builders - Premier Marine by linxiaoqin

VIEWS: 1 PAGES: 107

									 

 




     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



         
 

 

 

 

 

 

 

 




    1.0 GENERAL INFORMATION
 

 

          

 

 
                                                                                            GENERAL INFORMATION
COMPANY BACKGROUND:
     Premier is a boutique Managing General Agency (M.G.A.) focusing on several specialty areas of insurance. The
     Premier insurance products are marketed exclusively through independent brokerages across Canada.

     Founded in 1989, Premier is proud to be a Canadian company and independently owned. Premier operates from
     three offices in Canada (Vancouver, Toronto, and London), and one in the United States (Seattle), to serve our broker
     customers. Headquarters are located in Vancouver.

     The Premier capacity providers include Lloyds Underwriters, Ascentus (member of Royal Sun Alliance Group),
     Sovereign General, and Intact (formerly ING).

     Premier was founded on a service first commitment - fast turnaround, no runaround! providing you with:

          •    Accessible underwriting and claims staff (no voicemail !)
          •    Quotations are returned to brokers promptly
          •    Prompt and accurate policy issuance
          •    Prompt and fair claims handling
          •    and a great selection of specialty insurance products, growing in scope each year.


BROKER GUIDELINES / TERMS:
          •    Brokers do not have binding authority. Brokers may quote these rates subject to eligibility and underwriting criteria
               being satisfied. The company in its sole judgement may elect to accept or reject any application. Insurance is not in effect
               until Premier Marine has issued a binder number.
          •    Broker credit terms can be arranged (refer to Premier Marine).



CLAIMS PROCEDURES:
    •    All claims can be faxed to Premier Marine using the appropriate Claim Report Form.
    •    Any supporting documentation available at the time of reporting the loss should accompany your report to Premier Marine.


BRANCH LOCATIONS:
Western Canada (HEAD OFFICE)           625 Howe St., Suite 650, Vancouver, BC V6C 2T6       Tel (604) 669-5211   Fax (604) 669-2667
Central & Atlantic (Personal Lines)    40 University Ave., Suite 201, Toronto, ON M5J 1T1   Tel (416) 365-0444   Fax (416) 365-0446
Central & Atlantic (Marine only)       439 Waterloo Street, London, ON N6B 2P1              Tel (519) 850-1610   Fax (519) 850-1614
U.S.A. (Marine only)                   800 Fifth Ave., Suite 4100, Seattle, WA 98104        Tel (800) 589-4208   Fax (800) 522-4461


Website: www.premiermarine.com
    •    Visit our Broker friendly website, no code is necessary! All of Premier’s applications, wordings and warranties can be
         downloaded.


PREMIER MARINE                                                                                                                 CAN Mar 11
                                                                                                                                       1.1
2.0 MARINE – Recreational
                                                                                                      2.0 M A RIN E

B O AT/ Y ACHT P ROGR AM O VERVI EW
This department is able to provide coverage for Sea-Doo’s right up to yachts with values of $20 million.
Premier insures the following risks everyday:

        Outboard Boats                        Sailboats
        Runabouts                             Power Cruisers
        Sport Boats                           Trawlers
        Cuddy Cabin Boats

We also provide coverage for specialty watercraft:

        Jet Boats                             High Performance
        Riverboats                            Houseboats/Pontoon Boats
        Ski-Boats                             Steel Boats
        Bass Boats                            Skippered Fishing Charters
        Aluminum Boats                        Classic (wood construction)
        Inflatables

Extended Navigation Limits are also available:

        Mexico                                Australia
        South Pacific                         and most other ports in the world

We also offer our PREMIER PWC PAC offering coverage for:

        Sea Doo
        Tigershark
        Jet Ski
        Yamaha Waverunner
        Etc.




PREMIER MARINE                                                                                              CAN Mar 9/07

                                                                                                                     2.1
                                                                                                       2.0   M A R I NE  

U NDERWRITING G UIDELINES

APPLICANT:
       Registered owner and principal operator must be 25 years of age or over.

       Registered owner and principal operator must have a minimum of two years prior ownership of a similar vessel and
         be able to provide prior carrier information. Exceptions can be made – refer to Underwriting Department.

       The automobile driving record during the past three years criteria are:
         Not more than 2 minor violations per individual per household.
         No major violations.
         No more than one "at fault" accident per household.

       Maximum one boating loss in the past three years.

       Applicant must not have had insurance cancelled or refused.

       No criminal code violations.


VESSEL:
       Vessels over 15 years old require a survey.
       Vessels over 15 years old but under 25 feet require a photo instead of survey.
       Vessel must be insured to fair market value.
       Refer to Premier for all vessels built with material other than fiberglass.
       All rates in this package apply to fiberglass boats only.
       Ferro cement construction not eligible.



WHY CHOOSE A STANDALONE BOAT POLICY OVER A HOMEOWNERS EXTENSION?
   Removal of Wreck Coverage – Recovery of a sunk vessel may be quite costly, and not insured by most
         homeowners policies.
     Uninsured Boater Coverage – this coverage is not provided on most homeowners policies.
     Having a claim on the boat may result in losing a claims-free homeowners discount.
     When you have a boat claim, you want an expert in boats arriving at your door to assist – not a general adjuster
         with no expertise in watercraft.


UNIQUE PREMIER POLICY LANGUAGE THAT GUARANTEES COVERAGE WHEN NEED MOST.
Premier Marine protects you from consequential property damage. Most marine policies contain language that allows those
underwriters to deny any claim arising from damage by, or resulting from, wear and tear, corrosion, rust, etc.
Unique to Premier, our policies specifically bring back the coverage for basic marine perils such as fire, sinking, submersion,
demisting, collision or stranding. Most other policies leave you without coverage should a thru hull corrode or vermin chew
the exhaust valves and cause the vessel to sink. Refer to policy form.




PREMIER MARINE                                                                                                       CAN Apr 11 

                                                                                                                            2.2 
                                                                                                               2.0   M A R I NE  
RATES-OUTBOARD BOATS & SMALL BOATS

Policy Coverage / Standard limits

Policy Form:           Multi-Standard Policy Agreement
                       All Risk
                       Replacement Cost (refer to wording for limits)

Standard Limits:       Protection & Indemnity:        $1 Million
                       Pollution / Spill Liability:   $1 Million
                       Medical Payments:              $5,000
                       Uninsured Boater:              $1,000,000
                       Accidental Death Benefits:     $10,000 max.
                       Loss of Use:                   $500
                       Personal Effects:              $1,000
                       Emergency Towing:              $1,000

Deductibles:     $250 on Hull and $500 on Underwater Machinery
                 $250 deductible on Electronic Equipment, Personal Effects, Trailer,
                 Dinghy Auxiliary Motor.
_______________________________________________________________________________________________

OUTBOARD BOAT                                         SMALL BOATS
(Outboard motors only)                                (Inboard motors & Inboard/Outboard motors)

To qualify for the Outboard Boat Program
rates, the following additional criteria must
be met.                                               Refer to Underwriters for a quote.

       Outboard powered only                         Vessel Value Sample Premium
       Maximum horsepower: 130hp                     $20,000………………….…….. $245
       Maximum speed:        47mph
       Fiberglass & Aluminum Hull only               $30,000…………………………. $315
                                                      Increase Liability to $2 Million add $45

PKG. VALUE
(Boat, Motor & Trailer) Premium                       (Rates subject to eligibility)
$0 to $5,999………………………… $156
$6,000-$6,999…………………….... $167                        Various Discounts Available:
$7,000-$7,999……………………… $176                           (excludes outboard boats)
$8,000-$8,999……………………… $187
$9,000-$9,999……………………… $208                                Mature Mariners (Age 50 & older)
$10,000-$10,999…………………… $219                               Claims Free
$11,000-$11,999…………………… $229                               CYA Courses (Excluding Pleasure Craft Operator Card)
$12,000-$12,999…………………… $239                               Canadian Power and Sail Squadron (Excluding
$13,000-$13,999…………………... $249                          Pleasure Craft Operator Card)
$14,000-$14,999…………………... $260                         Equipment
$15,000-$15,999…………………… $270                           Yacht club members
                                                       Other marine coarses
Increase Liability to $2 Million add $45.
                                                        The following risks must be referred to Premier for rating:
10% Surcharge for saltwater use.                           High Performance
                                                           Jet Boats
                                                           Bass Boats
                                                           Pontoon Boats
                                                           Houseboats, etc



                Fast Turnaround, No Runaround! Quotations and Binders Guaranteed within one hour!

PREMIER MARINE                                                                                                            CAN Apr 11 

                                                                                                                                 2.3 
                                                                                                           2.0   M A R I NE  
RATES-POWER CRUISERS & SAILBOATS

To qualify as a cruiser / sailboat:
     Vessel must be equipped with: head, galley, sleeping quarters, depth finder and S/S radio.
     Vessel must be 24’ in length or larger (see small boat rates if smaller).


Policy Coverage / Standard limits

Policy Form:               Mariner’s Choice Policy Agreement
                           All Risk
                           Replacement Cost (refer to wording for limits)

Standard Limits:           Protection & Indemnity:         $1 Million
                           Pollution / Spill Liability:    $1 Million
                           Medical Payments:               $5,000
                           Uninsured Boater:               $1,000,000
                           Accidental Death Benefits:      $10,000 max.
                           Loss of Use:                    $1,500
                           Personal Effects:               5% up to $5,000
                           Emergency Towing:               $1,000

Deductibles:     1% of vessel value on Hull and Underwater Machinery damage (Min. $500)
                 $250 deductible on Electronic Equipment, Personal Effects, Trailer,
                 Dinghy Auxiliary Motor.
_______________________________________________________________________________________________


GASOLINE POWERED CRUISERS                                            SAILBOATS

 Vessel Value Sample Premium                                         Vessel Value Sample Premium
$50,000………………………………$348                                              $50,000………………………………$320


$90,000………………………………$503                                              $70,000………………………………$448

Refer to Underwriters for a quote.                                   Refer to Underwriters for a quote.


(Rates subject to eligibility)                                       (Rates subject to eligibility)


Increase Liability to $2 Million add $65.                      Increase Liability to $2 Million add $35.


Various Discounts Available:

   Mature Mariners (Age 50 & older)
   Claims Free
   CYA Courses (Excluding Pleasure Craft Operator Card)
   Canadian Power and Sail Squadron
    (Excluding Pleasure Craft Operator Card)
   Equipment
   Yacht club member
   Other marine coarses
   Trawler style yachts (single engine)


                   Fast Turnaround, No Runaround! Quotations and Binders Guaranteed within one hour!


PREMIER MARINE                                                                                                       CAN Apr 11 

                                                                                                                            2.4 
                                                                                                     2.0   M A R I NE  

PLATINUM YACHT PROGRAM (for high-valued Yachts)

To qualify as a Platinum Yacht:
     Power or Sail
     Minimum Value $400,000*
     Yachts valued up to $25 million
     Seasoned Yachtsmen (experience and ownership history required to qualify)

* refer to Premier's Mariners Choice and Multi-Standard Program for vessels valued under $400,000



Policy Coverage I Standard Limits

Policy Form:       Platinum Yacht Policy Agreement
                   All Risks
                   Inflation Protection (up to 115% of limit on Declaration Page) for vessels 3 years and newer


Standard Limits:   Protection & Indemnity:       $2 million
                   Spill Liability:              $2 million (sub-limit of P&I coverage)
                   Medical Payments:             $25,000
                   Accidental Death Benefits:    Up to $10,000
                   Uninsured Boater:             $1 million
                   Personal Effects:             $25,000


Optional Coverage: Boathouse
                 Additional Personal Effects


Extensions of Coverage:
                  Emergency Navigational Extension
                  Consequential Damage Coverage
                  Loss of Use:               $ 1,500
                  Emergency Towing:          $ 2,500
                  Emergency Vacation Expense: Up to $250 per day (subject to conditions in Policy Wording)


Deductible:        1% of Boat Value
                   $250 respects; tender, tender motor and navigation electronic equipment


Various Discounts (at underwriter discretion):
Age of Vessel
Higher Deductible Option
Power Squadron graduates
Claims Free
Trawler Style with Single Engine or Sailboats
Members of Yacht Clubs




               Fast Turnaround, No Runaround! Quotations and Binders Guaranteed within one hour!


PREMIER MARINE                                                                                                    CAN Apr 11 

                                                                                                                         2.5 
                                                                                              2.0 M A RIN E
R AT E S – P . W . C . ( F O R S E A - D O O ’ S )


PROVIDING COVER FOR:

Arctic Cat              Bombardier          Jet Ski        Kawasaki    Polaris      Sea Doo
Tigershark              Wet Jet             Yamaha Waverunner



ELIGIBILITY REQUIREMENTS:

•   Principal operator and owner must be over 16 years old.
•   Principal operator must have valid driver’s license.
•   No more than one boating claim in last 3 years.
•   No major driving violations in last 3 years.
•   No more than 2 minor driving violations in last 3 years.
•   No more than one at fault auto accident in last 3 years.
•   Engine must be stock (no modifications)
•   Refer to Premier for units valued over $20,000.



COVERAGES:

•   All Risk*
•   *Theft cover limited – see form.
•   Actual cash value.
•   Marine Liability (P & I) See optional limits.
•   Medical Payments $2,500
•   Accidental Death Benefit $5,000
•   Uninsured Boater $25,000
•   Deductible - $100



RATING SCHEDULE:

Base Premium (Includes $250,000 P&I):
Units valued up to $6,499……………………………………………………………………………………………….. $240
Units valued $6,500 to $12,999………………………………………………………………………………………… $290
Units valued $13,000 and up……………………………………………………………………………………………$365
Increase P&I to $500,000……………………………………………………………………………………………….. $75
Increase P&I to $1 Million……………………………………………………………………………………………….. $125
Trailer Coverage…………………………………………………………………………………………………………. $10

Discount System:
  - at least 2 years experience with these craft or a supporting boat policy with Premier……………………. -$50




                 Fast Turnaround, No Runaround! Quotations and Binders Guaranteed within one hour!




PREMIER MARINE                                                                                        CAN Mar 9/07

                                                                                                               2.6
PREMIER MARINE INSURANCE – SMALL BOAT & YACHT                                                                                                                                  QUOTE ONLY
                           APPLICATION FORM                                                                                                                                    PLEASE BIND
INSURED:_________________ _____ ____REG’D OWNER:__ __________________________PHONE: (BUS):______                                        _____________ (RES):__________________________

ADDRESS:_________________________________________________ CITY:_______________________________PROV:______________P.C:___________________________

DATE OF BIRTH:___________________OCCUPATION:__________________________________EMPLOYER:_______________________________________________________

NO. OF YEARS AS OWNER OF A BOAT:_________________NO.OF YEARS AS OPERATOR/CREW:____________INSURANCE EFFECTIVE DATE:______________________

PREVIOUS INSURER (THIS OR PRIOR BOATS):______________________________________________POLICY NO.:_______________________EXPIRY DATE:_____________

SIZE AND TYPE OF PREVIOUS BOATS:_____________________________________________________MEMBER OF CRUISING CLUB:_________________________________

BOATING EDUCATION & COURSES:________________________________________________________DATE OF SURVEY:__________________________________________

BOATING LOSSES IN PAST 3 YEARS( CLAIMED OR OTHERWISE – GIVE DATE AND DESCRIPTION)_____________________________________________________________

COVERAGES – HULL & MACHINERY____________________________MAKE:___________________________MODEL:________________________YEAR:_____________
SERIAL#:______________________________________________________ REGISTRATION#:_______________________LENGTH:_________________ BEAM:____________


DATE                                      PURCHASE                    REPLACEMENT                 CURRENT
PURCHASED:_____________________________ PRICE:$___________________ COST NEW:$________________ MARKET VALUE:$________________
OUTBOARD/
AUXILIARY MOTOR:*________________________ SERIAL #:_______________________________________YEAR:____________VALUE:$______________

DINGHY:*__________________________________ SERIAL #:_______________________________________YEAR:____________VALUE:$______________

DINGHY MOTOR:*__________________________ SERIAL #:______________________________________ YEAR:___________ VALUE:$______________

*NOT COVERED UNLESS ITEMIZED                                                                         TOTAL HULL & MACHINERY                           VALUE:$_________ PREMIUM$___________

ADDITIONAL PERSONAL EFFECTS (to be listed separately):___________________________ ___________________________                                       _ VALUE:$_________ PREMIUM$___________

TRAILER: MAKE:____________________________ SERIAL #:______________________________________ YEAR:____________VALUE:$_________ PREMIUM$___________

OPTIONAL COVERAGES:____________________________________________________________________________________________________                                                             PREMIUM$___________

LOSS PAYABLE-_____NAME:____________________________________________                                  ____ __                             LIABILITY________ _                     _(1,000,000)$_______INCL

                                   ADRESS:______________________________________________ ____ __                                        LIABILITY_______________ (2,000,000)$_____ _ ____

                                   CITY:____________________PROV:_______POSTAL CODE:___________                                         POLICY FEE_______________________$__                                     35.00

                                                                                                                                       TOTAL PREMIUM______________ $___________

List all operators of the vessel*:                                                                  List all auto moving traffic violations and at fault accidents per operator:
(*Name; date of birth; years of experience; % use; DRIVERS LICENCE NUMBER)         (in past 3 years; date of conviction; description, Date of accident; amount paid; description; indicate if no current drivers licence)

1________________________________________________________________________________________________________________________________________________

2________________________________________________________________________________________________________________________________________________

WHERE IS BOAT MOORED?_________________________ ___________WHERE LAID UP?__________________________________ASHORE__________AFLOAT________

IS BOAT PERMANENTLY MOORED ON A MOORING BUOY? ___YES_____NO_______IS BOAT USED FOR WATERSKIING?___ ___YES_____NO _________________

IS YACHT TRANSPORTED OVERLAND?____________________YES_____NO_______HOW FAR?___________________HOW OFTEN?_____________________________

TYPE OF VESSEL:           SAILBOAT TRAWLER CRUISER HIGH PERFORMANCE HOUSEBOAT RUNABOUT SKIBOAT                                                             OTHER______________________

DOES YACHT HAVE:  SLEEPING QUARTERS GALLEY HEAD RADAR COMPASS DEPTH FINDER S/S RADIO PROPANE                                                                          LIVE ABOARD  YES  NO

LORAN GPS AUTOPILOT VAPOUR DETECTION SYSTEM  BUILT IN CO₂ OR HALON SYSTEM  FIRE EXTINGUISHERS (No.) ____________

IS YACHT OF FIBREGLASS CONSTRUCTION?__ _YES__NO, SPECIFY:_______________________________TYPE OF FUEL:____ _GAS___ DIESEL__MAX.SPEED:_______________

NO. OF ENGINES:________MANUFACTURER:_______  INBOARD_ OUTBOARD_ I/O__ JET_ TOTAL HORSEPOWER:_________PLEASURE USE ONLY?  YES  NO

NAVIGATIONAL LIMITS REQUESTED:____________________HAVE YOU EVER HAD ANY INSURANCE REFUSED OR CANCELLED?  YES  NO REASON:____________________________



PLEASE READ BEFORE SIGNING APPLICATION:
This application will be incorporated in its entirety into any relevant policy of insurance where Insurers have relied upon the information contained herein. Any
misrepresentations or concealment in this application for insurance, will render insurance coverage null and void from inception. Please therefore check to make sure
that all questions have been fully answered and that all facts material to your insurance have been disclosed, if necessary by a supplement to the application. A
consumer report containing personal, credit, factual or investigative information about the applicant may be sought in connection with this application for insurance or any
renewal, extension or variation thereof. Signing this form does not bind the Applicant to purchase the insurance or the Insurer to accept the risk, but it is agreed that this
form shall be the basis of the contract should a policy be issued.

DATE:_________________________________________________________________________________SIGNATURE OF APPLICANT:__________________________________

BROKERAGE FIRM:______________________________RETURN FAX NO.:________________________ SIGNATURE OF BROKER:____________________________________

BROKER EMAIL:________________________________________________________________________ BROKER AGENT # : _________________________________________

                                    NOTE: INSURANCE IS NOT IN EFFECT UNTIL PREMIER HAS ISSUED A BINDER NUMBER.
                               THE COMPANY IN ITS SOLE JUDGEMENT MAY ELECT TO ACCEPT OR REJECT ANY APPLICATION.

             ONTARIO & EASTERN CANADA                                                                                            WESTERN CANADA
           Tel: (519) 850-1610 Fax: (519) 850-1614                                                                        Tel: (604) 669-5211 Fax: (604) 669-2667

                                                                      www.premiermarine.com
PREMIER MARINE INSURANCE – PWC PAC APPLICATION FORM                                                                                              QUOTE ONLY
                                                                                                                                                 PLEASE BIND


INSURED:_________________ _____ ____REG’D OWNER:__ __________________________PHONE: (BUS):______                       _____________ (RES):__________________________


ADDRESS:_________________________________________________ CITY:_______________________________PROV:______________P.C:___________________________


DATE OF BIRTH:________________BOATING EXPERIENCE:___________________BOATING EDUCATION COURSES:__                              _______________________________________


PREVIOUS INSURER (THIS OR PRIOR BOATS):______________________________________________POLICY NO.:_______________________EXPIRY DATE:_____________


BOATING LOSSES IN PAST 3 YEARS (CLAIMED OR OTHERWISE – GIVE DATE AND DESCRIPTION)_____________________________________________________________


DRIVING RECORD LAST 3 YEARS, LICENSE #:__________                         ________________________INSURANCE EFFECTIVE DATE:_________________________________


HAVE YOU EVER HAD ANY INSURANCE REFUSED OR CANCELLED? YES_NO                          REASON:                                   PLEASURE USE ONLY? YES_NO               __



COVERAGES – HULL & MACHINERY___________MAKE:_________                         __________        __ ______MODEL:_____            ___________________YEAR:_____________


SERIAL#:___________________________ REGISTRATION #:_______________________MODIFICATIONS: (Y OR N)                           MAX.SPEED/HORSEPOWER:___________ ___

DATE                                               PURCHASE                   REPLACEMENT               CURRENT
PURCHASED:_____________________________            PRICE:$___________________ COST NEW:$_______________ MARKET VALUE:$________                    PREMIUM: $       ________


TRAILER: MAKE:____        ____________________ SERIAL #:___________________ YEAR:____________                       VALUE:$__                      PREMIUM: $__+_______


LOSS PAYABLE (if applicable):          ____________________________________________              ____ __            DISCOUNTS (MAX.$50)__ _       $        -       (        )

                                          _____________________________________________ ____ __                      LIABILITY ($250,000)________$__                   INCL._


NOTICE TO THE APPLICANT                                                                                             LIABILITY ($500,000) ($75) ___$__          +       _____ _

Keeping this coverage affordable requires making some sensible policy limitations.
This policy excludes the following:                                                                                 LIABILITY ($1 MILLION) ($125)_$__          +       _____ _
            Theft unless it occurred following illegal and forcible entry or exit to a locked building in which
             the insured property is located. There must be visible marks at the point of forced entry or exit.
             This theft coverage restriction does not apply where the personal watercraft is: onboard or tied
             to your yacht, on top of a dock whilst locked and chained to that dock, or on a boat lift system
             attached to a dock or land.
            Ingestion damage to the power unit however caused.                                                     POLICY FEE________________$__              +   35.00_
            The premium is fully earned and fully retained in the event of a cancellation.

                                                                                                                    TOTAL PREMIUM_____                $_____           ______




PLEASE READ BEFORE SIGNING APPLICATION:
I may have provided personal information in this document and by other means and I may in the future provide further personal information. Some of this personal
information may include, but is not limited to, my credit information and claims history. I authorize my broker or insurance company to collect, use and disclose any of this
personal information, subject to the law and to my broker’s insurance company’s policy regarding personal information, for the purposes of communicating with me,
assessing my application for insurance and underwriting my policies, evaluation claims, detecting and preventing fraud, and analyzing business results. I confirm that all
individuals whose personal information is contained in this document have authorized that I agree to the above on their behalf.



DATE:_________________________________________________________________________________SIGNATURE OF APPLICANT:__________________________________


BROKERAGE FIRM:______________________________RETURN FAX NO.:________________________ BROKER EMAIL:_                               ___________________________________


SIGNATURE OF BROKER:____                                                                         ________________________________________________________________


                               NOTE: INSURANCE IS NOT IN EFFECT UNTIL PREMIER HAS ISSUED A BINDER NUMBER.
                          THE COMPANY IN ITS SOLE JUDGEMENT MAY ELECT TO ACCEPT OR REJECT ANY APPLICATION.


            ONTARIO & EASTERN CANADA                                                                                  WESTERN CANADA
          Tel: (519) 850-1610 Fax: (519) 850-1614                                                              Tel: (604) 669-5211 Fax: (604) 669-2667

                                                                 www.premiermarine.com
PREMIER MARINE INSURANCE – QUICK QUOTE
                         (SHORT FORM APPLICATION)



Insured: __________________________________________                              Vessel Year: _____________________
Address: _________________________________________                               Make: __________________________
City: _______________________ Age: ________________                              Model: __________________________
Years as owner of a boat: ___________________________                            Engine: O/B          I/O     I/B
Date Purchased: __________________________________
Experience: NONE               Years: ______________________                    Length: ___________ H.P: _________

Boating Courses:                        NONE          YES                      Max. Speed: _____________________

Insurance every cancelled:              NO            YES
Driving Record:                         CLEAR OTHER                            Market Value: ____________________
Previous Insurer: __________________________________                             Trailer Value: _____________________
Boating Losses (last 3 years):          NONE           YES                     Other: __________________________

Describe: ________________________________________                                         Liability: $2 million

________________________________________________                                                      $1 million
________________________________________________                                                      PWC $500,000
Brokerage Firm: __________________________________                                                    PWC $250,000
Contact: ___________________ Date: _______________                                                    PWC $1,000,000
Broker Tel: _____________ Broker Fax: _______________                            Broker Email: _____________________

..........................................
QUOTATION (For Underwriter’s Use Only)
Class: __________________               Hull Limit: ___________________                    Premium: $ _______________
Deductible: ______________              Liability Limit:_________________                  Premium: $ _______________
_______________________                 Trailer Limit: _________________                   Premium: $ _______________
Nav.Limit: _______________              Other: ______________________                      Premium: $ _______________
Conditions: ______________              Wording: ____________________                      Policy Fee: $_35.00_________
________________________                ____________________________                       Ttl. Premium: $ ___________


                                                                                           Quoted By: ________________


NOTE: Quotation only. Subject to a fully completed application. Risk not bound until Premier issues a binder.


                                                 PREMIER MARINE
     ONTARIO & MARITIMES                                B.C. & PRAIRIES                                     U.S.A.
      Tel (519) 850-1610                               Tel (604) 669-5211                          Tel (800) 589-4208
      Fax (519) 850-1614                               Fax (604) 669-2667                          Fax (800) 522-4461
 

 

 

 

 

 

 

 




    3.0 RECREATIONAL VEHICLES
 

 

          

 

 
                                                          3.0 VACATION TRAILERS
 

                             Vacation Trailers - Ontario
                                Program Features:


Providing Coverage For:
    Travel Trailers                    Campers
    5th Wheel Campers              Horse Trailers
    Tent Trailers                      Utility Trailers


    Standard Package: Actual Cash Value Named Perils
        Personal Property 10% of trailer value included
        Emergency Vacation Expenses $1000
        Outbuilding $1000
        Golf Cart Property Coverage $5000

    Enhanced Standard Package: Actual Cash Value All Risk
       Personal Property 10% of trailer value included
       All Risk
       Emergency Vacation Expense $1000
       Outbuilding $1000
       Golf Cart Property Coverage $5000

    Premier Choice Package: Replacement Cost All Risk
        Must be the original owner
        Replacement cost on units 15 years and newer
        All Risk
        Personal Property 10% of trailer value included
        Emergency Vacation Expenses $2000
        Outbuilding $1000
        Golf Cart Property Coverage $5000

    20% Commission

    Optional Comprehensive Personal Liability - $25




PREMIER MARINE                                                  ON  Rev. NB Sep 15, 2011/REN Nov 1, 2011
                                                                                                3.1
                                                               3.0 VACATION TRAILERS
 

                                 Vacation Trailers - Ontario
                                  Underwriting Criteria:


Eligibility:        - Factory build and CSA approved units only
                    - Heated by electricity, natural gas or propane
                    - Up to 38 feet in length
                    - Up to 20 years old
                    - Insured values up to $150,000

Minimum Premium:
    Minimum Policy Premium (after credits)        $100
    Minimum Retained Premium                      $50
    Premier Marine Policy Service Fee             $25

Policy Wording:          Premier Marine Vacation Trailer Wording

Claims:                  Report all claims to Premier Marine

Risks to be referred to Premier Marine:
    Units over 15 years old
    Units that are registered in the name of a corporation but used strictly for recreational purposes.
    Units used for accommodation while working away from home
    History of non-payment of premium
    Two automobile claims in the past 3 years or 3 claims in the past 5 years

In-Eligible Risks:
    Units rented or leased to others
    Home made or customized units
    Units permanently parked in the USA
    Applicants, who for any reason have been previously cancelled, declined or refused renewal by
    another insurer during the last 5 years.
    Units used for commercial or business purposes
    Units in sub-standard condition
    Units used as living accommodations (longer than 6 months)
    Units used as permanent residence, demonstration, sales, office purposes, on job sites, or on
    farms




PREMIER MARINE                                                             ON  Rev. NB Sep 15, 2011/REN Nov 1, 2011
                                                                                                           3.2
                                                               3.0 VACATION TRAILERS
 


                                 Vacation Trailers - Ontario
                                  Underwriting Criteria:


Age

For replacement cost coverage unit must be 15 years old and newer and the insured must be the
original owner. No age restrictions on ACV coverages.

Horse or Stock Trailers

Use rates as per rate manual.

Permanently Parked Seasonal Holiday Trailers

You can insure your clients’ permanently parked summer / seasonal holiday trailer under our Mobile
Home program, provided they are blocked and skirted.

*Photos required for units’ 20 years and older.

Comprehensive Personal Liability (CPL)
If comprehensive personal liability is required on a holiday trailer, check applicable box on
application. Coverage available is $1,000,000 for additional premium of $25.

CPL Extended to Golf Cart
CPL can also be extended to cover the use of a golf cart while on the golf course or trailer park for an
additional premium of $25. Check applicable box on application.

OPTIONAL COVERAGE A

Available only on the Choice.

Additional Premium $25 for each of the following coverage items:

      1) Towing and Roadside assistance up to $500 per occurrence
      2) Reward Coverage – limit $250
      3) Lock Rekeying of trailer unit (no deductible) up to $250
      4) Accidental Death by Fire – limit up to $10,000




PREMIER MARINE                                                             ON  Rev. NB Sep 15, 2011/REN Nov 1, 2011
                                                                                                           3.2
                                                   3.0 VACATION TRAILERS
 



                              Vacation Trailers – Ontario
                        Standard Package – ACV / Named Perils
                        Vacation Trailer and Personal Property

$200 Deductible

    Actual Cash     Personal   Premium          Actual Cash     Personal   Premium
    Value of Unit   Property                    Value of Unit   Property
        2,000         200        156               27,000        2,700       530
        3,000         300        156               28,000        2,800       549
        4,000         400        156               29,000        2,900       569
        5,000         500        156               30,000        3,000       589
        6,000         600        156               31,000        3,100       608
        7,000         700        156               32,000        3,200       628
        8,000         800        156               33,000        3,300       647
        9,000         900        177               34,000        3,400       667
       10,000        1,000       197               35,000        3,500       687
       11,000        1,100       215               36,000        3,600       706
       12,000        1,200       236               37,000        3,700       726
       13,000        1,300       255               38,000        3,800       745
       14,000        1,400       275               39,000        3,900       767
       15,000        1,500       294               40,000        4,000       784
       16,000        1,600       315               41,000        4,100       805
       17,000        1,700       334               42,000        4,200       823
       18,000        1,800       353               43,000        4,300       844
       19,000        1,900       374               44,000        4,400       863
       20,000        2,000       392               45,000        4,500       883
       21,000        2,100       413               46,000        4,600       903
       22,000        2,200       431               47,000        4,700       922
       23,000        2,300       452               48,000        4,800       941
       24,000        2,400       470               49,000        4,900       961
       25,000        2,500       491               50,000        5,000       981
       26,000        2,600       509

Each additional $1000

Personal Property - $14.72
Vacation Trailer - $17.83

Additional Coverages Included
Outbuildings                           $1000
Emergency Vacation Expense             $1000
Golf Cart Property Coverage            $5000

 
 
 
 
 
                                                    3.0 VACATION TRAILERS
 

PREMIER MARINE                                                 ON  Rev. NB Sep 15, 2011/REN Nov 1, 2011
                                                                                               3.3

                            Vacation Trailers – Ontario
                     Enhanced Standard Package – ACV / All Risk
                       Vacation Trailer and Personal Property
                              Units 15 years and Newer

$200 Deductible
 
    Actual Cash     Personal   Premium             Actual Cash     Personal       Premium
    Value of Unit   Property                       Value of Unit   Property
       2,000          200        156                  27,000        2,700            530
       3,000          300        156                  28,000        2,800            549
       4,000          400        156                  29,000        2,900            569
       5,000          500        156                  30,000        3,000            589
       6,000          600        156                  31,000        3,100            608
       7,000          700        156                  32,000        3,200            628
       8,000          800        156                  33,000        3,300            647
       9,000          900        177                  34,000        3,400            667
       10,000        1,000       197                  35,000        3,500            687
       11,000        1,100       215                  36,000        3,600            706
       12,000        1,200       236                  37,000        3,700            726
       13,000        1,300       255                  38,000        3,800            745
       14,000        1,400       275                  39,000        3,900            767
       15,000        1,500       294                  40,000        4,000            784
       16,000        1,600       315                  41,000        4,100            805
       17,000        1,700       334                  42,000        4,200            823
       18,000        1,800       353                  43,000        4,300            844
       19,000        1,900       374                  44,000        4,400            863
       20,000        2,000       392                  45,000        4,500            883
       21,000        2,100       413                  46,000        4,600            903
       22,000        2,200       431                  47,000        4,700            922
       23,000        2,300       452                  48,000        4,800            941
       24,000        2,400       470                  49,000        4,900            961
       25,000        2,500       491                  50,000        5,000            981
       26,000        2,600       509
 
Each additional $1000

Personal Property - $14.72
Vacation Trailer - $17.83

Additional Coverages Included
Outbuildings                           $1000
Emergency Vacation Expense             $1000
Golf Cart Property Coverage            $5000

 
 
 
                                                            3.0 VACATION TRAILERS
 

PREMIER MARINE                                                          ON  Rev. NB Sep 15, 2011/REN Nov 1, 2011
                                                                                                        3.4

                          Vacation Trailers – Ontario
              Premier Choice Package – Replacement Cost / All Risk
                    Vacation Trailer and Personal Property
                           Units 15 years and Newer
$200 Deductible

 Replacement Personal Premium                                 Replacement     Personal     Premium
 Cost of Unit     Property                                     Cost of Unit   Property
     8,000          800        156                               37,000        3,700          726
     9,000          900        177                               38,000        3,800          745
    10,000         1,000       197                               39,000        3,900          767
    11,000         1,100       215                               40,000        4,000          784
    12,000         1,200       236                               41,000        4,100          805
    13,000         1,300       255                               42,000        4,200          823
    14,000         1,400       275                               43,000        4,300          844
    15,000         1,500       294                               44,000        4,400          863
    16,000         1,600       315                               45,000        4,500          883
    17,000         1,700       334                               46,000        4,600          903
    18,000         1,800       353                               47,000        4,700          922
    19,000         1,900       374                               48,000        4,800          941
    20,000         2,000       392                               49,000        4,900          961
    21,000         2,100       413                               50,000        5,000          981
    22,000         2,200       431                               51,000        5,100          987
    23,000         2,300       452                               52,000        5,200         1,006
    24,000         2,400       470                               53,000        5,300         1,025
    25,000         2,500       491                               54,000        5,400         1,044
    26,000         2,600       509                               55,000        5,500         1,063
    27,000         2,700       530                               56,000        5,600         1,082
    28,000         2,800       549                               57,000        5,700         1,101
    29,000         2,900       569                               58,000        5,800         1,120
    30,000         3,000       589                               59,000        5,900         1,139
    31,000         3,100       608                               60,000        6,000         1,158
    32,000         3,200       628                               61,000        6,100         1,176
    33,000         3,300       647                               62,000        6,200         1,196
    34,000         3,400       667                               63,000        6,300         1,214
    35,000         3,500       687                               64,000        6,400         1,234
    36,000         3,600       706                               65,000        6,500         1,252
Refer to Premier Marine for higher limits for Replacement Cost coverage – remember to include
applicable taxes.

Each additional $1000

Personal Property   - $14.72
Vacation Trailer    - $17.83

Additional Coverages Included
Outbuildings                         $1000
Emergency Vacation Expense       $1000
Golf Cart Property Coverage          $5000
                      3.0 VACATION TRAILERS
 


PREMIER MARINE              ON  Rev. NB Sep 15, 2011/REN Nov 1, 2011
                                                            3.5
 

 

 

 

 

 

 

 




    4.0 MOBILE HOMES
 

 

          

 

 
                                                                 4.0 MOBILE HOMES
 



PROGRAM OVERVIEW

1. OWNER OCCUPIED OPTIONS
    Mobile Home         Named Perils or All Risks
                        ACV or Replacement Cost

    Personal Property up to 100% of unit value*
                      Named Perils or All Risks
                      ACV or Replacement Cost

2. SUMMER OR SEASONAL
    Mobile Home         Named Perils
                        ACV

    Personal Property 10% of unit value*
                      Named Perils
                      ACV – (Up to $5,000 Burglary Coverage Available)



       special personal property limits apply




PREMIER MARINE                                                       ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                    4.1
                                                                           4.0 MOBILE HOMES
 

COVERAGES AND LIMITS

LIABILITY
        Varies by region – please refer to individual rate sheet.
        * not automatically included with Summer or Seasonal Units.
        A number of liability extensions are offered (see Liability Extension Schedule for rates).

PERSONAL CONTENTS:
        Varies by region – please refer to individual rate sheet.

SPECIAL PERSONAL PROPERTY LIMITS:


                                                                    POLICY WORDING
                                                   Owner Occupied        Summer/Seasonal
    Books, Tools & Instr., Prof. Use                  $ 2,500                     excluded
    Securities, Manuscripts                           $ 2,000                     excluded
    Money                                             $ 300                       excluded
    Watercraft (limited)                              $ 1,000                      $1,000
    Computer Software                                 $ 2,500                     excluded
    Jewelry, Furs                                     $ 3,000                     excluded
    Silverware                                        $ 7,500                     excluded
    Bicycles                                          $ 500                         $300
    Sports Cards/Collectibles                         $ 2,000                     excluded
    Stamps/Philatelic                                 $ 1,000                     excluded
    Coin Collections/Numismatic                       $ 500                       excluded
    Non-Boat Trailer                                  $ 2,000                     excluded
    Birds and Fish                                    $ 1,000                     excluded
    Garden Tractors                                   $ 2,500                      $5,000
    Property of a Student                             $ 2,500                     excluded
    Audio/Video recordings                            $ 3,000                       N/A
    Wine & Spirits                                    $ 2,500                       N/A
    Property in/on an automobile                   $1,500/$2,500                    N/A
                                                   IF AWAY 2 NIGHTS




PREMIER MARINE                                                                  ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                               4.2
                                                                        4.0 MOBILE HOMES
 

COVERAGES AND LIMITS (CONT’D)

OTHER POLICY LIMITS:

                                                             POLICY WORDING
                                        Owner Occupied                    Summer/Seasonal
    Outbuildings                            20% of home value                20% of home value
    Additional Living Expense               20% of home value                    Not covered
    Medical Payments Coverage                $2,500 ea. person                $2,500 ea. person
    Voluntary Property Damage              $1,000 ea. occurrence            $1,000 ea. occurrence
    Pers. Property off Premises              20% Max. $2,500                     Not covered
    Credit, ATM Card Forgery                      $2,500                         Not covered
    Fire Dept. Charges                             $500                          Not covered
    Home Freezer                                  $1,500                         Not covered
    Lock Replacement                               $500                          Not covered
    Mass Evacuation                               $2,500                         Not covered
    Sewer Back-up                                Included                         Included
    Earthquake                                   Optional                         Optional
    Outdoor trees & shrubs                          5%                               N/A
    Debris Removal                                 10%                               N/A



OPTIONAL COVERAGES/ENDORSEMENTS/FLOATERS:
       A number of optional coverages are offered in this program, such as, Computers, Boat, Motor,
       Trailer, Fine Arts and Earthquake, etc. Please refer to the Optional Coverages section for rates
       and criteria.

DEDUCTIBLE
       Standard $500 Deductible.

       Optional increased deductibles:
            $1,000 Deductible       -$25
            $2,500 Deductible       -$50
            Glass $100 Deductible +$25




PREMIER MARINE                                                               ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                            4.2
                                                                        4.0 MOBILE HOMES
 


UNDERWRITING GUIDELINES

GENERAL UNDERWRITING GUIDELINES:
    Current photograph required for all units older than 10 years of age.
    No more than one loss in the last five years.
    Unit must be fully skirted.
    Appraisal required for scheduled items in excess of $3,000 in value for a single item.
    All units with Solid Fuel Burning Devices as Primary heat must be referred to Premier.
    Units with Auxiliary Solid Fuel Burning Device are surcharged (see rate tables).
    Three cords or more is considered primary not auxiliary – a surcharge will be applied, refer to
    underwriter.
    Policy Term – Twelve (12) month policies only.
    No Roomers/Boarders.
    No Business Operations.
    Risks that have been cancelled mid-term by prior carrier (for whatever reason) are not eligible for
    this program.

