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HUB International/ICMAD COSMETIC PROPERTY QUESTIONNAIRE Over
HUB International/ICMAD
COSMETIC PROPERTY QUESTIONNAIRE
UNDERWRITING INFORMATION: (Make additional copies for each location before writing original.)
1. Location:
_______________________________________________________________________________________

2. Effective Date of Coverage: _________________________________________________________________________________


3. Coverage required LIMIT DEDUCTIBLE

Business Real Property (BRP) _________________________ _________________________

Business Personal Property (BRP) _________________________ _________________________

Electronic Data Processing Equipment _________________________ _________________________

Personal Property of Others _________________________ _________________________

Business Inc. / Extra Expense (BI/EE) _________________________ _________________________

Property at Other Locations _________________________ _________________________

Transit
_________________________ _________________________

Other (i.e. glass)
__________________________
_________________________
4. Landlord
_______________________________________________________________________________________


_______________________________________________________________________________________


_______________________________________________________________________________________
5. Additional Insured
( ) Yes ( ) No
Loss Payee
( ) Yes ( ) No
6. Certificate Required
( ) Yes ( ) No
Copy of Lease
( ) Yes ( ) No
7. Construction Type
____________________________________
Protection Class
_____________________________

# of Stories ___________
Year Built _____________ Total Area ________________
Part Occupied _____________
8. Other Occupancies in your building
_________________________________________________________________________



_________________________________________________________________________



_________________________________________________________________________
9. Flammables on Premises
( ) Yes ( ) No
If Yes, Quantity ___________________________________

Separate Flammable Storage Room
( ) Yes ( ) No

Separate from production
( ) Yes ( ) No
10. Burglar Alarm
( ) Yes ( ) No

Central Station
( ) Yes ( ) No
With Keys
( ) Yes ( ) No

Installed and Serviced by: _________________________________________________________________________________
Certificate#
____________________________________ Expiration
Date _____________________________
11. Fire Protection

Sprinklers
( ) Yes ( ) No
Standpipes
( ) Yes ( ) No

Central Station
( ) Yes ( ) No
Local Gong
( ) Yes ( ) No
Serviced
by:

_________________________________________________________________________________
12. Building Improvements

Wiring

( ) Yes ( ) No
If Yes, Year ______________________________________

Roofing

( ) Yes ( ) No
If Yes, Year ______________________________________

Plumbing

( ) Yes ( ) No
If Yes, Year ______________________________________

Heating

( ) Yes ( ) No
If Yes, Year ______________________________________

Other

( ) Yes ( ) No
If Yes, Year ______________________________________
13. Adjacent Building Occupancies

Left
______________________________ Distance from your building _____________________________

Right
______________________________ Distance from your building _____________________________

Rear
______________________________ Distance from your building _____________________________
14.

Loss History: Please attach 5 years of loss runs.




HUB International/ICMAD
COSMETIC PROPERTY QUESTIONNAIRE