19. If independent contractors: Certificates of Insurance obtained? Yes No 20. Applicant named as an additional insured with hold harmless on Yes No security’s policy? 21. Have there been any previous incidents of physical or sexual assault? Yes No If explain: “Yes,” please MAINTENANCE 22. Building Maintenance/Inspection Program? Yes No 23. Parking Lot Maintenance/Inspection Program? Yes No Maintenance is performed by: Employees Subcontractors If outside contractors: Certificates of Insurance are obtained Applicant is named as an additional insured with hold harmless on subcontractor’s policy 24. Snow/Ice Removal is performed by: Employees Subcontractors If outside contractors: Certificates of Insurance are obtained Applicant is named as an additional insured with hold harmless on subcontractor’s policy CONTRACTUAL INFORMATION 25. Is the landlord/tenant agreement a Triple Net Lease? Yes No 26. Certificates of Insurance required from tenants? Yes No 27. required to be equal to or Yes No Tenants’ limits greater than applicant’s? 28. Applicant named as additional insured on policies? Yes No Tenants’ 29. Hold harmless agreement in place with tenants in favor of applicant? Yes No This application does not bind the applicant or the Company to an agreement. However, the information stated on the application shall be the basis of the contract should a policy be issued. The application does not provide coverage or limits or limits than offered by the Company. and may reflect different coverage’s FRAUD WARNINGS: Attach completed WHI APP-152, State Fraud Notification Compliance form. APPLICANT NAME: APPLICANT SIGNATURE: DATE: (Authorized owner, partner or executive officer) PRODUCER: DATE: Individual to contact for inspection/audit: Name: Phone Number:
19. If independent contractors: Certificates of Insurance obtained? Yes No 20. Applicant named as an additional insured with hold harmless on security’s policy? Yes No 21. Have there been any previous incidents of physical or sexual assault? Yes No If “Yes,” please explain: MAINTENANCE 22. Building Maintenance/Inspection Program? Yes No 23. Parking Lot Maintenance/Inspection Program? Yes No Maintenance is performed by: Employees Subcontractors If outside contractors: Certificates of Insurance are obtained Applicant is named as an additional insured with hold harmless on subcontractor’s policy 24. Snow/Ice Removal is performed by: Employees Subcontractors If outside contractors: Certificates of Insurance are obtained Applicant is named as an additional insured with hold harmless on subcontractor’s policy CONTRACTUAL INFORMATION 25. Is the landlord/tenant agreement a Triple Net Lease? Yes No 26. Certificates of Insurance required from tenants? Yes No 27. Tenants’ limits required to be equal to or greater than applicant’s? Yes No 28. Applicant named as additional insured on Tenants’ policies? Yes No 29. Hold harmless agreement in place with tenants in favor of applicant? Yes No This application does not bind the applicant or the Company to an agreement. However, the information stated on the application shall be the basis of the contract should a policy be issued. The application does not provide coverage or limits and may reflect different coverage’s or limits than offered by the Company. FRAUD WARNINGS: Attach completed WHI APP-152, State Fraud Notification Compliance form. APPLICANT NAME: APPLICANT SIGNATURE: DATE: (Authorized owner, partner or executive officer) PRODUCER: DATE: Individual to contact for inspection/audit: Name: Phone Number:
WHI%20SUP-038%20-%20LRO%20Supplement.docx