    *For Units rented to others, refer to Premier’s Risk Assist Application.

MINI-HOMES (ATLANTIC PROVINCES)
    -   no steel frames
    -   no units with axels

RECOMMENDED VALUATION GUIDELINE:
    Must be used for Replacement Cost: $65.00 per square foot (including porches, and additions)
    plus we suggest an additional $2,500 be added for the connection/installation costs of things like
    skirting, delivery and setup.

    90% coinsurance applies.

    MINIMUM MOBILE HOME ACV LIMITS:
    Model Year        Single Wide             Double Wide
    1990 and newer       $35,000                $60,000
    1985 to 1989         $30,000                $55,000
    1980 to 1984         $25,000                $50,000
    1979 and older       $20,000                $40,000

    MINIMUM RC LIMITS:
    Model Year         Single Wide            Double Wide
    All years             $45,000               $70,000




PREMIER MARINE                                                                 ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                              4.3
                                                                      4.0 MOBILE HOMES
 

UNDERWRITING GUIDELINES (CONT’D)

PROTECTION GRADES:
    Protected:         Units within 1,000 ft of a fire hydrant, and within 8 km by road, of a
                       responding fire hall/department that is open year-round, full-time and paid
                       firefighters.

    Semi-protected:    Units within 8 km by road, of a responding fire hall/department that is open
                       year-round, full time and paid firefighters.

    Unprotected:       Neither protected nor semi-protected.

SOLID FUEL BURNING DEVICES:
    All primary or auxiliary devices must be CSA, UL or Warnock Hersey approved.
    If Primary heat is solid burning device –   Prior to quote, photo of inside and outside of unit.
                                                Surcharge may apply.
                                                Premier may elect to reject such risks.
    A Wood Heat Questionnaire is required to accompany the photos. If using three or more cords
    per season then the device is considered primary (93 bags of pellets equals 3 cords)


INFLATION PROTECTION:
    A 6% inflation increase will be automatic on any renewal account where replacement cost is in
    place in Ontario.

OIL TANK GUIDELINES:
    -   Photo of oil tank required
    -   Oil Tank Questionnaire must be completed
    -   Oil tanks over 15 years old not acceptable
    -   Oil tank must be above ground
    -   If abandoned underground oil tank – there must be a copy of certificate from Department of
        Environment and the Absolute Pollution Exclusion would apply.


EARTHQUAKE:
    In order to qualify, units must have a tie-down system.
    5% Deductible and Additional Premium $50.




PREMIER MARINE                                                            ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                         4.3
                                                                                  4.0 MOBILE HOMES
 

                                       MOBILE HOME OWNER OCCUPIED
                                            SOUTHERN ONTARIO
                                ACV ON MOBILE HOME AND PERSONAL PROPERTY
PROTECTED                                           ACV / ACV NAMED PERILS


      ACV of         Personal
      Mobile         Property       Model Year:
      Home            (Incl.)      1990 & Newer     1985-1989   1980-1984    1972-1979       1971 & Older
      25,000          20,000            ---            ---         282          345              590
      27,500          22,000            ---            ---         299          362              621
      30,000          24,000            ---            259         311          380              656

      32,500          26,000            ---            276          328        397                684
      35,000          28,000           259             288          334        414                716
      37,500          30,000           265             299          357        437                748
      40,000          32,000           276             311          368        449                782
      42,500          34,000           293             328          385        472                811

      45,000          36,000           305             339          397        495                840
      47,500          38,000           316             351          414        512                868
      50,000          40,000           322             362          431        529                897
      52,500          42,000           334             380          449        546                932
      55,000          44,000           351             397          460        569                972

      57,000          46,000            ---            ---          ---         ---              1012
      60,000          48,000           380             426          495        615               1058
      62,500          50,000           397             449          523        644                ---
      65,000          52,000           417             460          541        667                ---
      67,500          54,000           426             483          564        690                ---

      70,000          56,000           449             500          581        719                ---
      72,500          58,000           460             518          604        748                ---
      75,000          60,000           483             535          627        776                ---
      77,500          62,000           500             552          650        805                ---
      80,000          64,000           518             575          673        828                ---

    Add'l per 1000
      Building                         3.5             5.4          7.0         9.1               ---
      Outbldg                          2.0             3.5          5.4         7.0               9.1
     Contents                          2.0             3.5          5.4         7.0               9.1

    Auxiliary Wood Heat                35              35           35          35                35



Discounts:
Mature Market (55+)             -15%
Claims Free (3 Yrs)             -10%
Monitored Burglar Alarm          -5%          No Maximum on Discounts
Monitored Fire Alarm             -5%
Double Wide                     -20%
Mortgage Free                    -5%




PREMIER MARINE                                                                           ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                        4.4
                                                                                     4.0 MOBILE HOMES
 


                                   MOBILE HOME OWNER OCCUPIED
                                         SOUTHERN ONTARIO
                          ACV ON MOBILE HOME AND RC ON PERSONAL PROPERTY

PROTECTED                                           ACV / ACV NAMED PERILS

      ACV of         Personal
      Mobile         Property
      Home            (Incl.)       Model Year:
                                   1990 & Newer      1985-1989       1980-1984   1972-1979      1971 & Older
      25,000          20,000            ---             ---             351         466             748
      27,500          22,000            ---             ---             368         477             776
      30,000          24,000            ---             316             385         500             805

      32,500          26,000            ---             334            397         518               842
      35,000          28,000           311              345            414         535               874
      37,500          30,000           322              357            426         552               903
      40,000          32,000           328              368            443         575               934
      42,500          34,000           345              385            454         593               966

      45,000          36,000           357              397            472         610               989
      47,500          38,000           362              408            483         627              1026
      50,000          40,000           374              414            500         644              1052
      52,500          42,000           391              437            518         661              1093
      55,000          44,000           403              450            535         690              1127

      57,500          46,000           420              466            546         713              1167
      60,000          48,000           437              485            575         736              1208
      62,500          50,000           449              500            593         759               ---
      65,000          52,000           466              518            610         788               ---
      67,500          54,000           483              535            635         817               ---

      70,000          56,000           500              552            656         840               ---
      72,500          58,000           518              575            684         868               ---
      75,000          60,000           529              592            702         897               ---
      77,500          62,000           552              610            725         926               ---
      80,000          64,000           569              635            748         955               ---

    Add'l per 1000
      Building                         5.4              7.0             9.1        10.7              ---
      Outbldg                          2.0              3.5             5.4         7.0              9.1
     Contents                          2.0              3.5             5.4         7.0              9.1

    Auxiliary Wood Heat                35                35             35          35               35



Discounts:
Mature Market (55+)             -15%
Claims Free (3 Yrs)             -10%
Monitored Burglar Alarm          -5%          No Maximum on Discounts
Monitored Fire Alarm             -5%
Double Wide                     -20%
Mortgage Free                    -5%




PREMIER MARINE                                                                               ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                            4.4
                                                                                        4.0 MOBILE HOMES
 

                                       MOBILE HOME OWNER OCCUPIED
                                             SOUTHERN ONTARIO
                              RC ON MOBILE HOME AND RC ON PERSONAL PROPERTY

PROTECTED                                 RC / RC NAMED PERILS (NP) OR ALL RISK (AR)

NOTE: All Risk coverage available only on model year 1985 and newer

     RC of      Personal
     Mobile     Property
     Home        (Incl.)          Model Year:
                                1990 & Newer          1985-1989           1980-1984        1972-1979
                                 NP      AR          NP      AR           NP     AR        NP       AR
     45,000          45,000      357    437          397     483          473     ---      613       ---
     47,500          47,500      368    449          406     489          490     ---      630       ---
     50,000          50,000      380    460          420     506          504     ---      646       ---
     52,500          52,500      391    477          437     520          519     ---      668       ---
     55,000          55,000      403    483          449     535          536     ---      692       ---

     57,500          57,500     416     497          472     552          555     ---      713         ---
     60,000          60,000     437     518          484     564          574     ---      739         ---
     62,500          62,500     449     529          500     587          597     ---      765         ---
     65,000          65,000     466     552          519     604          616     ---      790         ---
     67,500          67,500     483     564          535     621          638     ---      815         ---

     70,000          70,000     497     581          552     638          659     ---      842         ---
     72,500          72,500     518     598          575     661          681     ---      869         ---
     75,000          75,000     535     615          592     681          700     ---      898         ---
     77,500          77,500     552     633          615     702          726     ---      926         ---
     80,000          80,000     569     656          633     725          750     ---      957         ---

    Add'l per 1000
     Building                   5.4     7.0          7.0     9.1          9.1     ---      10.7        ---
     Outbldg                    2.0     3.5          3.5     5.4          5.4     ---       7.0        ---
    Contents                    2.0     3.5          3.5     5.4          5.4     ---       7.0        ---

    Auxiliary Wood Heat          35      35           35     35           35      ---       35         ---


Discounts:
Mature Market (55+)             -15%
Claims Free (3 Yrs)             -10%
Monitored Burglar Alarm          -5%            No Maximum on Discounts
Monitored Fire Alarm             -5%
Double Wide                     -20%
Mortgage Free                    -5%




PREMIER MARINE                                                                            ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                         4.4
                                                                                  4.0 MOBILE HOMES
 

                                      MOBILE HOME OWNER OCCUPIED
                                           SOUTHERN ONTARIO
                               ACV ON MOBILE HOME AND PERSONAL PROPERTY

SEMI-PROTECTED                                      ACV / ACV NAMED PERILS

      ACV of         Personal
      Mobile         Property      Model Year:
      Home            (Incl.)      1992 & Newer      1985-1989   1980-1984   1972-1979      1971 & Older
      25,000          20,000             ---             ---        334         431             719
      27,500          22,000             ---             ---        357         454             762
      30,000          24,000             ---            328         380         483             805

      32,500          26,000            ---             345          397       506               845
      35,000          28,000           328              360          414       528               886
      37,500          30,000           345              380          437       552               926
      40,000          32,000           355              394          460       581               972
      42,500          34,000           371              414          477       610              1012

      45,000          36,000           391              429          500       633              1058
      47,500          38,000           408              449          518       656              1095
      50,000          40,000           426              466          535       690              1144
      52,500          42,000           449              489          558       707              1190
      55,000          44,000           466              506          581       742              1242

      57,500          46,000           484              535          607       771              1294
      60,000          48,000           506              558          638       805              1351
      62,500          50,000           524              581          667       840               ---
      65,000          52,000           552              610          696       880               ---
      67,500          54,000           575              633          725       914               ---

      70,000          56,000           598              657          753        950              ---
      72,500          58,000           615              684          782        989              ---
      75,000          60,000           644              707          817       1035              ---
      77,500          62,000           667              736          845       1064              ---
      80,000          64,000           696              771          874       1110              ---

    Add'l per 1000
      Building                          5.4             7.0          9.1       10.7              ---
      Outbldg                           3.5             5.4          7.0        9.1             10.7
     Contents                           3.5             5.4          7.0        9.1             10.7

    Auxiliary Wood Heat                 50              50           50         50               50



Discounts:
Mature Market (55+)             -15%
Claims Free (3 Yrs)             -10%
Monitored Burglar Alarm          -5%          No Maximum on Discounts
Monitored Fire Alarm             -5%
Double Wide                     -20%
Mortgage Free                    -5%




PREMIER MARINE                                                                           ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                        4.4
                                                                                  4.0 MOBILE HOMES
 

                                   MOBILE HOME OWNER OCCUPIED
                                         SOUTHERN ONTARIO
                          ACV ON MOBILE HOME AND RC ON PERSONAL PROPERTY

SEMI-PROTECTED                                       ACV / RC NAMED PERILS


      ACV of         Personal    Model Year:
      Mobile         Property
      Home            (Incl.)    1990 & Newer      1985-1989   1980-1984     1972-1979      1971 & Older
      25,000          20,000          ---             351         411           546             874
      27,500          22,000          ---             368         431           575             914
      30,000          24,000          ---             385         439           598             955

      32,500          26,000            ---           403           472        627                995
      35,000          28,000           385            414           489        650               1042
      37,500          30,000           397            437           512        673               1081
      40,000          32,000           414            449           527        702               1127
      42,500          34,000           431            472           552        725               1167

      45,000          36,000           449            489           569        748               1208
      47,500          38,000           460            512           587        776               1256
      50,000          40,000           477            529           610        805               1300
      52,500          42,000           500            546           633        828               1347
      55,000          44,000           519            564           654        857               1394

      57,500          46,000           541            592           679         888              1455
      60,000          48,000           564            615           707         932              1512
      62,500          50,000           587            638           736         966               ---
      65,000          52,000           610            661           765        1001               ---
      67,500          54,000           623            690           794        1035               ---

      70,000          56,000           650            714           822        1070               ---
      72,500          58,000           679            742           851        1110               ---
      75,000          60,000           703            771           886        1141               ---
      77,500          62,000           730            796           920        1185               ---
      80,000          64,000           753            822           949        1225               ---

    Add'l per 1000
      Building                         5.4            7.0           9.1        10.7               ---
      Outbldg                          3.5            5.4           7.0         9.1
     Contents                          3.5            5.4           7.0         9.1

    Auxiliary Wood Heat                50             50            50          50                50



Discounts:
Mature Market (55+)             -15%
Claims Free (3 Yrs)             -10%
Monitored Burglar Alarm          -5%          No Maximum on Discounts
Monitored Fire Alarm             -5%
Double Wide                     -20%
Mortgage Free                    -5%




PREMIER MARINE                                                                           ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                        4.4
                                                                                    4.0 MOBILE HOMES
 

                                   MOBILE HOME OWNER OCCUPIED
                                         SOUTHERN ONTARIO
                          RC ON MOBILE HOME AND RC ON PERSONAL PROPERTY

SEMI-PROTECTED                           RC / RC NAMED PERILS (NP) OR ALL RISK (AR)

NOTE: All Risk coverage available only on model year 1985 and newer

     RC of      Personal   Model Year:
     Mobile     Property
     Home        (Incl.)    1990 & Newer           1985-1989           1980-1984       1972-1979
                             NP      AR           NP      AR          NP      AR      NP      AR
     45,000      45,000      449     529          489     575         568     ---     748     ---
     47,500      47,500      460     547          506     592         588     ---     775     ---
     50,000      50,000      477     564          529     608         607     ---     795     ---
     52,500      52,500      500     581          546     627         628     ---     828     ---
     55,000      55,000      518     604          564     650         654     ---     857     ---

     57,500      57,500     541       622         587      679        681     ---     889      ---
     60,000      60,000     564       644         615      707        707     ---     926      ---
     62,500      62,500     587       667         638      736        737     ---     959      ---
     65,000      65,000     604       696         661      759        762     ---     994      ---
     67,500      67,500     626       725         690      794        792     ---    1028      ---

     70,000      70,000     650       748         713      817        821     ---    1066      ---
     72,500      72,500     673       776         742      852        852     ---    1105      ---
     75,000      75,000     703       806         765      886        881     ---    1142      ---
     77,500      77,500     730       834         794      914        913     ---    1181      ---
     80,000      80,000     753       863         822      949        943     ---    1221      ---

    Add'l per 1000
     Building                5.4      7.0          7.0     9.1        9.1     ---    10.7      ---
     Outbldg                 3.5      5.4          5.4     7.0        7.0     ---     9.1      ---
    Contents                 3.5      5.4          5.4     7.0        7.0     ---     9.1      ---

    Auxiliary Wood Heat      50       50           50      50         50      ---     50       ---


Discounts:
Mature Market (55+)          -15%
Claims Free (3 Yrs)          -10%
Monitored Burglar Alarm       -5%           No Maximum on Discounts
Monitored Fire Alarm          -5%
Double Wide                  -20%
Mortgage Free                 -5%




PREMIER MARINE                                                                         ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                      4.4
                                                                                 4.0 MOBILE HOMES
 

                                       MOBILE HOME OWNER OCCUPIED
                                            SOUTHERN ONTARIO
                                ACV ON MOBILE HOME AND PERSONAL PROPERTY

UNPROTECTED                                        ACV / ACV NAMED PERILS

      ACV of         Personal
      Mobile         Property    Model Year:
      Home            (Incl.)    1990 & Newer     1985-1989   1980-1984     1972-1979      1971 & Older
      25,000          20,000          ---            407         466           650              932
      27,500          22,000          ---            431         489           679              989
      30,000          24,000          ---            452         518           714             1047

      32,500          26,000           ---           477           539        748              1097
      35,000          28,000           466           501           564        776              1156
      37,500          30,000           483           523           592        811              1208
      40,000          32,000           506           546           614        845              1265
      42,500          34,000           523           569           638        880              1317

      45,000          36,000           546           591           667         909             1374
      47,500          38,000           568           615           690         937             1426
      50,000          40,000           591           639           719         972             1484
      52,500          42,000           615           661           748        1006             1541
      55,000          44,000           644           690           776        1047             1610

      57,500          46,000           673           720           812        1087             1679
      60,000          48,000           702           748           846        1127             1748
      62,500          50,000           730           782           879        1173              ---
      65,000          52,000           759           817           914        1219              ---
      67,500          54,000           788           845           955        1265              ---

      70,000          56,000           817           880            989       1311              ---
      72,500          58,000           852           914           1029       1363              ---
      75,000          60,000           886           949           1064       1409              ---
      77,500          62,000           920           983           1104       1461              ---
      80,000          64,000           949          1018           1145       1512              ---

    Add'l per 1000
      Building                         7.0           9.1           10.7       12.5              ---
      Outbldg                          3.5           5.4            7.0        9.1             10.7
     Contents                          3.5           5.4            7.0        9.1             10.7

    Auxiliary Wood Heat                75            75            75          75               75


Discounts:
Mature Market (55+)             -15%
Claims Free (3 Yrs)             -10%
Monitored Burglar Alarm          -5%         No Maximum on Discounts
Monitored Fire Alarm             -5%
Double Wide                     -20%
Mortgage Free                    -5%




PREMIER MARINE                                                                          ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                       4.4
                                                                                  4.0 MOBILE HOMES
 

                                   MOBILE HOME OWNER OCCUPIED
                                         SOUTHERN ONTARIO
                          ACV ON MOBILE HOME AND RC ON PERSONAL PROPERTY

UNPROTECTED                                          ACV / RC NAMED PERILS

      ACV of         Personal    Model Year:
      Mobile         Property
      Home            (Incl.)    1990 & Newer      1985-1989   1980-1984     1972-1979      1971 & Older
      25,000          20,000          ---             466         535           771             1093
      27,500          22,000          ---             489         564           805             1150
      30,000          24,000          ---             512         587           840             1202

      32,500          26,000            ---           535           615        868              1265
      35,000          28,000           523            564           638        897              1311
      37,500          30,000           541            581           667        932              1369
      40,000          32,000           564            604           690        966              1420
      42,500          34,000           585            627           713        995              1472

      45,000          36,000           610            644           742        1029             1524
      47,500          38,000           627            673           765        1058             1581
      50,000          40,000           644            696           794        1093             1639
      52,500          42,000           673            719           817        1127             1696
      55,000          44,000           700            748           851        1167             1760

      57,500          46,000           729            776           886        1208             1834
      60,000          48,000           759            805            920       1254             1909
      62,500          50,000           788            841            955       1294              ---
      65,000          52,000           815            874            989       1340              ---
      67,500          54,000           845            903           1024       1387              ---

      70,000          56,000            880           937           1058       1432              ---
      72,500          58,000            909           972           1099       1477              ---
      75,000          60,000            943          1006           1139       1524              ---
      77,500          62,000            978          1041           1179       1576              ---
      80,000          64,000           1012          1076           1219       1627              ---

    Add'l per 1000
      Building                         7.0            9.1           10.7       12.5              ---
      Outbldg                          3.5            5.4            7.0        9.1             10.7
     Contents                          3.5            5.4            7.0        9.1             10.7

    Auxiliary Wood Heat                75             75            75          75               75


Discounts:
Mature Market (55+)             -15%
Claims Free (3 Yrs)             -10%
Monitored Burglar Alarm          -5%          No Maximum on Discounts
Monitored Fire Alarm             -5%
Double Wide                     -20%
Mortgage Free                    -5%




PREMIER MARINE                                                                           ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                        4.4
                                                                                    4.0 MOBILE HOMES
 

                                   MOBILE HOME OWNER OCCUPIED
                                         SOUTHERN ONTARIO
                          ACV ON MOBILE HOME AND RC ON PERSONAL PROPERTY

UNPROTECTED                                          RC / RC NAMED PERILS

NOTE: All Risk coverage available only on model year 1985 and newer


     RC of      Personal    Model Year:
     Mobile     Property
     Home        (Incl.)    1990 & Newer           1985-1989           1980-1984      1972-1979
                             NP      AR           NP      AR          NP      AR      NP     AR
     45,000      45,000      610     702          644     742         737     ---    1026    ---
     47,500      47,500      627     725          673     771         762     ---    1056    ---
     50,000      50,000      644     748          696     799         789     ---    1089    ---
     52,500      52,500      673     771          725     828         814     ---    1127    ---
     55,000      55,000      702     805          748     857         845     ---    1164    ---

     57,500      57,500      730      840         776      891         879    ---    1206     ---
     60,000      60,000      759      874         805      932         915    ---    1251     ---
     62,500      62,500      794      903         840      966         949    ---    1291     ---
     65,000      65,000      817      937         874     1001         982    ---    1333     ---
     67,500      67,500      845      972         903     1035        1021    ---    1380     ---

     70,000      70,000      869     1012          937    1075        1059    ---    1428     ---
     72,500      72,500      909     1047          972    1116        1080    ---    1473     ---
     75,000      75,000      943     1081         1006    1156        1137    ---    1523     ---
     77,500      77,500      978     1121         1041    1197        1176    ---    1572     ---
     80,000      80,000     1012     1162         1075    1237        1213    ---    1623     ---

    Add'l per 1000
     Building                7.0      9.1          9.1    10.7        10.7    ---    12.5     ---
     Outbldg                 3.5      5.4          5.4     7.0         7.0    ---     9.1     ---
    Contents                 3.5      5.4          5.4     7.0         7.0    ---     9.1     ---

    Auxiliary Wood Heat               75           75      75          75     ---     75      ---



Discounts:
Mature Market (55+)          -15%
Claims Free (3 Yrs)          -10%
Monitored Burglar Alarm       -5%           No Maximum on Discounts
Monitored Fire Alarm          -5%
Double Wide                  -20%
Mortgage Free                 -5%




PREMIER MARINE                                                                        ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                     4.4
                                                                                  4.0 MOBILE HOMES
 

                                       MOBILE HOME OWNER OCCUPIED
                                     NORTHERN/NORTH WESTERN ONTARIO
                                ACV ON MOBILE HOME AND PERSONAL PROPERTY

PROTECTED                                           ACV / ACV NAMED PERILS

LIABILITY – rates include $1 million

      ACV of         Personal    Model Year:
      Mobile         Property
      Home            (Incl.)    1990 & Newer      1985-1989   1980-1984     1972-1979      1971 & Older
      25,000          20,000          ---             267         311           408             667
      27,500          22,000          ---             288         328           431             702
      30,000          24,000          ---             305         351           449             736

      32,500          26,000            ---           316           368        472               776
      35,000          28,000           305            334           385        495               817
      37,500          30,000           316            351           404        523               851
      40,000          32,000           334            368           419        546               891
      42,500          34,000           351            385           436        564               926

      45,000          36,000           368            397           455        587                960
      47,500          38,000           380            414           472        610               1001
      50,000          40,000           391            431           490        633               1041
      52,500          42,000           403            450           506        656               1081
      55,000          44,000           420            466           528        679               1121

      57,500          46,000           443            483           552        707               1162
      60,000          48,000           466            506           581        742               1225
      62,500          50,000           483            529           604        771                ---
      65,000          52,000           506            552           627        800                ---
      67,500          54,000           523            569           650        834                ---

      70,000          56,000           547            592           673         863               ---
      72,500          58,000           564            615           702         897               ---
      75,000          60,000           587            638           730         932               ---
      77,500          62,000           611            667           759         966               ---
      80,000          64,000           633            690           782        1001               ---

    Add'l per 1000
      Building                         5.8            7.5           9.3        11.2               ---
      Outbldg                          3.6            5.8           7.5         9.3              11.2
     Contents                          3.6            5.8           7.5         9.3              11.2

    Auxiliary Wood Heat                35             35            35          35                35


Discounts:
Mature Market (55+)             -15%
Claims Free (3 Yrs)             -10%
Monitored Burglar Alarm          -5%          No Maximum on Discounts
Monitored Fire Alarm             -5%
Double Wide                     -20%
Mortgage Free                    -5%




PREMIER MARINE                                                                           ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                        4.5
                                                                                  4.0 MOBILE HOMES
 

                                       MOBILE HOME OWNER OCCUPIED
                                     NORTHERN/NORTH WESTERN ONTARIO
                                ACV ON MOBILE HOME AND PERSONAL PROPERTY

PROTECTED                                            ACV / RC NAMED PERILS

      ACV of         Personal    Model Year:
      Mobile         Property
      Home            (Incl.)    1990 & Newer      1985-1989   1980-1984     1972-1979      1971 & Older
      25,000          20,000          ---             334         385           535             828
      27,500          22,000          ---             351         403           558             863
      30,000          24,000          ---             368         420           581             903

      32,500          26,000            ---           380           443        604                937
      35,000          28,000           368            397           460        627                978
      37,500          30,000           380            414           477        644               1012
      40,000          32,000           391            431           495        667               1047
      42,500          34,000           403            443           512        690               1087

      45,000          36,000           420            454           529        713               1121
      47,500          38,000           437            472           546        730               1162
      50,000          40,000           449            489           564        759               1202
      52,500          42,000           466            506           581        782               1242
      55,000          44,000           483            529           604        811               1288

      57,500          46,000           500            546           627        840               1334
      60,000          48,000           523            564           656        863               1380
      62,500          50,000           541            587           679        897                ---
      65,000          52,000           564            610           702        926                ---
      67,500          54,000           581            633           730        960                ---

      70,000          56,000           604            656           753         995               ---
      72,500          58,000           627            679           782        1024               ---
      75,000          60,000           644            702           805        1058               ---
      77,500          62,000           667            725           834        1093               ---
      80,000          64,000           690            753           863        1127               ---

    Add'l per 1000
      Building                         5.8            7.5           9.3        11.2               ---
      Outbldg                          3.6            5.8           7.5         9.3
     Contents                          3.6            5.8           7.5         9.3

    Auxiliary Wood Heat                35             35            35          35                35


Discounts:
Mature Market (55+)             -15%
Claims Free (3 Yrs)             -10%
Monitored Burglar Alarm          -5%          No Maximum on Discounts
Monitored Fire Alarm             -5%
Double Wide                     -20%
Mortgage Free                    -5%




PREMIER MARINE                                                                           ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                        4.5
                                                                                    4.0 MOBILE HOMES
 

                                   MOBILE HOME OWNER OCCUPIED
                                 NORTHERN/NORTH WESTERN ONTARIO
                          RC ON MOBILE HOME AND RC ON PERSONAL PROPERTY

PROTECTED                               RC / RC NAMED PERILS (NP) OR ALL RISK (AR)

NOTE: All Risk coverage available only on model year 1985 and newer


     RC of      Personal
     Mobile     Property   Model Year:
     Home        (Incl.)   1990 & Newer            1985-1989           1980-1984      1972-1979
                            NP      AR            NP      AR          NP      AR     NP      AR
     45,000      45,000     420     512           454     546         462     ---    676     ---
     47,500      47,500     437     523           472     564         522     ---    698     ---
     50,000      50,000     449     535           489     581         537     ---    720     ---
     52,500      52,500     466     552           506     598         554     ---    743     ---
     55,000      55,000     483     569           529     615         575     ---    769     ---

