| General Information |
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| Business name:
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| Name of principal:
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| Address:
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Phone number:
(Format: ###-###-####)
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| E-mail address:
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Postal code:
(Format: C#C#C#)
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Expiry date of current policy:
(Format: dd/mm/yyyy)
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| Eligibility |
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Nature of business / occupancy:
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Description of business:
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| Has the business had any claims in the last 3 years?
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Yes
No
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| Has the applicant had any previous insurance declined or cancelled?
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Yes
No
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| Does the floor area exceed 20,000 sq. ft.?
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Yes
No
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| Is this a seasonal business?
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Yes
No
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| Do gross sales exceed $3 million?
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Yes
No
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| Does the business sell or export goods or services outside of Canada?
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Yes
No
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| Is the building older than 35 years?
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Yes
No
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| Building Updates |
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| Is the business, in whole or part, for manufacturing or processing?
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Yes
No
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| Is the business a wholesaler?
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Yes
No
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| Does the business sell second-hand goods?
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Yes
No
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| Is the business located in a hotel?
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Yes
No
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| Does the business have an approved burglar alarm system?
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Yes
No
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Burglar Alarm Monitoring Classifications
The following definitions are provided to assist with completion of the Business Owners� Value Pak� Quotation Request:
Central Station System means one in which the operations of electrical protection circuits and devices are signaled automatically to, recorded in, maintained, and supervised from a central station having trained operators and security personnel in attendance at all times. Security personnel are dispatched to make immediate investigation of unauthorized entry or dispatched to make immediate investigation of unauthorized entry or opening of protected properties from which signals are received.
Monitoring Station System means one in which the operations of electrical protection circuits and devices are signaled automatically to, recorded in, maintained, and supervised from a monitoring station having trained operators in attendance at all times. Security personnel are not dispatched but police headquarters and subscribers are notified simultaneously of alarms.
Local Alarm System means one in which the protective circuits and devices are connected directly to:
A police station, or
A commercial telephone answering service.
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| Physical Risk Information |
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| Is the building owned by the applicant?
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Yes
No
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| Building construction:
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Construction Classifications
Fire Resistive
A building with reinforced concrete, brick or masonry walls with reinforced concrete or steel framework adequately fire-proofed with concrete floors, concrete roof deck and non-combustible roofing material. All interior partitions must be of non-combustible material.
Non-Combustible
A building in which the structural members including walls, columns, beams, floor and roof constructions are of non-combustible materials, not qualifying as Fire Resistive, but have a fire resistance that enables them to withstand some degree of fire severity. Into this category will fall masonry wall/steel roof on steel supports, all steel construction, concrete on steel deck roof with masonry walls.
Ordinary
A building in which the exterior bearing walls or bearing partitions of exterior walls are of non-combustible or limited combustible ratings and stability under fire conditions; roof, floors, and interior framing are wholly or partly of wood. Commonly referred to as brick, wood-joisted or brick-joist construction or concrete block with wood deck roof.
Frame
A building in which the exterior walls, bearing walls, partitions, floors and roofs and their supports are wholly or principally of frame or other combustible material. Included in this category are frame and stucco, brick veneer and frame metal clad.
Note:
A structure must be at least two thirds (2/3) of one class of construction to qualify for that class, providing the value of the building is in the same ratio as the construction (dollar amount).
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| Does the building have a sprinkler? |
Yes
No
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| Percent sprinkled (0 to 100): |
% |
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| Number of employees (including principals): |
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Year built:
(Format: yyyy)
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| Construction |
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| Walls:
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| Roof:
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| Roof surface:
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| Floors:
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| Does the building have a basement? |
Yes
No
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| Basement: |
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| Heating |
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| Heating: |
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| Chimney |
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| Chimney: |
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| Fuel |
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| Fuel: |
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| Oil Tank |
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| Does the building have an oil tank? |
Yes
No
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| Age of oil tank:
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| Special Hazards |
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| Special hazards: |
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| Burglary |
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| Windows barred or screened?
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Yes
No
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| Deadbolts?
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Yes
No
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| Alarm system?
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Yes
No
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| Is the alarm system ULC approved?
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Yes
No
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| Type of alarm system:
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Burglar Alarm Monitoring Classifications
The following definitions are provided to assist with completion of the Business Owners Value Pak Quotation Request:
Central Station System means one in which the operations of electrical protection circuits and devices are signaled automatically to, recorded in, maintained, and supervised from a central station having trained operators and security personnel in attendance at all times. Security personnel are dispatched to make immediate investigation of unauthorized entry or dispatched to make immediate investigation of unauthorized entry or opening of protected properties from which signals are received.
Monitoring Station System means one in which the operations of electrical protection circuits and devices are signaled automatically to, recorded in, maintained, and supervised from a monitoring station having trained operators in attendance at all times. Security personnel are not dispatched but police headquarters and subscribers are notified simultaneously of alarms.
Local Alarm System means one in which the protective circuits and devices are connected directly to:
- An enclosed tamper protected loud sounding gong or siren attached to the outside of the building in which the premises are located, or
- A police station, or
- A commercial telephone answering service.
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| Coverage |
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| Liability amount:
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Building amount:
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Contents amount:
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| Professional liability required?
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Yes
No
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| For...
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