Warehouse Legal Liability Standalone Applicationadmin2021-04-25T17:32:35-05:00 1. General InformationCompany Name* Company Address* Contact Person* Phone*Email* Years in Business* No. of Employees* Policy Effective Date* DD slash MM slash YYYY Please list all associations/organizations for which your Company holds membership:Current Insurance Carrier:* 2. Loss ControlDo you employ a Safety Officer or Risk Manager? Please provide name and years of experience.* 3. Company Operations & ServiceLOCATION ADDRESS* Commodities WarehousedGeneral Goods &/or Merchandise % Machinery &/or Machinery Equipment % Electronic &/or Electronic Equipment % Perishable/Refrigerated Food % Non-Perishable Food % Clothing & Footwear % Furniture % Household Goods & Personal Effects % Automobiles &/or Watercrafts % Tobacco &/or Tobacco Derivates % Non-Hazardous Chemicals % Paper Products % Others (Explain) Do you Provide Open Storage Facility? Yes No Do you provide refrigerated storage facility? (include B/M Dec Page) Yes No Do you provide your own Warehouse Receipts? (provide copy) Yes No Attach FileMax. file size: 512 MB.Is this facility sprinkled? Yes No Security and theft prevention system: Average Values Stored $Maximum Values Stored $Limit of Liability $4. Gross SalesGross Warehouses Receipts (Total Gross Sales Less Taxes)Last 12 MonthsNext 12 Months (estimated)5. DeductiblesValues $5,000 $10,000 $15,000 $25,000 $50,000 $100,000 6. Loss History (5 years)Claim YearYear PremiumTotal Paid
