11. If you are the owner of premises are any of the premises vacant? If yes please provide full details 13. If you flammable or toxic material on the premises please state the types and quantity in litres? 14. Please confirm the safety protection installed at each location Please tick for each location – Location 1 Location 2 Location 3 Location 4 Fire sprinkler System Fire extinguishers Local alarm Monitored alarm CCTV Electronic building entry Deadlocks on doors Property Cover 15. Please confirm property cover requirements for each location Location 1 Location 2 Location 3 Location 4 Building $ $ $ $ Contents $ $ $ $ Stock $ $ $ $ Theft Cover Yes No Yes No Yes No Yes No Cover 16. Do you require cover for replacement of glass? Location 1 Location 2 Location 3 Location 4 Yes No Yes No Yes No Yes No Business Interruption 17. Do you require cover for the following Gross revenue $ Gross profit $ Weekly revenue$ 18. Does the above amount include loss of rent? Yes No 19. Accounts receivable $ 20. Please confirm the indemnity period required for accounts receivable months 21. Do you require additional cost of working? $ 22. Please confirm the indemnity period required for additional cost of working months Money 23. Do you require cover for theft of money? Location 1 Location 2 Location 3 Location 4 $ $ $ $ Machinery Breakdown 24. Do you require for machinery breakdown? List any individual items to be covered
11. If you are the owner of premises are any of the premises vacant? If yes please provide full details 13. If you flammable or toxic material on the premises please state the types and quantity in litres? 14. Please confirm the safety protection installed at each location – Please tick for each location Location 1 Location 2 Location 3 Location 4 Fire sprinkler System Fire extinguishers Local alarm Monitored alarm CCTV Electronic building entry Deadlocks on doors Property Cover 15. Please confirm property cover requirements for each location Location 1 Location 2 Location 3 Location 4 Building $ $ $ $ Contents $ $ $ $ Stock $ $ $ $ Theft Cover Yes No Yes No Yes No Yes No Cover 16. Do you require cover for replacement of glass? Location 1 Location 2 Location 3 Location 4 Yes No Yes No Yes No Yes No Business Interruption 17. Do you require cover for the following Gross revenue $ Gross profit $ Weekly revenue$ 18. Does the above amount include loss of rent? Yes No 19. Accounts receivable $ 20. Please confirm the indemnity period required for accounts receivable months 21. Do you require additional cost of working? $ 22. Please confirm the indemnity period required for additional cost of working months Money 23. Do you require cover for theft of money? Location 1 Location 2 Location 3 Location 4 $ $ $ $ Machinery Breakdown 24. Do you require for machinery breakdown? List any individual items to be covered
OPP-Proposal-Form-V9.17.docx