Commercial Risk Profile Slip

Transcription

1 Insured Details Name Situation Contact Phone Work Fax Mobile Numbers Postal Address,, Current Insurance Details Current Insurer Policy Renewal Date Exclusions/Endorsements/Conditions Current Premium Are we the Holding Broker Yes No Business Occupation Details Full Description of Occupation Full Description of Activities Continuity Details Commercial Risk Profile Slip 203 Adelaide Street, MARYBOROUGH QLD 4650 (07) b.h (07) fax Number of Years in business: Experience details: Types of Qualifications: Does the Insured do any of the following activities: Site Preparation Yes No Details/Comments : Land clearing Yes No Details/Comments : Road works Yes No Details/Comments : Mine sites Yes No Details/Comments : Use sub-contractors Yes No Details/Comments : On, in over or under water Yes No Details/Comments : Sand or beach operations Yes No Details/Comments : Demolition Yes No Details/Comments : Logging Yes No Details/Comments : Dry Hiring Yes No Details/Comments : Welding Yes No Details/Comments : Engineering Yes No Details/Comments : Claims History Date of Claim Details of Claim Amount Claimed

2 Disclosure Questions Had any Insurance decline or cancelled, renewal refused, claim rejected, special conditions or excess imposed by any Insurer? Yes No Details/Comments Have you in the last 5 years received any demand or writ for personal injury, slander or damage to property? Yes No Details/Comments Have you in the last 5 years been bankrupt or had a receiver or administrator appointed? Yes No Details/Comments Have you in the last 10 years been convicted of a criminal offence, fraud or dishonesty? Yes No Details/Comments Property Protection Fire Protection Fire Alarms Monitored Smoke Detectors Hard wired Back to Fire Brigade Fire Extinguishers Dry Chemical Co2 Water BCF Foam Maintenance Contract Date Last Serviced: Fire Blankets Hose Reels Number Connected to Mains Distance to Hydrant Fire Brigade Local Metro Rural Volunteer Water Supply Mains Tank Photos (Insert Photos Here of alarm, extinguishers, house reels, and hydrants) Location Details Residential Commercial Industrial Rural Security Protection Security Alarms Back to Base Siren Dialer Police Response Battery Backup Security Patrols Dogs on Site Heat Sensor Motion Sensors Infra Red Tremblers Panic Button Pressure Pads CCTV Yes No Number of Cameras How Long is footage kept Safe Fixed Key Combination Time Delay Fire Proof Water Proof Drill Resistant Doors Personal Access doors Sliding Roller Doors Gates Glass Glass Deadlocks Deadlocks Wood Deadlocks Barrel Bolts Barrel Bolts Steel Barrel Bolts Bars Bars DeadLocks Bars Alarmed Alarmed Barrel Bolts Alarmed Grills Grills Bars Grills Security Mesh Security Mesh Alarmed Security Mesh Grills Security Mesh Windows Non-opening Bars Grills Locks Alarmed Security Mesh

3 Vents/Ducts Open Bars Grills Non-Accessible Photos (Insert Photos Here of security protection, locks, grills, bolt, safes etc) Neighboring Details Details of Neighboring Properties Vacant Distance between Properties Waste Management Industrial Bins Skip Bins Wheelie Bins Bins Locked Unlocked Council Removal Contractor Removal Self Removal Cooking/Deep Frying Deep Frying Bench Units < 20 Liters Large Vats > 20 Liters Gas Electricity Thematically Controlled Automatic Cut-Off Stainless Backings Fire Proof Backings Flutes/Ducts How Often Cleaned Daily Weekly Monthly Cleaned By Self Contractor Photos (Insert Photos Here of Cooking Area, Fryers, Flutes/Ducts) Construction Details Heritage Listed Yes No Walls Brick Block Concrete Iron Timber Fibro Roof Iron Wood Concrete Aluminum Floors Basement Ground Floor Upper Concrete Timber Concrete Timber Concrete Timber Stairs Brick Block Concrete Iron Timber Fibro Age Year Built or No of Years Renovated years Wiring years Circuit Breakers Switch Board Earth Leakage Rewired years Last Inspected years House Keeping Clean Recently Painted Maintained Gardens Ownership Owner/Occupier Maintained by Owner Leased/Rented - Maintained by Tennant Maintained by Tennant Maintained by Owner Any EPS? No Yes Percentage of Total Builidng: Less than 15% Greater than 15% but less than 25% Great than 25% Other: Specify: Number of Coldrooms: Types of Coldrooms: Area of Coldrooms: Size of Building: Length: Height: wide: Area of Building: sq/metres

