by common carrier? |
| EDP07 | Is the equipment shipped by company vehicle? |
| CERT025 | Is the excess / umbrella policy primary and non-contributory for additional insureds? |
| CPR56 | Is the exterior in poor condition? |
| HOME49 | Is the fire station over eight miles away from the structure? |
| HOME51 | Is the general care and cleanliness of the property good? |
| CERT011 | Is the General Liability policy form ISO or ISO modified? |
| CPR52 | Is the heating unit in poor condition? |
| SFH33 | Is the heating unit thermostatically controlled? |
| HOME83 | Is the home ever unoccupied for more than the specified number of consecutive days? |
| EQ005 | Is the home reinforced by an earthquake resistant bracing system certified by the California Department of Housing and Community Development? |
| AGLIA78 | Is the information provided for all locations? |
| CYBR34 | Is the infrastructure of the applicant's web site hosted by a third party, or Is the content of the applicant's website managed bya third party? (If "yes", attach copy of third party agreement) (193 characters) |
| CERT020 | Is the insured contract exception to the employers liability exclusion removed or modified (GL Policy)? |
| CERT009 | Is the insurer an admitted/authorized? |
| CERT010 | Is the insurer excess line or free trade zone? |
| CPR55 | Is the interior in poor condition? |
| PROP30 | Is the lender other than a federally or state chartered lending institution? |
| WORK60 | Is the loss sensitive rating program (LSRP) contingency deposit being paid in full at this time? |
| EDP08 | Is the media/data shipped by common carrier? |
| EDP09 | Is the media/data shipped by company vehicle? |
| FLOOD32 | Is the most recent improvement the construction of the building? |
| HOME31 | Is the named insured the owner of the property? If not, provide the owner name and address information in the Additional Interest Section of the form. |
| AUPWI14 | Is the non-owned vehicle operated by the applicant a commercial vehicle? |
| AUPWI13 | Is the non-owned vehicle operated by the applicant a private passenger vehicle? |
| AUPWI15 | Is the non-owned vehicle operated by the applicant a taxi or bus? |
| AUPWI16 | Is the non-owned vehicle operated by the applicant other than private passenger, commercial, taxi or bus? |
| AUPWI17 | Is the non-owned vehicle operated in the applicant's occupation or business? |
| AUPWI18 | Is the non-owned vehicle owned by a member of the household? |
| WIND03 | Is the opening protection Class A? |
| WIND04 | Is the opening protection Class B? |
| WIND05 | Is the opening protection Class C? |
| HOWC002 | Is the other apartment occupied by the other co-owner? |
| HOTEL02 | Is the parking lit in good condition and well lighted? |
| WORKA1 | Is the party who is requesting the waiver a landlord? |
| DRIVE11 | Is the peripheral vision restricted? |
| HOME53 | Is the physical condition of the building good? |
| SFH23 | Is the pipe assembly crimped down to control creosote? |
| SFH28 | Is the pipe assembly no more than two bends? |
| SFH24 | Is the pipe assembly secured with sheet metal screws? |
| CPR54 | Is the plumbing in poor condition? |
| FIN01 | Is the policy in force? |
| HOWC006 | Is the policy to include premises liability coverage for the entire property? |
| INJW004 | Is the premises shared with others? |
| GENRL42 | Is the premium financed? |
| FIN02 | Is the premium fully earned? |
| CPR23 | Is the producer/agency incorporated? |
| HOME44 | Is the property accessible for fire equipment? |
| CPR12 | Is the property currently cited for building, fire safety, health or construction code violations? |
| DFIRE03 | Is the property currently under construction or rehabilitation? |
| HOME34 | Is the property in foreclosure? |
| PROP23 | Is the property listed for sale by a licensed real estate agent? |
| FLOOD34 | Is the property located inland of the intracoastal canal? |
| CPR07 | Is the property occupied as an agricultural products storage or processing operation? |
| CPR05 | Is the property occupied as an auto body repair shop with spray painting? |
| CPR06 | Is the property occupied as a restaurant or other commercial cooking operation? |
