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Craft Program Application

Date:
Business Name/Address:

Name

Street Address 1

Street Address 2

City

State

Zip

County

Phone

Fax

Email

Type of Business IndividualCorporationPartnership LLC
Years in Business

Insured's Name/Address:

Name

Street Address 1

Street Address 2

City

State

Zip

Phone

Fax

Email

Description of your Craft
Number of Employees
Annual Gross Sales
Prior Insurance Company Premium
Losses (Last 3 Years)

Business Information:

Is your studio located at your primary residence? YesNo
If yes, please continue to Item A - Coverage Requested.
If no, please continue to Item B - Coverage Requested.

Item A - Coverage Requested:

Contents/Business Property
(Includes tools,raw materials)

Item B - Coverage Requested:
Building Limit (if applicable) (Maximum $100,000)

Contents/Business Property
(Include tools & raw materials)

Building Information:

Square Footage

Whole Bldg Studio Area
Occupancy OwnRent 

Year Built


If building is over 40 years old, list when updates completed:
Heating: Wiring:
Plumbing: Roof:

Stories in Building

Studio Floor Location

Building Construction

Sprinkler System 

YesNo

Central Alarm

YesNo
1- Has the building been converted from another occupancy? YesNo
2- Is the Building well maintained including windows, walls, ceilings and storage area? YesNo
3- Is there any evidence of prior damage to building? YesNo
4- Are all Doors Protected by Double Cylinder Dead Bolt Locks? YesNo
5- Is the building more than 25% vacant or unoccupied? YesNo

Applicable in the state of Ohio Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any false information or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act, which is a crime.

Applicable in the states of Florida, Kentucky, Michigan, Minnesota, New Jersey, New York and Pennsylvania Any person who knowingly and with intent to defraud any insurance company or another person files and application for insurance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and (NY: substantial) civil penalties.

Applicable in the state of Utah Any person who knowingly presents false of fraudulent underwriting information, files or causes to be filed a false or fraudulent claim for disability compensation or medical benefits, or submits a false or fraudulent report or billing for health care fees or other professional services is guilty of a crime an may be subject to fines and confinement in state prison.

OPERATING WITH A KILN OR FURNACE  It is not our intention to provide coverage where there is an open furnace.  Kilns or furnaces must have a flow regulator and/or a temperature control valve. Loss arising out of a kiln or a furnace with no flow regulator or temperature control valve will be denied. 

NOTE TO JEWELERS  Theft is limited to $5,000 for jewelry, watches, watch movements, jewels, pearls, precious and semiprecious stones, gold, silver, platinum and other precious alloys and metals.  This limit does not apply to jewelry and watches worth $100 or less per item.

UNDERWRITING QUESTIONS
   
1. Are there any other business interests or activities of the named insured that have not been identified or scheduled on this policy? Yes   No
2. Any exposures to flammables, explosives or chemicals? Yes   No
3. Any policy or coverage declined, cancelled or non-renewed during the prior 3 years?                               Yes   No
4. During the last five years, has any applicant been convicted of any degree of the crime of arson?               Yes   No
5. Are there any discontinued operations? Yes   No
6. Any bankruptcies, tax or credit liens against the applicant in the past 5 years?       Yes   No

7. Are any locations vacant, unoccupied or have an occupancy rate of less than 80%?                                

 Yes   No
8. Any uncorrected fire code violations? Yes   No
Please explain any Yes answers.


2008 The Managing Agency Group