4 Photos (Insert Photos Here of Building/s) Hazards & Perils Fire Storm Flammable Liquids Details: Possible water can blow in Windows Fire can spread From Neighbor To Neighbor Possible Damage by Trees Possible Damage by Hail Contents/Machinery Combustible Non-Combustible Possible Damage by Lightning Examples of how a fire could break out: Malicious Damage Hazards Evidence of any local vandalism Previous Reports of vandalism Impact Hazards Near Highway,Freeway Nearby Trees Near Power Lines Near Airport Rainwater/Flood Hazards Flood Area Date Since Last Flood Does Client Want Flood: Yes or No Open Drains Distance Does Client Want Flood: Yes or No Creek/River Distance Does Client Want Flood: Yes or No Risk of Storm Surge Does Client Want Flood: Yes or No Water from Neighboring Properties Other: Does Client Want Flood: Yes or No Risk Management Non-smoking Signs Designated Areas for smokers Policies/Procedures manuals Quality Assured Incident Reports First Aid Kit Staffed Trained Safety Officer Material Loss or Damage Requested Not Requested Are you obligated to insure the property for the Landlord / Lessor Yes No Replacement & Reinstatement Indemnity Market Value Building/s Contents Stock/Client Goods Specified Illuminated Signs Other Fixed Structures Details: ROD Extra Costs Accidental Damage Flood Playing Surfaces

5 Rewriting of Records Transit Photos (Insert Photos Here) Business Interruption/Loss of Profit/Rent Requested Not Requested Are you obligated to insure the Loss of Rent for Landlord / Lessor Yes No Types of Records Financial Reporting Location of Records Restoration of Records Computer Accountant Onsite Computer Backups Manual No Accountant Offsite Will need to be re-written Sections that could invoke a Claim Fire/Defined Events Burglary/Theft Money Glass Electronic Equipment Equipment Breakdown Details: Extensions of Cover Required Prevention by Authorities Interruption of Electricity Interruption of Gas Interruption of Water Interruption of Electricity Interruption of Communication Items to Consider Rental or Temporary Premises Advertising Extra Labor Costs Indemnity Period required 6 months 12 months 18 months 24 months (Till back at 100% before loss) Gross Profit Figures from P&L Yes No If Yes Period Ending Turnover Closing Stock Opening Stock Additional Expenditure Book debts Claim Preparation Costs Insurable Wages Loss of Rent Receivable Specified Customers & Suppliers Premises p.a Uninsured Working Expenses Purchases Electricity Gas Rent Phone Wages Other: Burglary/Theft Requested Not Requested Is Temporary Protection Required Yes No Insured items in common areas, outside etc Yes No Details: Employees have Personal work Yes No Details: Details of any items that would be very attractive for theft: Stock of Cigs, Smokes Stock all other Contents Damage to Premises

6 Specified Items Money Requested Not Requested Is money seasonal Yes No Details: Is money to and from Client Premises Yes No Details: Maximum Amount at any one time on Premises: How do you record money transactions: Do Employees handle/carry money: Yes No Details: In Transit On Premises During b/h s Outside b/h s In Safe In Residence In Transit Client Premises Glass Requested Not Requested Are you obligated to insure the glass for Landlord / Lessor Yes No Is there Internal Glass Yes No Largest Size Details: Is there External Glass Yes No Largest Size Details: Is there Signage Yes No Could Stock be destroyed by broken Glass Yes No Details: Is there Glass, Plastic or Illuminated signs Yes No Details: Would there Incidental Costs e.g. temporary protection, alarm tapes Yes No Details: External Glass Internal Glass Sign writing Destruction of Stock Incidental Costs Illuminated Signs Replacement Value Replacement Value Equipment/Machinery Breakdown Requested Not Requested Are you obligated to insure and maintain plant for Landlord / Lessor Yes No Is there Perishable Stock that would need to be insured Yes No Value of Refrigerated Stock: Insurable Items Description Power Rating Serial number Approx Age Electronic Equipment Requested Not Requested Are you obligated to insure and maintain any electronic equipment for Landlord / Lessor Yes No

7 Do any items leave the premises (E.G Laptops Phones) Yes No Data backups Yes No How Often Daily Weekly Monthly Incremental Revolving Offsite Onsite Would you need Substitute Electronic Processing Equipment Yes No Details: Would you need to pay extra labor costs to restore Data and Equipment Yes No Details: Insurable Items Description Serial No Type of Cover Transit & Temp Removal Transit Requested Not Requested You do carry stock in Own Vehicles Professional Couriers Do you want Fire, Flood, Collision and Overturning Loading and Unloading Accidental Damage Description of Property Shipped Method Total Value Road Annual Sendings Location From: To: Limit any One Conveyance Required: 5,000 10,000 15,000 20,000 Other: Portable Property Requested Not Requested Description Liability Requested Not Requested Are you obligated to insure the liability for Landlord / Lessor Yes No Limit of Public Liability Required: Not Required 5 mil 10 mil 15 mil 20 mil Other: Limit of Products Liability Required: Not Required 5 mil 10 mil 15 mil 20 mil Other: Of the building, are You: Owner Sole Occupier Part Owner Part Occupier How many employees do you have: Casual Part-Time Full Time Turnovers/Income Last 12 Months Estimated Current Year Sub-Contractors Yes No Contract Reason Labor / Labor + Materials Hold Own Insurance COC on File Contract Value

8 Hired Labor Yes No Labor Type Labor / Labor + Materials Hold Own Insurance COC on File Contract Value Cross-Endorsements Yes No Details Hold Harmless Agreements Yes No Details Goods in Care Control & Custody Yes No Details of Goods In care Control & Custody Value Special Endorsements Yes No Conditionally/Unregistered Vehicles and Plant Outdoor Furniture/Signs Participation Aircraft Landing Area Other: