General Liability - Universal Marketing and management

AGENCY NAME

PROPOSED EFFECTIVE DATE

NAIC CODESee ( https://insurance.umm2u.com/naics-codes/ ) for reference

PRODUCTS & COMPLETED OPERATIONS AGGREGATE

PERSONAL & ADVERTISING INJURY

PROPOSED RETROACTIVE DATE:

ENTRY DATE INTO UNINTERRUPTED CLAIMS MADE COVERAGE:

HAS ANY PRODUCT, WORK, ACCIDENT, OR LOCATION BEEN EXCLUDED, UNINSURED OR SELF-INSURED FROM ANY PREVIOUS COVERAGE?

DOES APPLICANT DRAW PLANS, DESIGNS, OR SPECIFICATIONS FOR OTHERS?

WAS TAIL COVERAGE PURCHASED UNDER ANY PREVIOUS POLICY?

DO ANY OPERATIONS INCLUDE BLASTING OR UTILIZE OR STORE EXPLOSIVE MATERIAL?

APPLICANT / FIRST NAMED INSURED

ARE SUBCONTRACTORS ALLOWED TO WORK WITHOUT PROVIDING YOU WITH A CERTIFICATE OF INSURANCE?

DO YOUR SUBCONTRACTORS CARRY COVERAGES OR LIMITS LESS THAN YOURS?

MEDICAL EXPENSE (Any one person)

DO ANY OPERATIONS INCLUDE EXCAVATION, TUNNELING, UNDERGROUND WORK OR EARTH MOVING?

EACH OCCURENCE

EACH OCCURRENCE DAMAGE TO RENTED PREMISES (each occurrence)

FOREIGN PRODUCTS SOLD, DISTRIBUTED, USED AS COMPONENTS? (If "YES", attach ACORD 815)

DOES APPLICANT LEASE EQUIPMENT TO OTHERS WITH OR WITHOUT OPERATORS?

DOES APPLICANT INSTALL, SERVICE OR DEMONSTRATE PRODUCTS?

IS A FEE CHARGED FOR PARKING?

PRODUCTS RELATED TO AIRCRAFT/SPACE INDUSTRY?

RESEARCH AND DEVELOPMENT CONDUCTED OR NEW PRODUCTS PLANNED?

PRODUCTS UNDER LABEL OF OTHERS?

PRODUCTS RECALLED, DISCONTINUED, CHANGED?

PRODUCTS OF OTHERS SOLD OR RE-PACKAGED UNDER APPLICANT LABEL?

DOES ANY NAMED INSURED SELL TO OTHER NAMED INSUREDS?

VENDORS COVERAGE REQUIRED?

ANY MEDICAL FACILITIES PROVIDED OR MEDICAL PROFESSIONALS EMPLOYED OR CONTRACTED?

ANY EXPOSURE TO RADIOACTIVE/NUCLEAR MATERIALS?

DO/HAVE PAST, PRESENT OR DISCONTINUED OPERATIONS INVOLVE(D) STORING, TREATING, DISCHARGING, APPLYING, DISPOSING, OR TRANSPORTING OF HAZARDOUS MATERIAL? (e.g. landfills, wastes, fuel tanks, etc)

ANY OPERATIONS SOLD, ACQUIRED, OR DISCONTINUED IN LAST FIVE (5) YEARS?

ANY WATERCRAFT, DOCKS, FLOATS OWNED, HIRED OR LEASED? *

ANY PARKING FACILITIES OWNED/RENTED?

GUARANTEES, WARRANTIES, HOLD HARMLESS AGREEMENTS?

ANY DEMOLITION EXPOSURE CONTEMPLATED?

RECREATION FACILITIES PROVIDED?

ANY STRUCTURAL ALTERATIONS CONTEMPLATED?

ARE DAY CARE FACILITIES OPERATED OR CONTROLLED?

IS THERE A LABOR INTERCHANGE WITH ANY OTHER BUSINESS OR SUBSIDIARIES?

HAS APPLICANT BEEN ACTIVE IN OR IS CURRENTLY ACTIVE IN JOINT VENTURES?

HAVE ANY CRIMES OCCURRED OR BEEN ATTEMPTED ON YOUR PREMISES WITHIN THE LAST THREE (3) YEARS?

IS THERE A FORMAL, WRITTEN SAFETY AND SECURITY POLICY IN EFFECT?

DOES THE BUSINESSES' PROMOTIONAL LITERATURE MAKE ANY REPRESENTATIONS ABOUT THE SAFETY OR SECURITY OF THE PREMISES?

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