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Applicant is:
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Limit of Liability required:
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Deductible:
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Additional Coverage (A separate application is required for each coverage listed below)
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Do you require Employee Dishonesty?
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Do you require a Provincial Licensing Bond?
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Do you require Property coverage?
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Name of Insurer
Policy Limit
Deductible
Period
Premium
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Is renewal being offered?
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Has any insurer declined, cancelled or non
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LIABILITY INFORMATION
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LIABILITY INFORMATION
Operations:
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Is Tenants Legal Liability required?
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ESTIMATE your revenue and Payroll for the next 12 month period and fill in the appropriate categories below: If your Estimated Revenue differs great from your Actual Revenue, please provide reason for expected increase or decrease in Revenue:
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Security Guard Service–Static type
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Security Guard – Alarm Response
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Special Events Security (Concerts & Sporting Events) including Dogs with Handlers
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Armed Guards
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Retail Store Security
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Telephone Answering including Paging
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Private Investigator
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Alarm Monitoring
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Fire & Burglary Alarm Sales & Service
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Fire Extinguishing Equipment excluding Sprinklers
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Sprinkler Systems
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Central Vac, Intercom & Audio Systems
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Locksmiths, Door Locks & Hardward
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Electrical Wiring, CCTV & Home Automation, Electronic Card Access
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Management
Supervisors
Accredited workers
Clerical/others
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Are all employees covered by Worker's Compensation?
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Are all products U.L.C. approved or similar?
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100% of the products used in your installations are from Canadian and/or USA manufacture?
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If no, please advise the following
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e) Do you alter the products in any way, before installation?
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f) Do you re-label the products?
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Do you provide any services at Airports?
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If you or your employees drive vehicles for business that are NOT Owned or Leased in the Company Name, please provide
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Do you have any U.S. sales?
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Do you sublet work?
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Do you secure Liability Certificates from sub-contractors?
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Are hold harmless agreements in favor of your company in place from supplier?
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Do you ever act as a subcontractor?
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If yes, are these projects insured separately under a wrap up?
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The completion of this form is for quote purpose and does not provide any insurance coverage. We may require more information in order to provide a quote. This quote request contains some information about coverage offered but it does not contain all. *
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