| PROP24 | Is the property part of an estate in the process of settlement? |
| CPR79 | Is the property protected by a construction fence? |
| FLOOD35 | Is the property protected by an approved seawall? |
| CPR09 | Is the property situated on a farm? |
| EPL01 | Is the prospective insured requesting duty to defend coverage? |
| BOP37 | Is there a basement present? |
| SFH18 | Is there a carbon monoxide (CO) dectector in the dwelling? |
| FIDL09 | Is there a Certified Account letter to management relating to internal control weaknesses? |
| WIND08 | Is there a CIT-W04 21 Windstorm Protective Device? |
| LIQ014 | Is there a cover charge? |
| SFH19 | Is there a fire alarm system in the building? |
| SFH15 | Is there a fire extinguisher in operating condition in the dwelling? |
| CPR16 | Is there a fire hydrant within 1,000 feet of the structure? |
| HOME46 | Is there a fire hydrant within 500 feet of the structure? |
| AVIA07 | Is there a Fire Station on premises? |
| CPR24 | Is there a fire station within 5 miles? |
| HOME48 | Is there a fire station within eight miles of the structure? |
| HOME47 | Is there a fire station within five miles of the structure? |
| CGL08 | Is there a formal, written safety and security policy in effect? |
| CYBR18 | Is there a formal process in place for general counsel approval of web site content, including banner advertising? |
| CPR28 | Is there a government order to vacate or destroy the building or has the building been classified as uninhabitable or structurally unsafe? |
| SFH17 | Is there a heat sensor in the dwelling? |
| BOP19 | Is there a hood and duct maintenance contract schedule? |
| HOME56 | Is there a hot tub or swimming pool on the premises? |
| CGL05 | Is there a labor interchange with any other business or subsidiaries? |
| LIQ013 | Is there a ladies night? |
| CRIM01 | Is there a licensed securities firm responsible for investing of funds under plan(s)? |
| GENRL51 | Is there a lifeguard on the swimming pool premises? |
| AIRP10 | Is there a manager on premises during operation? |
| SFH26 | Is there a minimum 1/4 inch rise per linear foot of horizontal run? |
| PRE03 | Is there an active crisis management plan? |
| PRE01 | Is there an active quality plan? |
| PRE02 | Is there an active recall plan? |
| AIRP08 | Is there an airport manager? |
| AGLIA10 | Is there an airstrip on the premises? |
| AVIA08 | Is there an Air Traffic Control Tower? |
| HOME25 | Is there an approved carbon monoxide alarm in operating condition within the mandated number of feet of every room used for sleeping purposes? |
| HOTEL10 | Is there an emergency evacuation plan in place? |
| WORK08 | Is there an Employee Health Plan provided? |
| CRIM47 | Is there an employee or department whose sole duty is security? |
| CRIM10 | Is there an internal audit by an internal audit department under the control of an employee who is a public accountant or equivalent? If "yes", [see next entry]. |
| DO32 | Is there an Outside Auditor? |
| AGLIA69 | Is there any ATV or dirt bike exposure? |
| HOME57 | Is there any brush fire hazard? |
| CPR63 | Is there any existing damage or damage in progress related to mine subsidence? |
| AUIN003 | Is there any fogged, cracked or broken glass? |
| CPR57 | Is there any hazardous waste? |
| FIDUC12 | Is there any known violation(s) of ERISA or any similar common or statutory law of the US, Canada, or any state or other jurisdiction anywhere in the world to which a plan is subject? |
| BOP59 | Is there any office occupancy? |
| HOME72 | Is there any other building fire insurance currently on this property or is an application for such insurance being made? |
| PROP33 | Is there any other insurance in force or to be secured on this property? |
| AGMOR05 | Is there any other insurance on any animal included in this application. |
| AGLIA32 | Is there any pollution liability coverage currently in effect? |
| AGLIA70 | Is there any snowmobile exposure? |
| HOME61 | Is there any unpaid, uncontested premium due? |
| WORK17 | Is there any unpaid workers compensation premium due or in dispute from you or any commonly managed or owned enterprise? If yes, explain including entity name(s) and policy number(s). |
