SEARS DEALERS

COMMERCIAL INSURANCE QUESTIONNAIRE

General:

Named Insured (Corporation Name):  

Mailing Address:  

Location of Store:

Number of Years in Business:

Percentage of Hardware vs. Appliance Sales:

Current Insurance Carrier and Expiration Date:

Current Insurance Premiums:

Any Claims in the Last 5 Years? If yes, please provide date of loss, brief description, and amount paid:

Property/Liability:

Do You Own the Building or are You a Tenant?

Strip Mall or Stand Alone Store:

Construction of Building:

Year Built:

Square Feet of Store:  

Number of Stories:

Sprinklered   – Yes / No

Neighbor on Each Side of Store:

Fire Alarm - Yes / No - Type:

Burglar Alarm - Yes / No -   Type:

Building Limit (If Applicable):

Business Personal Property / Inventory Limit:

Property Deductible on Current Policy:

Employee Dishonesty Limit (Sears Requires $50,000):  

Number of Employees?  

Transit Limit ($30,000):

Liability Limits (Sears Requires $1,000,000):  

Estimated Annual Sales:  

Auto

Liability Limits (Sears Requires $1,000,000):

Comprehensive and Collision Deductibles:

Year, Make, Model, and Vehicle Identification Number (VIN) of each vehicle:

Drivers Info: Name, Driver's License Number, State, and Date of Birth for each person that drives the vehicles listed above:

Do you use any of the above vehicles for delivery? If so, which one(s)? How far do you deliver (within 50 mile radius)?

Worker's Compensation:

Are any Owners, Partners, Officers, etc. excluded? If so, what are their names?

Employer's Liability Limits (Sears Requires $500,000):

Class Code(s), Classification(s), and Estimated Payroll(s) on Current Policy:

IF YOU DO NOT KNOW, PROVIDE ESTIMATED ANNUAL PAYROLL FOR:

Retail Sales Employee(s):

Driver(s):

Warehouse Employee(s) (If Applicable):

Umbrella (Excess Layer of Liability Coverage):

Limit Provided on Current Policy ($1MM):

ANY OTHER COVERAGES????