Fitness Center Product

Transcription

1 UNITED STATES LIABILITY INSURANCE GROUP A BERKSHIRE HATHAWAY COMPANY Fitness Center Prodct Why Do Fitness Centers Need To Prchase Insrance? One of yor patrons places a weight back into its holder and it collapses on their feet Yor hot tb cases a severe skin reaction One of yor patrons drops their child off with yor sitting center and the child breaks a finger The advice and instrction yo give to one of yor patrons cases damage to them One of yor patrons is claiming they were sexally absed by one of yor employees In order to increase membership, yo host a fnction at a local mall and while it is going on, someone trips over cords that were not secred properly Why shold yo choose or Fitness Center Prodct? The following are important featres; make sre yo have them all: Coverage Featres Or Grop Competitors Policy Professional Liability Coverage provided for no additional charge Incldes Molestation & Abse Coverage at $100,000 per occrrence / $300,000 Aggregate limit for no additional charge Defense Cost coverage provided otside the limit of liability? Personal Trainers covered for no additional charge Child Sitting services covered for no additional charge Limited Tanning Bed Liability coverage available Non-owned and Hired Ato Liability coverage available Atomatically inclded Clb Members as Additional Insreds Landlords can be inclded as additional insreds for no additional premim No liability dedctible Expanded definition of Bodily Injry to inclde sickness or disease cased by mental angish or emotional distress - See L-610? Why choose to be insred with United States Liability Insrance Grop? One of only 20 A++ rated insrance grops in the United States by A.M. Best. A prod member of the Berkshire Hathaway Grop, recently voted the #1 most admired Property & Casalty Company in the world (Fortne Magazine). This docment does not amend, extend or alter the coverage afforded by the Policy. For a complete nderstanding of any insrance yo prchase, yo mst first read yor Policy, Declaration Page and any Endorsements and discss them with yor Broker. A specimen policy is available from an Agent of the Company. Yor actal Policy Conditions may be amended by Endorsement or affected by State Laws. FC-POS-10-09

2 UNITED STATES LIABILITY INSURANCE GROUP A BERKSHIRE HATHAWAY COMPANY Fitness Center Prodct We are in great shape to handle yor Fitness Center Bsiness! Or prodct targets fitness centers with p to $2,000,000 in annal sales per location. Eligible classes inclde aerobic stdios, corporate fitness centers, independently owned fitness centers and franchised fitness centers. Prodct Featres: Available as Monoline Liability or as a Package Coverage for the following exposres is atomatically inclded for no additional charge: Profesional Liability Molestation and Abse at a $100,000/$300,000 limit (increased limits available for a charge) Child sitting services Personal Trainers/Aerobic Instrctors 4 sport corts Jaczzis, Hot tbs, Sanas and Steam rooms Landlords, Property Managers, Clb Members, Mortgagees can be named as Additional Insreds for no additional charge General Liability coverage with expanded definition of Bodily Injry to inclde Mental Angish and Emotional Distress No Liability dedctible Low minimm premims Optional Featres Available: Limited coverage for tanning nits Coverage for massage services Stop Gap Liability Coverage for special events with p to 500 attendees Hired and Non-owned Ato coverage Additional Advantages: A.M. Best rated A++ carrier Qick qote and binder trnarond Package Coverages Available: Property coverage sing ISO s broad April 02 coverage form Vale Pls Endorsement - 15 additional coverages for one flat charge Eqipment Breakdown - incldes free boiler inspections if reqired in yor jrisdiction Special Form and Replacement Cost coverage is available Money & Secrities coverage Employee Dishonesty coverage This docment does not amend, extend or alter the coverage afforded by the Policy. For a complete nderstanding of any insrance yo prchase, yo mst first read yor Policy, Declaration Page and any Endorsements and discss them with yor Broker. A specimen policy is available from an Agent of the Company. Yor actal Policy Conditions may be amended by Endorsement or affected by State Laws. FCP-NR (10/09)

3 UNITED STATES LIABILITY INSURANCE GROUP A BERKSHIRE HATHAWAY COMPANY Fitness Center Prodct Claim Examples Property: A fire in an adjoining bilding cased water and smoke damage. There was $15,000 of bilding damage and $35,000 of bsiness personal property damage. In order to repair the damage and replace the workot eqipment, the fitness center had to be closed for 1 month, which reslted in the loss of bsiness income for the insred. Property: The owner arrived at the fitness center one morning to find that the bilding had been spray painted by vandals. The owner called the police to report the incident. The vandalism cased $5,000 in damages. Medical Payments: A cstomer was exercising on a sqat machine. The machine came off the grond and ct her leg. She incrred $3,000 in medical expenses. General Liability: A cstomer was lifting weights when a 500- pond machine fell on his back and crshed him. The man sstained crshed lngs, fractred vertebrae in his spine, and $150,000 in medical bills, as well as loss of income from being ot of work. General Liability: A cstomer slipped and fell in the entrance way of the fitness center de to the floor being wet from the rain. The cstomer sstained a non-displaced fiblar fractre and sed the restarant $12,000 in medical expenses and lost wages. Molestation and Abse: A member sed the fitness center alleging negligent hiring of an employed instrctor who exhibited inappropriate behavior when training the member. The cost to defend the claim was $17,000. Hired and Non Owned Atomobile Liability: The manager of the fitness center asked an employee to rn to the bank. While on the way to the bank, the employee rear-ends another car casing $4,000 worth of property damage to the other atomobile and $40,000 in bodily injry to the other driver and damage to their atomobile. The employee s car was nderinsred when they injred the other driver. Vale Pls: A bilding next to the insred s premises caght fire. The fire did not damage the insred s bilding, however, the fire spread to the insred s property and destroyed the insred s TV Satellite dish located otside of the bilding. The vale of the Satellite dish was $10,000. Eqipment Breakdown: The insred s HVAC system was damaged de to an electrical shortage cased dring a power srge. The HVAC system needed to be replaced. An eqipment breakdown claim was made for $2,000 Professional Liability: A professional trainer at the center was working with a member and encoraged them to increase the pace of their work ot. Dring the session the member injred their back and sed the fitness center for $35,000 in medical costs and loss of wages. This docment does not amend, extend or alter the coverage afforded by the Policy. For a complete nderstanding of any insrance yo prchase, yo mst first read yor Policy, Declaration Page and any Endorsements and discss them with yor Broker. A specimen policy is available from an Agent of the Company. Yor actal Policy Conditions may be amended by Endorsement or affected by State Laws. FCP COMML-CLA (11/09)

4 Fitness Center Prodct Application All States YOU CAN OBTAIN A QUOTE BY PROVIDING THE INFORMATION IN SECTION I - INSTANT QUOTE BELOW, SUBJECT TO THE REMAINDER PROVIDED PRIOR TO BINDING. I. INSTANT QUOTE INFORMATION Instant Qote is only available for acconts with no losses in the past three years. If there is loss history, please complete the entire application. Applicant s name: Location address: Same as mailing address. City: State: Zip: Description of Operations: How many years has the applicant been at the crrent location? Do yo own the bilding? Yes No (If No, skip Bilding Owner Qestions nder both the Property & Liability Sections below) PROPERTY SECTION Constrction: Frame Joisted masonry Non-combstible Masonry non-combstible Modified fire-resistive Fire-resistive Other Protection class: Reqested case of loss: Basic Special Reqested valation: Replacement cost Actal cash vale Dedctible: $1,000 $2,500 $5,000 Coinsrance: 80% 90% 100% Bsiness personal property limit $ Bsiness income & extra expense limit $ Bilding Owner Bilding limit $ What year was the bilding constrcted? What is the sqare footage of the entire strctre? sq. ft. Is the bilding flly protected by an operational sprinkler system covering 100% of the premises? Yes No GENERAL LIABILITY SECTION Limit: $100,000/$200,000 $300,000/$600,000 $500,000/$1,000,000 $1,000,000/$2,000,000 Abse & molestation liability limit: $100,000/$300,000 $300,000/$300,000 $500,000/$500,000 $1mil/$1mil Exposre basis: Annal gross sales: $ Nmber of members: # Fll-time employees: # Part-time employees: (<30 hrs/week) Nmber of sports corts: Does the facility have any treadmills? Yes No Any jaczzis, hot tbs, sana or steam rooms? Yes No Are there any shower facilities? Yes No Are there any swimming pools? Yes No Is the facility open 24 hors? Yes No If Yes, do yo have a fitness staff certified in CPR on dty all hors of operation? Yes No Do members have access otside of reglar bsiness hors? Yes No Nmber of massage services nits Nmber of tanning nits Do yo have exposre to child sitting services? Yes No Bilding Owner Is any portion of the bilding leased to commercial tenants? Yes No If Yes, applicable sq. ft. Does the applicant lease any apartments at this location? Yes No If Yes, nmber of nits applicable sq. ft. of apts. Additional Interests (AI = Additional Insred, LP = Loss Payee, M = Mortgagee) Name Relationship/Interest Address City, State, Zip AI LP M FCA 8/12 page 1 of 4

