ACORD 126 - Universal Marketing and management

ACORD 126 General Liability

Submission Date

Proposed Effective Date

Business Name

Contact Name

Contact Type

Street Address

City, State, ZIP code

Email Address

Phone

CONTRACTORS

1. Does applicant draw plans, designs, or specifications for others?

2. Do any operations include blasting or utilize or store explosive material?

3. Do any operations include excavation, tunneling, underground work or earth moving?

4. Do your subcontractors carry coverages or limits less than yours?

5. Are subcontractors allowed to work without providing you with a Certificate of Insurance?

6. Does applicant lease equipement to others with or without operators?

Describe the type of work subcontracted

PRODUCTS / COMPLETED OPERATIONS

Products

Annual Gross Sales

Number of units

Time in market

Expected life

Intended use

Principal components

1. Does applicant install, service or demonstrate products?

2. Foreign products sold, distributed, used as components?

3. Research and development conducted or new products planned?

4. Guarantees, warranties, hold harmless agreements?

5. Products related to aircraft/space industry?

6. Products recalled, discontinued, changed?

7. Products of others sold or re-packaged under applicant label?

8. Products under label of others?

9. Vendors coverage required?

10. Does any named insured sell to other named insureds?

GENERAL INFORMATION

1. Any medical facilities provided or medical professionals employed or contracted?

2. Any explosure to radioactive/nuclear materials?

3. Do/have past, present or discontinued operations involve(d) storing, treating, discharging, applying, disposing, or transporting of hazardous material?

4. Any operations sold, acquired, or discontinued in last five (5) years?

5. Do you rent or loan equipment to others?

6. Any watercraft, docks, floats owned,hired or leased?

7. Any parking facilities ownes/rented?

8. Is a fee charged for parking?

9. Recreation facilities provided?

10. Are there any lodging operations including apartements?

11. Is there a swimming pool on premises?

12. Are social events sponsored?

13. Are athletic teams sponsored?

14. Any structural alterations contemplated?

15. Any demolition exposure contemplated?

16. Has applicant been active or is currently active in joint ventures?

17. Do you lease employees to or from other employers?

18. Is there a labor interchange with any other business or subsidiaries?

19. Are day care facilities operated or controlled?

20. Have any crimes occurred or been attempted on your premises within the last three (3) years??

21. Is the a formal, written safety and security policy in effect?

22. Does the businesses' promotional literature make any representations about the safety or security of the premises?