| WORK52 | Is there any unpaid Workers Compensation premium in dispute from you or any commonly managed enterprises? |
| AIRC11 | Is there any unrepaired damage to the aircraft? |
| BOP23 | Is there any volunteer or donated labor? |
| AGLIA71 | Is there any watercraft exposure? |
| GENRL19 | Is there any watercraft or snowmobile exposure? |
| SFH21 | Is there a one inch gap between the shield and the wall? |
| HOME86 | Is there a paid full-time caretaker or regular monitoring? |
| BOP08 | Is there a playground on premises? |
| LIQ026 | Is there a recreation area or other activities that would include patron participation? |
| RESTA20 | Is there a Refrigerator / Freezer, Walk-in or otherwise on site for cold storage? |
| BOP32 | Is there a roof tank? |
| BOP49 | Is there a sensor motion detector on the premises? |
| EDP18 | Is there a separate air conditioning system designed to specifically protect the Electronic Data Processing (EDP) equipment? |
| SFH16 | Is there a smoke detector in the dwelling? |
| FLOOD11 | Is there a solid perimeter with openings according to code, such as vents (garage doors are not permanent openings)? |
| LIQ023 | Is there a stage? |
| CGL34 | Is there a standpipe on each floor? |
| GENRL15 | Is there a swimming pool on premises? |
| CERT007 | Is there a terrorism specific exclusion? |
| RESTA17 | Is there a time guarantee associated with deliveries? |
| GENRL31 | Is there a trampoline on the premises? |
| BOP17 | Is there a U.L. Approved Automatic extinguishing system under semi-annual contract? |
| INMRC09 | Is there a vehicle maintenance program in operation? |
| FLOOD09 | Is there a washer, dryer, or food freezer? |
| WORK85 | Is there a written contract between the labor contractor and the client? |
| CRIM37 | Is there a written policy regarding EFTs? |
| RESTA22 | Is there a written service / maintenance contract for all refrigeration / cooling equipment? |
| AGLIA63 | Is there a year-round water supply usable for fire protection? |
| EDP26 | Is there below floor protection? |
| CYBR17 | Is there centralized control over web site(s) development? |
| FLOOD21 | Is there coverage for a condo unit? |
| AUPWI01 | Is there damaged glass on the vehicle? |
| CGL36 | Is there emergency lighting on premises? |
| CGL37 | Is there emergency power on premises? |
| FLOOD06 | Is there equipment (furnace, air conditioner, heat pump, hot water heater, etc.) in the basement or attached garage? |
| GENRL50 | Is there limited access to the swimming pool? |
| AGMOR11 | Is there now any contagious or infectious disease on any premises, or has there been during the last twelve (12) months? |
| WIND02 | Is there opening protection? |
| SFH20 | Is there protective material on the walls? |
| SFH22 | Is there protective material under the unit? |
| DFIRE05 | Is the requested amount of insurance on the building equal to at least 80% of the replacement cost? |
| WIND01 | Is there secondary water resistance? |
| HOME24 | Is the residence in a gated community? |
| LIQ024 | Is there special equipment? |
| PROP34 | Is there unrepaired damage or have items been stripped from building? |
| EQ001 | Is there unrepaired prior earthquake damage to the dwelling? |
| LIQ011 | Is there video surveillance on premises during operating hours? |
| CPR61 | Is the risk(s) insured by an association of property owners? |
| SFH11 | Is the stove vented into the same chimney flue (double vented) with a heating device using a different fuel? |
| PROP08 | Is the structure equipped with built in appliances? |
| CPR68 | Is the structure fully enclosed with no open sheds attached? |
| HOTEL05 | Is the structure in compliance with (National Fire Protection Association) NFPA 13 and NFPA 101? |
| PROP09 | Is the structure is equipped with additional features? |
| GENRL49 | Is the swimming pool above ground? |
| CERT002 | Is the Truckers Uniform Intermodal Interchange Endorsement (Form UIIE-1 or CA 23-17 equivalent) part of the auto policy(ies)? |
| LIQ028 | Is the type of clientele area residents? |
| LIQ030 | Is the type of clientele area workers? |
| LIQ031 | Is the type of clientele college students? |
| LIQ032 | Is the type of clientele is other than those listed? |
| LIQ029 | Is the type of clientele tourists? |
| FLOOD33 | Is the type of condo ownership the entire building? |
| CUMBR28 | Is the underlying commercial auto liability coverage written on as ISO BAP symbol 1 or an equivalent basis? |
| WIND07 | Is the unit above the ground floor of the building? |
| HOME71 | Is the unit in which you reside on the residence premises rented or intended for rental at any time during the year? |
| CERT006 | Is the vehicle or equipment financed? |
| BOATC08 | Is the vessel is equipped with a tender? |
| EQ004 | Is the water heater secured to the building frame? |
| HOME54 | Is the yard cluttered? |
| WORK73 | Is this a legal liability company that is manager managed? |
| WORK72 | Is this a legal liability company that is member managed? |
| FIDUC01 | Is this a multi-employer or multiple employer plan? |
| BOP36 | Is this a multiple occupancy building? |
| HOME78 | Is this an endorsement for coverage adding personal liability coverage to a dwelling fire policy? |
| WORK38 | Is this an estimated exposure? |
| CPR17 | Is this a seasonal residence? |
| CPR18 | Is this a secondary residence? |
| WIND15 | Is this a title transfer? |
| AUTOP08 | Is this brokered business to the agent? |
| GENRL56 | Is this business new to the agency? |
| GENRL34 | Is this company a subsidiary of another entity? |
| GARAG18 | Is this garage or dealer an official state vehicle inspection station? |
| CPR87 | Is this new construction from ground up? |
| WORKA2 | Is this new payroll not currently accounted for on the policy and should be added with this waiver? |
| WORK41 | Is this policy a Managed Care Organization (MCO) policy? |
| WORK36 | Is this policy a multi-state policy? |
| WORK37 | Is this policy an interstate rated policy? |
| WORK39 | Is this policy a retrospective rated policy? |
| WORK35 | Is this policy a three year fixed rate policy? |
| FIN06 | Is this policy subject to audits? |
| PROP01 | Is this property located in a rural fire protection district or in an area protected by a rural fire department? |
| BOP31 | Is this the primary premise? |
| GARAG04 | Is tire recapping or retreading performed? |
| WORK79 | Is U.S.L.&H. required? |
| CUMBR29 | Is Uninsured/Underinsured Motorist coverage provided by the underlying commercial auto policy? |
| AUPFL03 | Is Uninsured Motorist coverage desired for other than specifically insured or identified motor vehicles(s) registered or principally garaged in Florida? |
| PROP19 | Is vacant or unoccupied area above ground level (2nd floor and above) accessible from the outside? |
| PROP18 | Is vacant or unoccupied area at or below ground level (1st floor/bsmt ) accessible from the outside? |
| CPR29 | Is water, sewage, electricity or heat out of service? |
| EDP03 | Is your equipment manufacturer in a position to replace your equipment promptly? |
| EDP04 | Is your equipment under manufacturer's warranty? |
| EO27 | Is your sales staff specifically instructed not to exaggerate the capabilities of your products or services? |
| GENRL67 | I verify this risk does not violate any of the eligiblity criteria listed below. |
| HOFP006 | Liability coverage requested? |
| CGL25 | Machinery or equipment loaned or rented to others? |
| GENRL02 | Not For Profit Organization? |
| FIDUC07 | Now, or in the last year, has there been consideration of any merger, acquisition, restructuring or consolidation of or by the sponsor org. or any subsidiary that has or may result in plan participants moving to another plan, co. or subsidiary? |
| OT | Other |
| AUPWI09 | Other person involved in accident was convicted, applicant or operator was not convicted? |
| HOME15 | Other than computer systems or office equipment, do you install or service any products off premises? |
| AUPWI11 | Other type of accident - non chargeable under provisions of the plan? |
| AUTOB11 | Over 50% of employees use their automobiles in business? |
| CRIM38 | Prior to funds transfer, does financial institution verify authenticity with another employee? |
| CUMBR19 | Product liability loss in past 3 years (specify) |
| CGL18 | Products of others sold or repackaged under applicant label? |
