Retailers - Hutch

Retailers – Hutch

Business

Business name:

Legal entity:

Number of employees:

Contact name:

First Last

Phone:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Other location(s):

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email:

Website / Social Media:

Annual sales:

Annual payroll:

Federal tax ID number:

Franchise:

Current carrier:

Years with current carrier:

Policy expiration date:

Number of claims:

Claim(s) details:

General

Is your store part of a chain/franchise?

Is your store a consignment, thrift or used merchandise operation?

Does this retailer have a brick and mortar location?

How many locations do you own / operate?

What is the total insured value of all locations?

(If more than $2,000,000–refer to underwriter)

What type of merchandise is sold?

In addition to retail sales, do you offer any other services?

Percentage of total sales completed exclusively online?

Automatic Sprinkler System

Automatic Sprinkler System?

Provide annual service date:

Fire and Burglary Protection

Multi-purpose fire extinguisher?

Is there a fire alarm?

Are fire extinguishers provided and property maintained?

Any storage of or use of flammable or combustible liquids?

Is smoking allowed on the premises?

If yes, is it restricted to certain areas?

Adequate disposal containers?

Adequate separation of at least 3 feet between ignition sources?

(ex. heaters) and retail displays?)

A proper emergency evacuation plan including notification of customers in store?

Are there fire exposures from adjacent tenants or buildings?

(i.e. Commercial cooking, welding, etc.)

Is there a pre-employment screening program for employees who will have access to cash and goods?

Is cash on hand or in cash drawers kept at a minimum?

Daily deposits?

Surveillance cameras positioned to monitor cash registers?

Are there established “buddy” procedures for opening and closing the business?

Adequate interior and exterior lighting?

Property / Liability

Description of inventory stored:

Safety Data Sheets on site for each material kept on site?

Is there a plan in place for snow removal?

If yes, Third Party Vendor with COI obtained?

Are storage racks bolted to the floor or wall?

Approximate height (feet) of storage rack:

Width of aisles (feet)?

Describe inventory control system:

Is warehouse heated?

Are powered industrial trucks used?

(forklifts, order pickers, powered pallet jacks, etc.)

Forklift refueling area controlled?

Pest control program in place?

General Premises

Hours of operation?

Year of roof:

Roof type:

Roof condition:

Roof concerns:

Burglar Alarm:

Outside Lighting:

Peeling / Flaking paint?

If yes, where?

Any Deterioration / Dry Rot?

If yes, where?

Is building or occupancies segregated via fire divisions or walls?

Egress routes well marked and maintained?

Emergency lighting provided?

Spills cleaned up immediately and “Caution Wet Floor” signs displayed around the affected area?

Foundation condition:

Walking surfaces:

Heating type:

Heating condition:

Age:

Electrical condition:

Age:

Overall Housekeeping?

Property

Blanket

Deductible amount:

Building value:

Additional Property (signs, lights, clocks, fences, playgrounds, etc.)

Construction type:

Protection class:

Year built:

Total square footage:

Applicant square footage:

Number of stories:

List other tenants:

Sewer / Drain:

Employee dishonesty:

Computer coverage:

Include enhancement endorsement

General Liability Limit

Select one:

Umbrella?

Rating basis:

Sales / Receipts:

Payroll:

Data Breach liability:

Employee benefit liability:

Employment practices liability:

Deductible:

Number of Employees (full-time):

Number of Employees (part-time):

Third-party coverage?

Workers’ Compensation

Any back injury prevention training?

Are safety meetings held?

Use of powered pallet jacks?

Forklifts?

Including proper training?

Use of any mobile lifts for stocking of inventory in racks?

Use any rolling ladders, step ladders?

Training and inspection?

Expert modification factor:

Expert modification date:

Sole proprietor / Partners coverage?

Corporate officer coverage?

List

Class code #:

Payroll =

Average length of employment:

Safety:

Safety meetings

Lifting training

Forklift training

PPE training

(check all that apply)

Eye washing stations?

Autos

Auto used in business?

Autos titled to?

Hired / Non-owned?

Do your corporate officers maintain a personal auto policy?

If no, consider adding the corporate officers named coverage endorsement.

Liability

Med Pay

Um / Uim

Comp

Coll

List

Year

Make

Model

VIN

Documents

Exterior photos of front and back

Interior photos of waiting room, exam room, kennel/boarding area

Loss runs

Check each box when complete: