Company Name: | |
Qualified Licensee: | |
Website: | |
Address: |
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Do you maintain additional offices or other locations? | |
If YES, please list addresses: | |
Person to contact: | |
Title: | |
Phone: | |
Fax: | |
E-mail: | |
Date: | | / | | / | | | | | | |
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License #: | |
Considered: | |
Do you currently or have you ever operated under another name? | |
If YES, what is the Name and Date established of the entity? | |
Principal: | |
Experience: | |
In regards to your clients, do you assume any duties not related to security (e.g. monitoring pressure control or temperature control, valet services or janitorial)? | |
If YES, please describe: | |
Do you subcontract out work to others? | |
If YES, answer the four (4) questions below. If NO, leave them blank.
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1) What type of operation are you subcontracting? | |
2) What is your total cost of subcontracted work? | |
3) Do you require certificates or proof of WC or GL coverage from your subcontractors? | |
4) Are you named as an additional insured on all subcontractor policies? | |
Do you have a training program for new employees? | |
If YES, please describe here: | |
Does your Pre-Employment screening include: | |
Total number of employees: | |
How many worked full time: | |
How many worked part time: | |
How many were armed: | |
How many were unarmed: | |
If you have armed employees, briefly describe your gun control program: | |
Are all armed personnel properly licensed and certified? | |
Do you operate a fee based security training school for guards that are not your employees? | |
Do you sell products? | |
If YES, answer the bottom three (3) questions. If NO, leave blank.
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1) What type of products do you sell? | |
2) How are these products distributed? | |
3) What are the annual gross sales associated with these products? | |
Do you perform fee based credit checks or pre-employment screening services for other companies? | |
Do you provide alarm installation/monitoring/service or CCTV/Access TV Installation/monitoring/service? | |
SECURITY GUARD OPERATIONS ONLY
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Number of supervisors: | |
Number of guards: | |
Total number of guard hours billed to clients ANNUALLY:
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Armed: | |
Unarmed: | |
Do you utilize dogs? | |
If YES, please answer the bottom two (2) questions. If NO, leave blank.
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1) # of dogs: | |
2) Are all dogs attended by trainers: | |
Do you utilize mobile equipment (golf/security carts)? | |
If yes, what is your policy with regard to transporting non-employees? | |
Do you have a standard client contract? | |
If YES, please answer the two (2) questions below. If NO, leave blank.
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1) Percentage using standard contract? | |
2) Before use, are contracts reviewed by counsel in each state in which you operate? | |
Do you have a standard written procedure for reporting incidents? | |
Equipment: Are security officers provided with any of the following equipment prior to starting a post?
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Aerosol chemicals: | |
Handcuffs: | |
Night Stick - Standard: | |
Flashlights: | |
Five cell flashlights: | |
Five cell flashlights:(1) | |
Night Sticks - PR24 or ASP: | |
If YES to any of the above, are officers trained according to applicable state laws? | |
INVESTIGATION ONLY
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Do your final reports include recommendations or an appropriate course of action? | |
If involved in background/credit checks, are all employees trained in fair credit reporting act compliance? | |
Does your firm have procedures in place to protect against clerical errors? | |
Does your firm attach standard disclaimers to all completed reports? | |
GENERAL LIABILITY SECTION
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Client Name: | |
Effective Date (start): | |
Effective Date (end): | |
Check if Limit of Liability Desired is: | |
If a different number, how much? | |
During the past five years have any claims been presented to your present or prior insurer? | |
Do you have any knowledge concerning any incidents that have occurred prior to the date of this application which may result in a future claim? | |
If YES, please provide details: | |
Has your liability insurance ever been canceled, declined or non-renewed in the past three years? | |
If YES, explain: | |
Total Number of Clients: | |
Please provide a list of your 5 largest clients along with a brief description of services provided:
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1) Client Name: | |
1) Description of Service: | |
2) Client Name: | |
2) Description of Service: | |
3) Client Name: | |
3) Description of Service: | |
4) Client Name: | |
4) Description of Service: | |
5) Client Name: | |
5) Description of Service: | |
Additional Coverages
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Do any of your clients, by virtue of written contract, require any of the following: | |
Certain extensions of coverage are available for an additional premium. Please check below if you would like quotes to include the following extensions (subject to underwriting approval). | |
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SUPPLEMENT APPLICATION - complete this section if you have operations in any of the categories.
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Clients Name: | |
Schools and Colleges
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List the names and addresses of the schools where you are providing security.
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1) School Name: | |
1) School Address: |
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2) School Name: | |
2) School Address: |
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3) School Name: | |
3) School Address: |
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Do your duties require that you security check students entering any building? | |
Any work at dormitories or student housing? | |
Do security officers have arrest or detention authority? | |
Do security officers working at schools receive site specific pre-screening and training? | |
SHIPPING PORTS, PIERS, MARINAS List the name(s) of the ports, piers or marinas where you are providing security along with a description of your work.
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1) | |
2) | |
3) | |
Do you provide work at Detention Areas - detain illegal immigrants? | |
Do you provide assistance to passengers with disabilities? (transport on carts or wheelchair assistance) | |
Do you provide passenger screening or screening of any personnel? | |
Do you provide baggage screening or X-Ray services? | |
Do you provide screening of cargo or take custody of any cargo? | |
AIRPORTS List the name(s) of the Airports where you are providing security along with a description of your work.
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1)Airport | |
2)Airport | |
3)Airport | |
-Do you provide work at Detention Areas - detain illegal immigrants? | |
-Do you provide assistance to passengers with disabilities? (transport on carts or wheelchair assistance) | |
-Do you provide passenger screening or screening of any personnel? | |
-Do you provide baggage screening or X-Ray services? | |
-Do you provide screening of cargo or take custody of any cargo? | |
COURIER/TRANSPORT
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Who are your clients for this exposure and what is being transported? | |
Is there separate coverage for loss or damage to the items being transported? | |
Do you have separate Auto coverage in place for operation? | |
HOUSING/RESIDENTIAL Please list the addresses to all residential locations where you provide security.
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EXECUTIVE PROTECTION/BODYGUARD SERVICES
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Do you provide security for any public figures (celebrities, entertainers, sports figures, politicians)? | |
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