| CGL17 | Products recalled, discontinued, changed? |
| CGL16 | Products related to aircraft/space industry? |
| CGL19 | Products under label of others? |
| CONTR02 | Property used underground? |
| CGL28 | Recreation facilities provided? |
| GENRL32 | Renters and Condos Only: Is the building entrance locked? |
| HOME07 | Renters and Condos Only: Is there a manager on the premises? |
| HOME08 | Renters and Condos Only: Is there a security attendant? |
| CGL14 | Research and development conducted or new products planned? |
| CUMBR01 | Services of an Advertising Agency used? |
| AUPIA01 | Should the insured contact the agency in case of emergency? |
| CGL29 | Sporting or social events sponsored? |
| INMRC74 | Sprinklers? |
| HOFP005 | Swimming pool/hot tub jacuzzi/trampoline on premises? |
| TEXT | Text Question |
| CPR90 | Upon completion will the building be commercial? |
| CPR88 | Upon completion will the building be one to four habitational units? |
| CPR89 | Upon completion will the building be over five habitational units? |
| AUTOB10 | Vehicles not solely owned by applicant? |
| CGL20 | Vendors coverage required? |
| AUTOP14 | Was a standard child passenger restraint system (child seat) installed in the vehicle at the time of the accident? |
| AUTOP09 | Was previous insurance provided by Assigned Risk? |
| CGL11 | Was tail coverage purchased under any previous policy? |
| CYBR46 | Was the applicant specifically targeted for such computer attacks? |
| AUTOP15 | Was the child passenger restraint system (child seat) in use by a child during the time of the accident? |
| SFH09 | Was the chimney installed after the house was built and for this solid fuel heating device? |
| AUPWI03 | Was the mandated number of years assignment completed? |
| MHOME26 | Was the mobile home purchased from a dealer? |
| HOME10 | Was the structure originally built for other than a private residence and then converted? |
| RESTA16 | Was the structure originally designed for its current use? |
| WORK40 | Was this policy cancelled midterm? |
| WIND16 | Was your prior policy issued for less than a full annual term? |
| CRIM09 | Were any discrepancies or loose practices commented upon in this audit? If "yes", submit a copy of the audit and auditor's comments. |
| EPL91 | Were any employees or officers terminated or do you plan to terminate any employees or officers in the specified period of time? |
| CYBR48 | What were the direct costs associated with all computer attacks? |
| AIRC07 | Will aircraft be normally operated from other than paved airports? |
| AIRC10 | Will aircraft be used for any purpose(s) for which a charge is made other than those allowed in FAR Part 91? |
| AIRC12 | Will aircraft be used for other than transportation of persons (such as hunting, aerial applications, patrol, research, etc.)? |
| AIRC08 | Will aircraft be used for student or pilot instruction other than for recurrent training of named pilots? |
| INMRP02 | Will any property be exhibited? |
| INMRP03 | Will any special restrictions/endorsements apply? |
| INMRP04 | Will any type of deductible apply? |
| VACB05 | Will applicant occupy the building upon completion? |
| CERT018 | Will the additional insured receive advance notice if insurer cancels (GL policy)? |
| AIRC09 | Will the aircraft be operated off airport? |
| MHOME23 | Will the mobile home be moved during the policy period? |
| CPR22 | Will the policy be paid in installments? |
| PRLI10 | Will you be purchasing excess coverage over this insurance? |
| DO07 | Within next 12 or past 36 months, has applicant completed or agreed to or is contemplating the sale, distribution or divestiture of any assets or stock other than in ordinary course of business an amount exceeding 25% of applicant's consolidated assets? |
| FIDUC25 | Within the last specified number of years has any plan loaned money to, or invested in, the securities of the applicant or its affiliates? |
| AUTOP11 | With the exception of any encumbrances, are any vehicles for which insurance is requested not solely owned by and registered to the applicant? |
| GENRL72 | Would you like to apply this change to other policies on this account? |