Inland Marine and Property – This is the application for business Equipment and/or Property Coverage. Want create site? Find Free WordPress Themes and plugins. For General Liability Coverage application please click here. Step 1 of 4 25% Please complete the following application. Once the application is received, a quotation will be sent within one business day. As activities vary, some questions may not be applicable. Please indicate N/A where necesary. (*) indicate required fieldsGENERAL INFORMATIONFacility Name*Contact Person*Your Phone*Your Email Address* Enter Email Confirm Email Number of Employees FEIN/TAX ID Fax Website Address Facility Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address Same as my physical address Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code INSURANCE INFORMATIONCurrently insured?*-Select-YesNoCurrent Insurance CompanyHas Prior Insurance ever Been Cancelled / Non-Renewed?*-Select-YesNoEQUIPMENT / PROPERTY: PART A100% Replacement value of building (IF OWNED)?100% Replacement value of building (IF OWNED)?Number of stories?Square footage of part of building occupied?Square footage of entire building?Building age-Select-2017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900EQUIPMENT / PROPERTY: PART BDo you rent any of your equipment to the sole care, custody and control of others?YesNoIf Yes, is this done for more than 25% of your business?YesNoSports, Leisure & Recreation Equipment TOTAL VALUE ( Replacement Cost) $?Do you have any one single item valued over $5,000 (including sales tax)?YesNoWhere do you store your equipment majority of the time?-Select-WarehouseGarageStorageOtherDoes this place have an alarm system connected to an outside monitoring company?YesNoDo you travel with your equipment outside the United States more than 5 times a year?YesNoCurrently the policy has a Locked Vehicle Warranty. This means there is no coverage for theft from an UNLOCKED vehicle unless you elect to remove this warranty for an additional 10% of the premium. Would you like to remove this warranty for an additional 10% charge?YesNoHave you ever had an equipment claim in the last 5 years?YesNoIf yes, please describe all claims (including date, payout, and loss details).Claim 1Claim 2Claim 3EQUIPMENT / PROPERTY: PART CWiring Year?-Select-2017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Roofing Year?-Select-2017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Plumbing Year?-Select-2017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Heating Year?-Select-2017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Any restaurants or apartments located next door to or inside your building?YesNoBurglar alarm company and type?Fire Sprinklers?YesNoExtinguishers?YesNoINVENTORY LISTDo you rent your amusement devices or rides with or without an operator or attendant present?*-Select-With Operator/AttendantWithout Operator/AttendantDo you allow customer pick-up for any rental equipment?*-Select-YesNoInflatables and Mechanical ridesAttach Separate Inventory List if neededItems (including non-inflatable)Sizes Length x Width x HeightPrice Non Inflatable Items (Tables, Chairs etc.)Items (including non-inflatable)quantityPrice GENERAL LIABILITY COVERAGE LIMITOccurrence$1,000,000$2,000,000$3,000,000$4,000,000$5,000,000Aggregate$2,000,000$3,000,000$4,000,000$5,000,000 DOCUMENT UPLOADAre participants required to sign a Waiver & Release of Liability / Rental Agreement? attach a copy.Accepted file types: pdf, doc, docx.upload your resume in .pdf, .doc or .docx formatAre written emergency procedures in place (Emergency Evacuation Plan)? attach a copyAccepted file types: pdf, doc, docx.upload your resume in .pdf, .doc or .docx formatCopy of Posted RulesAccepted file types: pdf, doc, docx.upload your resume in .pdf, .doc or .docx formatOther DocumentsAccepted file types: pdf, doc, docx.upload your resume in .pdf, .doc or .docx formatHow did you hear about us?Ninja JumpJungle JumpBouncing AngelsMagic JumpEZ InflatablesInternetReferralOtherTerms and ConditionsThe undersigned being authorized by and acting on behalf of the applicant and all persons or concerns seeking insurance, has read and understands this proposal and declares all statements set for herein are true, complete, and accurate. The undersigned further declares and represents that any occurrence or event taking place prior to the inception of the policy applied for which may render inaccurate, untrue, or incomplete any statement made herein will immediately be reported in writing to the insurer. The undersigned acknowledges and agrees that the submission and the insurer’s receipt of such report prior to the inception of the policy applied for is a condition precedent to coverage. It is understood and agreed that the completion of this application shall not be binding either to the Proposed Insured or to the Company until accepted by the Company or Companies. Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly provides false information in an application for insurance may be guilty of a crime and may be subject to civil fines and criminal penalties. I certify that the above information is true and coverage is not applicable until accepted.Acceptance* I agree to the Terms and Conditions Did you find apk for android? You can find new Free Android Games and apps.