5 II. LOSS INFORMATION FOR THE PAST THREE YEARS Liability Coverages None, or provide detail below. Year Stats Incrred Description Property Coverages None, or provide detail below. Year Stats Incrred Description III. ADDITIONAL PROPERTY INFORMATION If yo own the bilding and it is more than 10 years old, please complete the following: Age of roof yrs. Plmbing pdated (yr) Electrical pdated (yr) Heating pdated (yr) Roof type: Flat Wood shake Shingle Metal Tile Slate Other Plmbing type: PVC Copper Lead Galvanized Other What type of brglar alarm is on the premises? Central station Local None IV. ELIGIBILITY CRITERIA 1. No bankrptcies, tax or credit liens against the applicant in the last five years Tre False 2. Coverage has not been cancelled or non-renewed in the last three years (not applicable in Missori) Tre False If False, advise reason Property 1. For any bilding bilt prior to 1978, 100% of the electric wiring is on fnctioning and operating circit breakers N/A Tre False 2. For any bilding bilt prior to 1978, there is no alminm wiring or knob and tbe wiring N/A Tre False 3. Fnctioning and operational fire extingishers available Tre False 4. Fnctioning and operational smoke detectors Tre False 5. Bilding is not a non-standard strctre (i.e. bbble, dome, etc.) Tre False General Liability 1. Applicant has not, is not and will not act as a franchisor (grantor of a franchise) Tre False 2. No alcohol sales Tre False 3. No contact martial arts or boxing activities Tre False 4. No rock/wall climbing activities Tre False 5. No gymnastics activities/instrction Tre False 6. All members and gests sing the facility are reqired to sign a release/waiver of liability Tre False 7. All personal trainers and aerobic instrctors are reqired to be certified Tre False 8. All fitness personnel are reqired to be CPR certified Tre False 9. Service logs are maintained on all eqipment Tre False 10. No chiropractic, physical therapy, rehabilitation services or similar professional services by direct employees and all professionals renting space from the insred are reqired to carry their own insrance and name the applicant as an additional insred Tre False 11. Applicant does not manfactre or alter the packaging of any diet aids, vitamins, spplements or similar prodcts Tre False 12. Warning signs posted in clear view of all tanning nits, hot tbs, sanas, steam rooms and fitness eqipment Tre False 13. No actal or alleged incidents regarding molestation or abse Tre False 14. No type of acpnctre services, electrolysis or hair removal services, body wrapping services or any type of body container services are provided by yor center Tre False 15. No medical services, blood analysis, stress testing, weight loss or diet clinic exists Tre False 16. No formal instrction or classes for children nder the age of 12 Tre False Additional General Liability Information Yo have an exposre to tanning nits Yes No If Yes, please answer the following qestions: 1. No more than for nits Tre False 2. All nits are UL Approved Tre False 3. All minors are reqired to have a parent or gardian sign a release prior to se Tre False 4. Individals are warned against sing tanning nits when pregnant or sing photosensitive medication Tre False 5. Applicant has exclsive access to controls Tre False 6. Individals are reqired to wear goggles Tre False 7. Logs are kept on each person s se and maximm nmber of ses is enforced Tre False Yo have an exposre to child sitting services Yes No If Yes, please answer the following qestions: 1. Criminal and backgrond checks are performed on all potential employees having exposre to or responsibility for children Tre False 2. No children nder 6 weeks old accepted Tre False 3. Children are reqired to be signed in and signed ot Tre False 4. A member signing in a child mst be on premises at all times Tre False FCA 8/12 - USLI page 2 of 4

6 V. ADDITIONAL APPLICANT INFORMATION Form of bsiness: Individal Corporation Partnership LLC Other What year did the bsiness start? Applicant s mailing address: (if different than the location address above) City: State: Zip: address of primary contact: Phone: Inspection contact name: Telephone/ address: Adit contact name: Telephone/ address: FRAUD STATEMENTS Arizona Notice: Misrepresentations, omissions, concealment of facts and incorrect statements shall prevent recovery nder the policy only if the misrepresentations, omissions, concealment of facts or incorrect statements are; fradlent or material either to the acceptance of the risk, or to the hazard assmed by the insrer or the insrer in good faith wold either not have issed the policy, or wold not have issed a policy in as large an amont, or wold not have provided coverage with respect to the hazard reslting in the loss, if the tre facts had been made known to the insrer as reqired either by the application for the policy or otherwise. Colorado Frad Statement: It is nlawfl to knowingly provide false, incomplete, or misleading facts or information to an insrance company for the prpose of defrading or attempting to defrad the company. Penalties may inclde imprisonment, fines, denial of insrance and civil damages. Any insrance company or agent of an insrance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the prpose of defrading or attempting to defrad the policyholder or claimant with regard to a settlement or award payable from insrance proceeds shall be reported to the Colorado division of insrance within the department of reglatory agencies. District of Colmbia Frad Statement: WARNING: It is a crime to provide false or misleading information to an insrer for the prpose of defrading the insrer or any other person. Penalties inclde imprisonment and/or fines. In addition, an insrer may deny insrance benefits if false information materially related to a claim was provided by the applicant. Florida Frad Statement: Any person who knowingly and with intent to injre, defrad, or deceive any insrer files a statement of claim or an application containing any false, incomplete, or misleading information is gilty of a felony of the third degree. FLORIDA NOTICE FOR NON ADMITTED POLICIES ONLY: Yo are agreeing to place coverage in the srpls lines market. Sperior coverage may be available in the admitted market and at a lesser cost. Persons insred by srpls lines carriers are not protected nder the Florida Insrance Garanty Act with respect to any right of recovery for the obligation of an insolvent nlicensed insrer. Florida and Illinois Notice: I nderstand that there is no coverage for pnitive damages assessed directly against an insred nder Florida and Illinois law. However, I also nderstand that pnitive damages that are not assessed directly against an insred, also known as vicariosly assessed pnitive damages, are insrable nder Florida and Illinois law. Therefore, if any Policy is issed to the Applicant as a reslt of this Application and sch Policy provides coverage for pnitive damages, I nderstand and acknowledge that the coverage for Claims broght in the State of Florida and Illinois is limited to vicariosly assessed pnitive damages and that there is no coverage for directly assessed pnitive damages. Kansas Frad Statement: Any person who, knowingly and with intent to defrad, presents, cases to be presented or prepares with knowledge or belief that it will be presented to or by an insrer, prported insrer, broker or any agent thereof, any written statement as part of, or in spport of, an application for the issance of, or the rating of an insrance policy for personal or commercial insrance, or a claim for payment or other benefit prsant to an insrance policy for commercial or personal insrance which sch person knows to contain materially false information concerning any fact material thereto; or conceals, for the prpose of misleading, information concerning any fact material thereto may be gilty of a crime and may be sbject to fines and confinement in prison. Kentcky Frad Statement: Any person who knowingly and with intent to defrad any insrance company or other person files an application for insrance containing any materially false information or conceals, for the prpose of misleading, information concerning any fact material thereto commits a fradlent insrance act, which is a crime. Maine and Washington Frad Statement: It is a crime to knowingly provide false, incomplete or misleading information to an insrance company for the prpose of defrading the company. Penalties may inclde imprisonment, fines or a denial of insrance benefits. Maryland: Any person who knowingly or willflly presents a false or fradlent claim for payment of a loss or benefit or who knowingly or willflly presents false information in an application for insrance is gilty of a crime and may be sbject to fines and confinement in prison. Athorization or agreement to bind the insrance may be withdrawn or modified only based on changes to the information contained in this application prior to the effective date of the insrance applied for that may render inaccrate, ntre or incomplete any statement made with a minimm of 10 days notice given to the insred prior to the effective date of cancellation when the contract has been in effect for less than 90 days or is being canceled for nonpayment of premim. New Jersey Frad Statement: Any person who incldes any false or misleading information on an application for an insrance policy is sbject to criminal and civil penalties. New York Disclosre Notice: This policy is written on a claims made basis and shall provide no coverage for claims arising ot of incidents, occrrences or alleged Wrongfl Acts or Wrongfl Employment Acts that took place prior to retroactive date, if any, stated on the declarations. This policy shall cover only those claims made against an insred while the policy remains in effect for incidents reported dring the Policy Period or any sbseqent renewal of this Policy or any extended reporting period and all coverage nder the policy ceases pon termination of the policy except for the atomatic extended reporting period coverage nless the insred prchases additional extend reporting period coverage. The policy incldes an atomatic 60 day extended claims reporting period following the termination of this policy. The Insred may prchase for an additional premim an additional extended reporting period of 12 months, 24 months or 36 months following the termination of this policy. Potential coverage gaps may arise pon the expiration for this extended reporting period. Dring the first several years of a claims-made relationship, claims-made rates are comparatively lower than occrrence rates. The insred can expect sbstantial annal premim increases independent overall rate increases ntil the claims-made relationship has matred. North Dakota Frad Statement: Notice to North Dakota applicants Any person who knowingly and with the intent to defrad and insrance company or other person, files an application for insrance or statement of claim containing any materially false information, or conceals for the prpose of misleading, information concerning any fact material thereto, commits a fradlent insrance act, which is a crime and shall also be sbject to a civil penalty. Ohio Frad Statement: Any person who, with intent to defrad or knowing that he is facilitating a frad against an insrer, sbmits an application or files a claim containing a false or deceptive statement is gilty of insrance frad. I nderstand that any material misrepresentation or omission made by me on this application may act to render any contract of insrance nll and withot effect or provide the company the right to rescind it. By acceptance of this policy, the Insred agrees the statements in the application (new or renewal) sbmitted to the company are tre and correct. It is nderstood and agreed that, to the extent permitted by law, the Company reserves the right to rescind this policy, or any coverage provided herein, for material misrepresentations made by the Insred. It is nderstood and agreed that the statements made in the insrance applications are incorporated into, and shall form part of, this policy. Oklahoma Frad Statement: WARNING: Any person who knowingly, and with intent to injre, defrad or deceive any insrer, makes any claim for the proceeds of an insrance policy containing any false, incomplete or misleading information is gilty of a felony. FCA 8/12 page 3 of 4

7 Oregon Frad Statement: Notice to Oregon applicants: Any person who, with intent to defrad or knowing that he is facilitation facilitating a frad against an insrer, sbmits an application or files a claim containing a false or deceptive statement may be gilty of insrance frad. Any person who knowingly and with intent to defrad any insrance company or other person files an application for insrance or statement of claim containing any materially false information or conceals for the prpose of misleading, information concerning any fact material thereto commits a fradlent insrance act, which is a crime and sbjects sch person to criminal and civil penalties. Tennessee and Virginia Frad Statement: It is a crime to knowingly provide false, incomplete or misleading information to an insrance company for the prpose of defrading the company. Penalties inclde imprisonment, fines and denial of insrance benefits. Utah Notice: I nderstand that Pnitive Damages are not insrable in the state of Utah. There will be no coverage afforded for Pnitive Damages for any Claim broght in the State of Utah. Any coverage for Pnitive Damages will only apply if a Claim is filed in a state which allows pnitive or exemplary damages to be insrable. This may apply if a Claim is broght in another state by a sbsidiary or additional location(s) of the Named Insred, otside the state of Utah, for which coverage is soght nder the same policy Vermont Frad Statement: Any person who knowingly presents a false or fradlent claim for payment of a loss or benefit or knowingly presents false information in an application for insrance may be sbject to fines and confinement in prison. Virginia Notice: This Policy is written on a claims-made basis. Please read the policy careflly to nderstand yor coverage. Yo have an option to prchase a separate limit of liability for the extended reporting period. If yo do not elect this option, the limit of liability for the extended reporting period shall be part of the and not in addition to limit specified in the declarations. If yo have any qestions regarding the cost of an extended reporting period, please contact yor insrance company or yor insrance agent. Statements in the application shall be deemed the insred s representations. A statement made in the application or in any affidavit made before or after a loss nder the policy will not be deemed material or invalidate coverage nless it is clearly proven that sch statement was material to the risk when assmed and was ntre. Virginia Frad Statement: Any person who knowingly and with intent to defrad an insrer, sbmits an Application for insrance or files a claim containing a false or deceptive statement is gilty of insrance frad. Utah Frad Statement: Any person who, with intent to defrad or knowing that he is facilitating a frad against an insrer, sbmits an application or files a claim containing a false or deceptive statement is gilty of insrance frad. Washington Frad Statement: Any person, who, knowing it to be sch: (1) Presents, or cases to be presented, a false or fradlent claim or any proof in spport of sch a claim, for the payment of a Loss nder a contract of insrance; or (2) Prepares, makes, or sbscribes any false or fradlent accont, certificate, affidavit, or proof of Loss, or other docment or writing, with intent that it be presented or sed in spport of sch a claim, is gilty of a gross misdemeanor, or if sch claim is in excess of one thosand five hndred dollars, of a class C felony. Frad Statement (All Other States): Any person who knowingly presents a false or fradlent claim for payment of a loss or benefit or knowingly presents false information in an application for insrance is gilty of a crime and may be sbject to fines and confinement in prison. Retail agency name: License #: Main agency phone nmber: Agency mailing address: City: State: Zip: The signer of this application acknowledges and nderstands that the information provided in this Application is material to the Insrer s decision to provide the reqested insrance and is relied on by the Insrer in providing sch insrance. The signer of this application represents that the information provided in this Application is tre and correct in all matters. The signer of this Application frther represents that any changes in matters inqired abot in this Application occrring prior to the effective date of coverage, which render the information provided herein ntre, incorrect or inaccrate in any way will be reported to the Insrer immediately in writing. The Insrer reserves the right to modify or withdraw any qote or binder issed if sch changes are material to the insrability or premim charged, based on the Insrer s nderwriting gides. The Insrer is hereby athorized, bt not reqired, to make any investigation and inqiry in connection with the information, statements and disclosres provided in this Application. The decision of the Insrer not to make or to limit any investigation or inqiry shall not be deemed a waiver of any rights by the Insrer and shall not estop the Insrer from relying on any statement in this Application in the event the Policy is issed. It is agreed that this Application shall be the basis of the contract shold a policy be issed and it will be attached and become a part of the Policy. New York Frad Statement: Any person who knowingly and with intent to defrad any insrance company or other person files an application for insrance or statement of claim containing any materially false information, or conceals for the prpose of misleading, information concerning any fact material thereto, commits a fradlent insrance act, which is a crime and shall also be sbject to a civil penalty not to exceed five thosand dollars and the stated vale of the claim for each sch violation. Applicant s signatre: Title: Date: page 4 of 4