     57,500      57,500     500       587         546      633        600     ---    794      ---
     60,000      60,000     523       610         564      656        620     ---    822      ---
     62,500      62,500     541       633         587      679        643     ---    850      ---
     65,000      65,000     564       650         610      702        662     ---    880      ---
     67,500      67,500     581       673         633      725        691     ---    912      ---

     70,000      70,000     604       696         656      753        715     ---     942     ---
     72,500      72,500     627       719         679      782        741     ---     975     ---
     75,000      75,000     644       742         702      805        767     ---    1005     ---
     77,500      77,500     667       765         725      834        790     ---    1037     ---
     80,000      80,000     690       794         753      863        819     ---    1072     ---

    Add'l per 1000
     Building                5.8      7.5          7.5     9.3        9.3     ---    10.6     ---
     Outbldg                 3.6      5.8          5.8     7.5        7.5     ---     8.9     ---
    Contents                 3.6      5.8          5.8     7.5        7.5     ---     8.9     ---

    Auxiliary Wood Heat      35       35           35      35         35      ---     35      ---



Discounts:
Mature Market (55+)          -15%
Claims Free (3 Yrs)          -10%
Monitored Burglar Alarm       -5%           No Maximum on Discounts
Monitored Fire Alarm          -5%
Double Wide                  -20%
Mortgage Free                 -5%




PREMIER MARINE                                                                        ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                     4.5
                                                                                  4.0 MOBILE HOMES
 

                                       MOBILE HOME OWNER OCCUPIED
                                     NORTHERN/NORTH WESTERN ONTARIO
                                ACV ON MOBILE HOME AND PERSONAL PROPERTY

SEMI-PROTECTED                                      ACV / ACV NAMED PERILS

      ACV of         Personal
      Mobile         Property    Model Year:
      Home            (Incl.)    1990 & Newer      1985-1989   1980-1984     1972-1979      1971 & Older
      25,000          20,000          ---             363         403           529             863
      27,500          22,000          ---             385         431           558             920
      30,000          24,000          ---             408         460           592             978

      32,500          26,000            ---           431           489        627               1029
      35,000          28,000           414            454           512        661               1087
      37,500          30,000           431            483           535        690               1144
      40,000          32,000           454            506           564        725               1196
      42,500          34,000           477            529           592        759               1254

      45,000          36,000           500            552           615        788               1305
      47,500          38,000           523            575           644        822               1363
      50,000          40,000           541            598           667        857               1420
      52,500          42,000           569            627           702        891               1484
      55,000          44,000           592            656           730        937               1553

      57,500          46,000           621            690           765        978               1622
      60,000          48,000           656            719           800        1024              1696
      62,500          50,000           684            753           834        1070               ---
      65,000          52,000           713            782           874        1116               ---
      67,500          54,000           742            817           909        1162               ---

      70,000          56,000           771            851            949       1167               ---
      72,500          58,000           805            886            983       1254               ---
      75,000          60,000           840            920           1029       1305               ---
      77,500          62,000           874            960           1070       1357               ---
      80,000          64,000           909            995           1110       1409               ---

    Add'l per 1000
      Building                         7.8            9.8           11.6       13.8               ---
      Outbldg                          3.8            6.0            7.8        9.8              11.6
     Contents                          3.8            6.0            7.8        9.8              11.6

    Auxiliary Wood Heat                50             50            50          50                50


Discounts:
Mature Market (55+)             -15%
Claims Free (3 Yrs)             -10%
Monitored Burglar Alarm          -5%          No Maximum on Discounts
Monitored Fire Alarm             -5%
Double Wide                     -20%
Mortgage Free                    -5%




PREMIER MARINE                                                                           ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                        4.5
                                                                                  4.0 MOBILE HOMES
 

                                    MOBILE HOME OWNER OCCUPIED
                                  NORTHERN/NORTH WESTERN ONTARIO
                          ACV ON MOBILE HOME AND RC ON PERSONAL PROPERTY

SEMI-PROTECTED                                       ACV / RC NAMED PERILS

      ACV of         Personal
      Mobile         Property    Model Year:
      Home            (Incl.)    1990 & Newer      1985-1989   1980-1984     1972-1979      1971 & Older
      25,000          20,000          ---             431         489           661             1029
      27,500          22,000          ---             449         512           690             1087
      30,000          24,000          ---             472         541           725             1144

      32,500          26,000            ---           495           564        759               1202
      35,000          28,000           472            518           592        788               1254
      37,500          30,000           495            546           615        822               1311
      40,000          32,000           518            569           644        857               1369
      42,500          34,000           541            592           673        891               1420

      45,000          36,000           558            615           696         926              1478
      47,500          38,000           581            638           725         955              1530
      50,000          40,000           604            661           748         983              1587
      52,500          42,000           633            690           782        1024              1650
      55,000          44,000           656            719           811        1064              1719

      57,500          46,000           679            753           845        1110              1794
      60,000          48,000           713            782           880        1156              1863
      62,500          50,000           742            817           914        1202               ---
      65,000          52,000           771            845           955        1248               ---
      67,500          54,000           805            880           989        1294               ---

      70,000          56,000           840            914           1029       1340               ---
      72,500          58,000           868            949           1070       1392               ---
      75,000          60,000           903            983           1110       1438               ---
      77,500          62,000           937           1024           1156       1489               ---
      80,000          64,000           972           1058           1190       1541               ---

    Add'l per 1000
      Building                         7.8            9.8           11.6       13.8               ---
      Outbldg                          3.8            6.0            7.8        9.8              11.6
     Contents                          3.8            6.0            7.8        9.8              11.6

    Auxiliary Wood Heat                50             50            50          50                50


Discounts:
Mature Market (55+)             -15%
Claims Free (3 Yrs)             -10%
Monitored Burglar Alarm          -5%          No Maximum on Discounts
Monitored Fire Alarm             -5%
Double Wide                     -20%
Mortgage Free                    -5%




PREMIER MARINE                                                                           ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                        4.5
                                                                               4.0 MOBILE HOMES
 

                                   MOBILE HOME OWNER OCCUPIED
                                 NORTHERN/NORTH WESTERN ONTARIO
                          RC ON MOBILE HOME AND RC ON PERSONAL PROPERTY

SEMI-PROTECTED                       RC / RC NAMED PERILS (NP) OR ALL RISK (AR)

     RC of      Personal
     Mobile     Property   Model Year:
     Home        (Incl.)   1990 & Newer         1985-1989         1980-1984        1972-1979
                            NP      AR         NP      AR        NP      AR       NP      AR
     45,000      45,000     558     656        615     713       639     ---      848     ---
     47,500      47,500     581     679        638     736       662     ---      877     ---
     50,000      50,000     604     702        661     765       684     ---      906     ---
     52,500      52,500     633     725        690     794       714     ---      938     ---
     55,000      55,000     656     753        719     828       744     ---      978     ---

     57,500      57,500     684    788         753     863       774     ---    1019       ---
     60,000      60,000     713    817         782     897       807     ---    1059       ---
     62,500      62,500     742    851         817     937       837     ---    1101       ---
     65,000      65,000     771    891         845     972       873     ---    1143       ---
     67,500      67,500     805    926         880    1012       910     ---    1187       ---

     70,000      70,000     840     960         914   1052        944    ---    1229       ---
     72,500      72,500     868    1001         949   1093        978    ---    1273       ---
     75,000      75,000     903    1041         983   1133       1015    ---    1321       ---
     77,500      77,500     937    1075        1024   1179       1055    ---    1370       ---
     80,000      80,000     972    1116        1058   1219       1091    ---    1416       ---

    Add'l per 1000
     Building               7.8    9.8         9.8    11.6       9.7     ---    11.4       ---
     Outbldg                3.8    6.0         6.0     7.8       6.4     ---     8.2       ---
    Contents                3.8    6.0         6.0     7.8       6.4     ---     8.2       ---

    Auxiliary Wood Heat      50     50          50     50         50     ---      50       ---


Discounts:
Mature Market (55+)         -15%
Claims Free (3 Yrs)         -10%
Monitored Burglar Alarm      -5%          No Maximum on Discounts
Monitored Fire Alarm         -5%
Double Wide                 -20%
Mortgage Free                -5%




PREMIER MARINE                                                                     ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                  4.5
                                                                                  4.0 MOBILE HOMES
 

                                       MOBILE HOME OWNER OCCUPIED
                                     NORTHERN/NORTH WESTERN ONTARIO
                                ACV ON MOBILE HOME AND PERSONAL PROPERTY

UNPROTECTED                                         ACV / ACV NAMED PERILS

      ACV of         Personal    Model Year:
      Mobile         Property
      Home            (Incl.)    1990 & Newer      1985-1989   1980-1984     1972-1979      1971 & Older
      25,000          20,000          ---             449         520           759             1127
      27,500          22,000          ---             475         552           799             1196
      30,000          24,000          ---             506         587           840             1259

      32,500          26,000            ---           535           615         874              1328
      35,000          28,000           529            558           644         914              1392
      37,500          30,000           552            587           679         955              1461
      40,000          32,000           581            615           707         995              1524
      42,500          34,000           604            644           742        1029              1593

      45,000          36,000           633            673           771        1070              1656
      47,500          38,000           656            702           805        1110              1725
      50,000          40,000           679            725           834        1150              1788
      52,500          42,000           713            759           868        1190              1863
      55,000          44,000           742            788           903        1236              1944

      57,000          46,000           776            828           943        1288              2030
      60,000          48,000           811            863           989        1340              2122
      62,500          50,000           845            897           1029       1397               ---
      65,000          52,000           886            937           1075       1449               ---
      67,500          54,000           920            978           1121       1501               ---

      70,000          56,000            960          1018           1162       1558               ---
      72,500          58,000           1001          1058           1213       1616               ---
      75,000          60,000           1041          1104           1259       1679               ---
      77,500          62,000           1081          1144           1305       1737               ---
      80,000          64,000           1121          1190           1357       1800               ---

    Add'l per 1000
      Building                         11.2          13.0           14.7       17.0               ---
      Outbldg                           5.8           7.5            9.3       11.2              13.0
     Contents                           5.8           7.5            9.3       11.2              13.0

    Auxiliary Wood Heat                75             75            75          75                75


Discounts:
Mature Market (55+)             -15%
Claims Free (3 Yrs)             -10%
Monitored Burglar Alarm          -5%          No Maximum on Discounts
Monitored Fire Alarm             -5%
Double Wide                     -20%
Mortgage Free                    -5%




PREMIER MARINE                                                                           ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                        4.5
                                                                                  4.0 MOBILE HOMES
 

                                    MOBILE HOME OWNER OCCUPIED
                                  NORTHERN/NORTH WESTERN ONTARIO
                          ACV ON MOBILE HOME AND RC ON PERSONAL PROPERTY

UNPROTECTED                                          ACV / RC NAMED PERILS

      ACV of         Personal    Model Year:
      Mobile         Property
      Home            (Incl.)    1990 & Newer      1985-1989   1980-1984     1972-1979       1971 & Older
      25,000          20,000          ---             512         598           886              1294
      27,500          22,000          ---             541         627           951              1397
      30,000          24,000          ---             564         661          1010              1495

      32,500          26,000            ---           592           690        1058              1576
      35,000          28,000           587            621           725        1098              1633
      37,500          30,000           615            650           759        1139              1702
      40,000          32,000           638            673           788        1179              1777
      42,500          34,000           667            702           817        1219              1846

      45,000          36,000           690            730           851        1259              1915
      47,500          38,000           719            759           880        1300              1984
      50,000          40,000           742            788           914        1340              2053
      52,500          42,000           771            817           949        1386              2133
      55,000          44,000           805            851           983        1432              2214

      57,500          46,000           840            886           1024       1489              2306
      60,000          48,000           874            926           1064       1547              2398
      62,500          50,000           909            960           1110       1604               ---
      65,000          52,000           943           1001           1150       1656               ---
      67,500          54,000           978           1041           1196       1714               ---

      70,000          56,000           1018          1081           1242       1771                ---
      72,500          58,000           1058          1121           1288       1834                ---
      75,000          60,000           1098          1162           1340       1898                ---
      77,500          62,000           1144          1208           1386       1955                ---
      80,000          64,000           1185          1248           1432       2024                ---

    Add'l per 1000
      Building                         11.2          13.0           14.7       17.0                ---
      Outbldg                           5.8           7.5            9.3       11.2               13.0
     Contents                           5.8           7.5            9.3       11.2               13.0

    Auxiliary Wood Heat                75             75            75          75                 75


Discounts:
Mature Market (55+)             -15%
Claims Free (3 Yrs)             -10%
Monitored Burglar Alarm          -5%          No Maximum on Discounts
Monitored Fire Alarm             -5%
Double Wide                     -20%
Mortgage Free                    -5%




PREMIER MARINE                                                                           ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                        4.5
                                                                               4.0 MOBILE HOMES
 

                                   MOBILE HOME OWNER OCCUPIED
                                 NORTHERN/NORTH WESTERN ONTARIO
                          RC ON MOBILE HOME AND RC ON PERSONAL PROPERTY

UNPROTECTED                          RC / RC NAMED PERILS (NP) OR ALL RISK (AR)

     RC of      Personal   Model Year:
     Mobile     Property   1990 & Newer         1985-1989         1980-1984      1972-1979
     Home        (Incl.)    NP      AR         NP      AR        NP      AR      NP     AR
     45,000      45,000     690     794        730     840       807     ---    1141    ---
     47,500      47,500     719     822        759     874       837     ---    1176    ---
     50,000      50,000     742     851        788     903       868     ---    1213    ---
     52,500      52,500     771     886        817     937       902     ---    1251    ---
     55,000      55,000     805     926        851     978       932     ---    1357    ---

     57,500      57,500     840     960         886   1018        975    ---    1347      ---
     60,000      60,000     874    1001         926   1064       1013    ---    1397      ---
     62,500      62,500     909    1047         960   1104       1056    ---    1449      ---
     65,000      65,000     943    1087        1001   1150       1097    ---    1500      ---
     67,500      67,500     983    1127        1041   1196       1141    ---    1551      ---

     70,000      70,000     1018   1170        1081   1242       1181    ---    1605      ---
     72,500      72,500     1058   1219        1121   1288       1227    ---    1662      ---
     75,000      75,000     1098   1265        1162   1340       1272    ---    1717      ---
     77,500      77,500     1139   1310        1208   1386       1318    ---    1777      ---
     80,000      80,000     1185   1356        1248   1438       1365    ---    1834      ---

    Add'l per 1000
     Building               11.2   13.0        13.0   14.7       14.0    ---    0.0       ---
     Outbldg                 5.8    7.5         7.5    9.3        8.9    ---    16.1      ---
    Contents                 5.8    7.5         7.5    9.3        8.9    ---    10.6      ---

    Auxiliary Wood Heat      75     75          75     75         75     ---      75      ---




Discounts:
Mature Market (55+)         -15%
Claims Free (3 Yrs)         -10%
Monitored Burglar Alarm      -5%          No Maximum on Discounts
Monitored Fire Alarm         -5%
Double Wide                 -20%
Mortgage Free                -5%




PREMIER MARINE                                                                    ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                 4.5
                                                                             4.0 MOBILE HOMES
 

                                              MOBILE HOME ONTARIO
                                              SUMMER OR SEASONAL

$500 Deductible                                   ACV / ACV FIRE & EC

       ACV                Out      Personal
      Mobile           Building    Property    Protected   Semi-Protected   Unprotected
      Home              (Incl.)     (Incl.)
      15,000            1,500       1,725        230            268            308
      16,000            1,600       1,840        239            282            327
      17,000            1,700       1,955        251            296            342
      18,000            1,800       2,070        263            309            359
      19,000            1,900       2,185        275            322            376

      20,000               2,000    2,300        288            339            392
      21,000               2,100    2,415        296            353            409
      22,000               2,200    2,530        308            366            426
      23,000               2,300    2,645        320            381            442
      24,000               2,400    2,760        332            393            459

      25,000               2,500    2,875        344            408            477
      26,000               2,600    2,990        354            423            491
      27,000               2,700    3,105        366            436            507
      28,000               2,800    3,220        377            451            526
      29,000               2,900    3,335        389            463            541

      30,000               3,000    3,450        400            477            558

    Add'l per 1000
      Building                                   9.32          10.58            15
      Outbldg                                    9.32          10.58            13
     Contents                                    9.32          10.58            13

    Auxiliary Woodburning
    Device                                        35            50              75

    (No Discount Allowed)


Burglary Coverage for Personal Property:
- show limit on declarations page
- rate $10.00 per $1000 of coverage
- maximum amount of burglary coverage on contents $5000

Add Liability
$1,000,000           $15
$2,000,000           $25




PREMIER MARINE                                                                    ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                 4.6
                                              Sherkston Shores Mobile Home Program


Underwriting Guides
Mobile Home must be owner occupied as Seasonal or Full Time occupancy
No Short or Full Term Rentals Permitted
Wording: MH2
Deductible: $1,000 on wind with $500 all other losses
Location: Sherkston Shores Mobile Home Park - fully protected

 Mobile Homes up to 10 years old                      Mobile Homes over 10 years old
Coverage : All Risk with RC , 100% contents &         Coverage: Fire & EC with ACV, 50% contents
20% outbuilding                                       & 20% outbuilding

   Limit   Premium Limit           Premium              Limit  Premium        Limit   Premium
    45,000    437   73,000           599                15,000   230           35,000   447
    46,000    446   74,000           607                16,000   239           36,000   456
    47,000    447   75,000           615                17,000   251           37,000   465
    48,000    456   76,000           623                18,000   263           38,000   475
    49,000    466   77,000           631                19,000   275           39,000   484
    50,000    460   78,000           640                20,000   288           40,000   493
    51,000    469   79,000           648                21,000   296           41,000   503
    52,000    473   80,000           656                22,000   308           42,000   512
    53,000    482   81,000           663                23,000   320           43,000   521
    54,000    491   82,000           670                24,000   332           44,000   530
    55,000    484   83,000           677                25,000   344           45,000   540
    56,000    493   84,000           684                26,000   354           46,000   549
    57,000    490   85,000           691                27,000   366           47,000   558
    58,000    499   86,000           698                28,000   377           48,000   568
    59,000    507   87,000           705                29,000   389           49,000   577
    60,000    516   88,000           712                30,000   400           50,000   586
    61,000    525   89,000           719                31,000   409
    62,000    527   90,000           726                32,000   419
    63,000    536   91,000           733                33,000   428
    64,000    544   92,000           740                34,000   437
    65,000    553   93,000           747
    66,000    561   94,000           754              Add Burglary Coverage on contents
    67,000    563   95,000           761              Rate of $10 per $1,000
    68,000    571   96,000           768
    69,000    580   97,000           775
    70,000    574   98,000           782
    71,000    582   99,000           789
    72,000    590  100,000           796

Additional limits per $1,000
Building                                 7.00          Building                            9.32
Outbuilding                              3.50          Outbuilding                         9.32
Contents                                 3.50          Contents                            9.32

Auxiliary Wood Heat Surcharge      $    35.00

Discounts on base premium
Mature - over 55                       -15%            Monitored Fire Alarm                -5%
3 years claims free                    -10%            Double Wide                        -20%
Monitored Burglary Alarm                -5%            Mortgage Free                       -5%

Liability
1,000,000                          $    15.00
2,000,000                          $    25.00


                                                        Premier Marine                             February 2012
                                                                         4.0 MOBILE HOMES
 

OPTIONAL COVERAGES
RATING & CRITERIA

CPL EXTENDED TO GOLF CART
CPL can also be extended to cover the use of a golf cart while in use within a private mobile home,
retirement or recreational park where the insured premises is situated for an additional $25
premium. A golf cart while in use on a golf course is automatically covered. Check applicable box
on the application.

OPTIONS                                                                                 ANNUAL RATES
                                                                                           PER $100
PERSONAL ARTICLES ENDORSEMENT
a)   Cameras. Includes all cameras, projection equipment and accessories pertaining thereto and
     moveable sound equipment pertaining to motion pictures. ……………………………………………………….. $2.00
b)   Firearms. Including all equipment pertaining thereto. …………………………………………………………….. $2.50
c)   Furs. Including furs and garments trimmed with fur. ……………………………………………………………… $1.00
d)   Jewelry. Including watches and precious stones. ………………………………………….First $5,000.……….             $1.50
     …………………………………………………………………………………………………….Excess……………… $2.00
e)   Musical Instruments. Including equipment and…………………………………………… Non-Professional….. $2.50
     accessories pertaining thereto (except Sheet Music)……………………………………… Professional……….. REFER
f)   Silverware. Including silver plated ware, Gold ware, gold plated ware and pewterware
     (excluding pens, pencils, smoking implements and articles of personal adornment). ………………………….. $1.50
g)   Stamp and Coin Collection. Including philatelic and
     numismatic equipment pertaining thereto. ……………………………………………………………………………. $1.00
h)   Hearing aid and/or contact lenses. …………………………………………………………………………………….. $3.50
i)   Miscellaneous Property. Deductible $100. …………………………………………………………………………… $2.00
     - Garden Tractors, Snow Blowers, etc. ……………………………………………………………………………….. $2.50
     - Golf Carts, Wheel Chairs ……………………………………………………………………………………………… $2.50
j)   Sports Equipment. Deductible $100.
     Bicycles……………………………………………………………………………………………………………………. $3.00
     Skis and equipment……………………………………………………………………………………………………… $3.00
     All others…………………………………………………………………………………………………………………… $2.00
k)   Tools. Deductible $100.
     Non-Professional use…………………………………………………………………………………………………….. $4.00
     Professional use………………………………………………………………………………………………………… Not Written
            Maximum Limits:
            Per Schedule $5,000
            Per Item       $1,000
            Refer to Company with full details all schedules over $5,000.
l)   Incidental business contents…………………………………………………………………………………………….. $2.50
     (List must be approved by Premier.)




PREMIER MARINE                                                                ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                             4.7
                                                                                 4.0 MOBILE HOMES
 

OPTIONAL COVERAGES (CONT’D)
RATING & CRITERIA
WATERCRAFT, OUTBOARD MOTOR, BOAT TRAILER AND MISCELLANEOUS EQUIPMENT
COVERAGE ENDORSEMENT DEDUCTIBLE $100.
     All risk ……………………………………………………………………………………………………………………                                                  $3.00
     Named Perils ……………………………………………………………………………………………………………                                                 $2.00
     SUBMIT TO COMPANY FOR QUOTES boats 20’ and over/or power by motor(s) over 100 hp.

TELEVISION – SATELLITE AND ANTENNA ENDORSEMENT
     Satellite Dish. Deductible $100. ………………………………………………………………………………………                                     $1.25
     By scheduling the equipment, windstorm and hail perils are covered.

EARTHQUAKE. Mobile home and contents………………………………………………………………………………….. $50.00
     - One or more earthquake shocks within 168 hours of the original tremor shall constitute a single earthquake.
     To qualify the mobile home must have an approved tie-down system.
     * please refer to wording
     Deductible: 5%

FINE ARTS ENDORSEMENT without breakage. Deductible Nil.
      Paintings…………………………………………………………………………………………………………………… $2.00
      China……………………………………………………………………………………………………………………….. $2.00
PERSONAL COMPUTER ENDORSEMENT. Deductible $100. …………………………………………………………………… $1.50




** CURRENT APPRAISALS ARE REQUIRED FOR SCHEDULED ARTICLES VALUED AT $3,000 ANY ONE ITEM.

REFER TO COMPANY INDIVIDUAL ITEMS IN EXCESS OF $2,500.
90% CO-INSURANCE APPLIES.




PREMIER MARINE                                                                        ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                     4.7
                                                                                        4.0 MOBILE HOMES
 


                                          EXTENSIONS OF LIABILITY

                                                                    LIMITS OF LIABILITY
                                                         $1,000,000                         $2,000,000
Principal Residence                                   Included in Owner                          $25
                                                      Occupied, Renters

Additional Residence                                         $25                                 $40

Seasonal/Rented to Others                                     $25                                $40

Incidental Office Use                                        $20                                 $40

Business Use:                                            $20 per child                      $40 per child
    Incidental School                                      (max. 3)                           (max. 3)

     Day Care                                            $75 per child                          $125
                                                           (max. 3)

Swimming Pool & Hot Tub                                      $15                                 $25

Each Saddle or Draft Animal                              $15 (max. 2)                       $25 (max. 2)

Farmers Personal Liability*                                  $25                                 $40

Outboard Motor &
Inboard/Outboard Motors:
    25 HP to 50 HP                                           $35                                $70
    51 HP to 100HP                                           $35                                $70
    101 HP & over                                     Refer to Company                   Refer to Company

Golf Carts                                            Refer to Company                   Refer to Company



*Farmers Personal Liability Coverage. In order to provide proper Liability Coverage for your clients who live on small acreage
and have a few farm animals, you may provide coverage by extending the liability in the Declarations.

This is for a small hobby farm, not the full time farmer, MAX $10,000 GROSS RECEIPTS.




PREMIER MARINE                                                                               ON  Rev. NB Oct 1, 2011/REN Nov 1, 2011
                                                                                                                             4.8
 

 

 

 

 

 

 

 




    5.0 HIGH VALUE HOMES
 

 

          

 

 
                                                                                  5.0   H I G H  V A L U E  H O M E  
P R O GR A M   O V E R V I E W  
    The Premier Sterling homeowner program is backed by Lloyds security. This
    means over 300 years of financial strength are behind every one of our policies.
    With more Fortune 500 companies placing their insurance with the Lloyds market
    than with any other one insurer, you can feel confident that you have placed your
    trust in the trusted.

FEATURES: 
    Capacity up to $20 million TIV (min. $550,000 dwelling value to qualify)
    All Risks Coverage
    Guaranteed Replacement Cost on building
    Automatic inflation protection increases at renewal
    Rebuilding to Code – No Limit
    Debris Removal – No Limit
    Deductible is waived if loss is $50,000 or greater
    Identity Fraud
    Personal Liability coverage including libel and slander, defamation of character,
    mental anguish or false arrest.


TAILORED SOLUTIONS … FOR DIFFICULT SITUATIONS: 
    Homes under extensive renovations
    Log construction
    Past loss frequency issues
    Heritage homes
    Seasonal dwellings
    Vacant dwellings
    Unprotected risks
    US and Overseas ownership of Canadian properties (ie. Seasonals)




PREMIER MARINE                                                                                             CAN Mar 2011 

                                                                                                                    5.1 
    High Value Homes Application – PREMIER Sterling Program                                                                                                                                  Page 1 of 2


NAME OF INSURED:                                                                                                                                                    □ QUOTE ONLY            □ PLEASE BIND

MAILING ADDRESS:                                                                                                      City:                                    Prov:                  PC:

LOCATION OF RISK:                                                                                                     City:                                    Prov:                  PC:

TELEPHONE: Residence: (               )                                                                    Business: (             )
Date of birth: Day: _______ Month: __________________ Year: _______________                                                   How many years have you resided in Canada?
Number of people in residence: Family__________________ Staff _______________                                                 How long have you lived at this location?               __________ years
Number of families:
Occupation and position held:

Are there any business pursuits or activities on the premises? □ NO                 □ YES        (details required)

Are you an officer or director of any club, condominium association or volunteer organization:                         □ YES □ NO
If yes, please state name of organization and position held:

MORTGAGEES - Mortgagees / Loss payees / Additional interest and other interested parties (name and address)




OCCUPANCY
Owner Occupied     □              Primary   □              Secondary     □             Seasonal       □               Vacant    □             Unoccupied     □           Under Construction      □
STRUCTURE/TYPE

Detached    □          Duplex     □             Triplex   □                               Year Built:                                                     Sq. Footage:

CONSTRUCTION
Brick   □          Frame   □              Stone    □            Masonry      □             Log    □              Other:

HEATING
Natural Gas   □        Electric   □         Oil (must provide Oil Tank Questionnaire & photo)   □          Solid Fuel Heating          □ Type (Aux or Primary): ____________ (must provide photo & Questionnaire)
UPDATE INFO:
Heating                            Electrical                                        Plumbing                                               Roof
Fire Protection:      Distance to Fire Hydrant: ________                  Distance to Fire hall: _______                □ Paid □ Volunteer
Describe any fire or burglary protection systems and confirm they are in good working order and have a maintenance agreement:




LIST ALL RESIDENCES YOU OWN OR OCCUPY
State occupancy: i.e. Apartment – Condominium – Duplex/Triplex – Pied-à-Terre – Rented to others – Seasonal residence – Single family

    ADDRESS                                                                                                   OCCUPANCY




LIMITS OF INSURANCE
$                              building (limit must not be less that 100% of estimated replacement cost value)
$                              detached buildings and structures
$                              personal property (unscheduled)
$                              additional living expenses
$                              liability insurance (basic limit)

Deductible:     □ $1,000           □ $2,500               □ $5,000           □ $10,000


PREMIER MARINE                                                                                                                                                                                 5.2
WESTERN CANADA
T 604.669.5211 F 604.669.2667
www.premiermarine.com
 
    High Value Homes Application – PREMIER Sterling Program                                                                                                 Page 2 of 2


ADDITIONAL COVERAGES

SCHEDULED PERSONAL ARTICLES (i.e. Jewellery, fine arts) (Please submit detailed list of articles to be scheduled)                                       Total Value

EARTHQUAKE PROTECTION ON BUILDING - deductible ____________ %                      □ YES □ NO
LOSS EXPERIENCE
Please describe all property and liability losses or claims during last 5 years:
DATE                       AMOUNT                   DESCRIPTION
(day/month/year)




PREVIOUS INSURER AND POLICY NUMBER(S):

HAS ANY INSURER DECLINED TO QUOTE OR CANCELLED?:                        □ YES □ NO      If yes, please provide details.




ADDITIONAL LIABILITY EXPOSURES:




ADDITIONAL INFORMATION: Please disclose all other facts, which may have influence on the acceptance or assessment of this application.




PLEASE READ BEFORE SIGNING

This application will be incorporated in its entirety into any relevant policy of insurance where Insurers have relied upon the information contained herein. Any
misrepresentations or concealment in this application for insurance, will render insurance coverage null and void from inception. Please therefore check to make sure that all
questions have been fully answered and that all facts material to your insurance have been disclosed. Signing this form does not bind the Applicant to purchase the insurance
or the Insurer to accept the risk, but it is agreed that this form shall be the basis of the contract should a policy be issued. For purposes of the Insurance Companies Act
(Canada), any document would be issued in the course of Lloyd’s Underwriters’ insurance business in Canada.

I have provided personal information in this document and otherwise and I may in the future provide further personal information. Some of this personal information may
include, but is not limited to, my credit information and claims history. I authorize my broker or insurance company to collect, use and disclose any of this personal
information, subject to the law and broker’s or insurance company’s policy regarding personal information, for the purposes of communicating with me, assessing my
application for insurance and underwriting my policies, evaluating claims, detecting and preventing fraud, and analyzing business results. I confirm that all individuals whose
personal information is contained in this document have authorized that I agree to the above on their behalf.



NOTE: INSURANCE IS NOT IN EFFECT UNTIL PREMIER HAS ISSUED A BINDER NUMBER.

Signature of Applicants:                                                                  Date:

Signature of Broker:                                                                      Date:

Broker Firm:                                                                              Broker AGT #:

Broker Email:                                                                            Tel:                                 Fax #:




PREMIER MARINE
                                                                                                                                                               5.2
WESTERN CANADA
T 604.669.5211 F 604.669.2667
www.premiermarine.com
 
 

 

 

 

 

 

 

 




    6.0 HARD TO PLACE HOMES
 

 

          

 

 
                                                                           6.0   H A R D  T O   P LACE  H O M E S  
P R O GR A M   O V E R V I E W  
    As the insurance giants grow larger, brokerages are finding these international
    conglomerates are not interested in looking at a risk on its individual merits.
    Premier developed this program in order to facilitate those risks that may fall
    “outside the box”, or require some “tailoring” due to poor loss experience in certain
    areas.

HOMEOWNERS ‐ HARD TO PLACE 
 
Eligible Risks: 
    Vacant Homes               Rented Dwellings                  Tenants
    Non-Payment issues         Loss Frequency Problems           Multiple mortgages
    60 AMP Service             Stand-Alone Seasonals             Log Homes
    Home Based Business        First time homeowners             Knob & Tube Wiring
    Galvanized plumbing
 
Ineligible Risks: 
    Poor Housekeeping or Poor Maintenance
    Farms or Farming Activities
    Unprotected risks
     


COVERAGES AVAILABLE 
 
BROAD 
    All Risk on building
    Named Perils on contents
    Replacement Cost on building and contents

STANDARD 
    Named Perils on building and contents
    Replacement Cost on building and contents

FIRE & EC 
    Replacement Cost on building
    Actual Cash Value on building
    ACV on contents




PREMIER MARINE                                                                                           CAN Mar 2011 

                                                                                                                  6.1 
   Hard To Place Homeowners                                                                                            PREMIER MARINE
NAME OF APPLICANTS:______________________________________________________________________________________ □ QUOTE ONLY                                                                  □ PLEASE BIND
Location - Address:____________________________________________________________________City:____________________Prov:_________P.C.:_____________
Age of Applicant: ______________________ years                                              Age of Home : ________________________
Heating:      □ Furnace Central                                                             OCCUPANCY                 Y   N                      STRUCTURE/TYPE                       CONSTRUCTION
              □ Solid Fuel Heating (Requires Questionnaire)                                 Owner Occupied?           □    □                     □ Detached                           □ Brick
              □ Combination with Wood                                                       Primary                   □   □                      □ Semi-detached                      □ Frame
              □ Electric                                                                    Secondary                 □   □                      □ Townhouse                          □ Aggregate
              □ Oil Furnace (Requires Oil Questionnaire)                                    Seasonal                  □    □                     □ Rowhouse                           □ Stone
              □ Aux Heat Type: ________________                                             Vacant                    □   □                      □ Pre Fab                            □ Masonry
                                                                                            Unoccupied                □   □                      □ Mobile Home                        □ Log
Value of Home: (100% of RCT) $___________________                                           Under construction        □   □                      □ Duplex                             Other: _________
Hydro: □ 60 amp □ 100 amp □ 200 amp            □ C.B’s                     □ Fuses                                                               □ Triplex                            Age of Roof? ___
Fire Protection:   Distance to Fire Hydrant: ________                      Distance to Firehall: _______         □ Paid □ Volunteer
Coverage Required:           □ Broad      □ Std     □ Fire & E.C.         □ Sewer Back-up             □ Earthquake
Other Coverage Required:____________________________________________________________________________________________________________________
List all claims in the past five years (Date, Description, Pd.):______________________________________________________________________________________
__________________________________________________________________________________________________________________________________________
Reason standard market chose not to renew: (Required)__________________________________________________________________________________________

To Be Answered By All Applicants:

Have you ever had insurance cancelled mid-term?                  □ YES          □ NO                      Reason:
Is the property for sale?                                                                                                                                                                □ YES       □ NO
How long has applicant lived at this location?
How many mortgages/liens/encumbrances do you have?                                                        Total Amount of Mortgages/Liens/Encumbrances: $
Are any of your mortgages/liens/encumbrance payments in arrears?                                                                                                                          □ YES      □ NO
Occupation?                                                                                             During the last 12 months, how long have you been employed?               __________ months
Have you had more than one fire loss in the last five years?                                                                                                                             □ YES       □ NO
Have you had any losses caused by arson?                                                                                                                                                 □ YES       □ NO
Do any business pursuits or farming take place on the premises?                  (if yes, describe)                                                                                      □ YES       □ NO
Are there any ex-farm buildings on the premises?           (if yes, describe)                                                                                                            □ YES       □ NO
Do you have any roomers/boarders on premises?                   □ YES           □ NO                      How many?
List and date all upgrades/maintenance done (electric/plumbing/heating etc.):____________________________________________________________________________
__________________________________________________________________________________________________________________________________________
Is the client new to your office? □ YES □ NO                         If no, how long have you known applicant? ______________
Is there any knob and tube, or aluminum wiring?                 □ YES           □ NO                      What percent?                      Location?

Are there more than two adults that live in the home?                                                                                                                                    □ YES       □ NO
Is there more than one family that lives in the home?                                                                                                                                    □ YES       □ NO
For risks where 60 amp service in use, do you have more than four major appliances in use at the home (eg. refrigerator, washer/dryer, water heater, etc)?                               □ YES       □ NO
For risks where 60 amp service in use, have you attached a Hydro Inspection Certificate or inspection report done by a qualified electrician?                                            □ YES       □ NO

PLEASE READ BEFORE SIGNING
This application will be incorporated in its entirety into any relevant policy of insurance where insurers have relied upon the information contained herein. Any misrepresentations or concealment in
this application for insurance, will render insurance coverage null and void from inception. Please therefore check to make sure that all questions have been fully answered and that all facts material
to your insurance have been disclosed. Signing this form does not bind the Applicant to purchase the insurance or the insurer to accept the risk, but it is agreed that this form shall be the basis of the
contract should a policy be issued.

NOTE: INSURANCE IS NOT IN EFFECT UNTIL PREMIER MARINE HAS ISSUED A BINDER NUMBER.

Signature of Applicants: ______________________________________________________                                       Date: _____________________________________________________
Signature of Broker: _________________________________________________________                                        Date: ______________________________________________________
Broker Name & City: ________________________________________________________                                          Broker Email: _______________________________________________
Broker Tel: ________________________________________________________________                                          Return Fax: _________________________________________________



PREMIER MARINE
                                                                                                                                                                                                   6.2
ONTARIO & EASTERN CANADA                                                                                              WESTERN CANADA
T 416.365.0444 F 416.365.0446                                                                                         T 604.669.5211 F 604.669.2667
www.premiermarine.com                                                                                                 www.premiermarine.com
  TENANTS PACKAGE
NAME OF APPLICANTS:

Address:                                                                            City:                                                                Prov.:                           P.C.:

Age of Building: _______________________                                            OCCUPANCY                                   Y      N                STRUCTURE/TYPE
Heating: □ Furnace Central                                                          Primary                                     □ □                     □ Detached                        □ High Rise
            □ Solid Fuel Heating Unit (Requires Questionnaire)                      Other __________________________                                    □ Semi-detached                   □ Mobile Home
            □ Combination Furnaces                                                  CONSTRUCTION                                                        □ Townhouse                       □ Multiplex
            □ Electric Baseboards                                                   □ Fire Resistive                                                    □ Rowhouse                        □ Basement Apartment
            □ Oil Furnace (Requires Questionnaire)                                  □ Non Fire Resistive
Fire Protection: _______ Hydrant within 300m,                                       ________Firehall within 8 kms or less,                              ________Firehall more than 8 kms
Hydro:      □ 60 amp                                                                □ 100 amp                                                           □ 200 amp
Explain and date all upgrades/maintenance:

Electrical:
Plumbing:
Heating:
Roof:

CONTENTS LIMIT: $ _______________ ($75,000 max. for fire resistive, $50,000 max. for other)

TO BE ANSWERED BY ALL APPLICANTS:
List all loses in the past five years (Date, Description, Amount Pd.):



Reason standard market chose not to write/renew?
Have you had insurance cancelled mid-term?                                                                                                                               □ YES            □ NO
Reason:
Have you been cancelled due to non-payment on more than one occasion?                                                                                                    □ YES            □ NO
Date of Birth                                     Occupation:

Have you been continuously employed for 12 consecutive months?                                                                                                           □ YES            □ NO
If no, explain:
Have you had any losses caused by arson?                                                                                                                                 □ YES            □ NO
Is the unit attached to a commercial exposure?                                                                                                                           □ YES            □ NO
If yes, explain:
Do any business pursuits take place on the premises?                                                                                                                     □ YES            □ NO
Are there more than 2 unrelated individuals living on the premises?                                                                                                      □ YES            □ NO
If yes, explain relationships of all occupants.


PLEASE READ BEFORE SIGNING
This application will incorporated in its entirety into any relevant policy of insurance where Insurers have relied upon the information contained herein. Any misrepresentations or concealment in this application for
insurance, will render insurance coverage null and void from inception. Please therefore check to make sure that all questions have been fully answered and that all facts material to your insurance have been
disclosed. Signing this form does not bind the Applicant to purchase the insurance or the Insurer to accept the risk, but it is agreed that this form shall be the basis of the contract should a policy be issued.
NOTE: INSURANCE IS NOT IN EFFECT UNTIL PREMIER HAS ISSUED A BINDER NUMBER.

Signature of Applicants:                                                                                               Date:

Signature of Broker:                                                                     Broker Firm:____________________________________                                   Date:
Broker Email:                                                                                         Tel:                                               Return Fax #:


PREMIER MARINE                                                                                                                                                                                                   6.3
CENTRAL & ATLANTIC CANADA                                                                                                              WESTERN CANADA
T 416.365.0444 F 416.365.0446                                                                                                          T 604.669.5211 F 604.669.2667
www.premiermarine.com                                                                                                                  www.premiermarine.com
    RISK assist            Rented Dwelling Application                   [Please answer all questions]        Page 1 of 2             PREMIER MARINE

NAME OF INSURED:

MAILING ADDRESS:                                                                     City:                                  Prov:               PC:

LOCATION OF RISK:                                                                    City:                                  Prov:               PC:

PRINCIPALS (if in a company name):

MORTGAGEES (name & address in payment order):

________________________________________________________________________________________________________________________________


BUILDING DETAILS:

FIRE PROTECTION:            Hydrant: Within 300m?    □ YES □ NO                          Fire Hall: Within 8km? □ YES        □ NO                □ Paid □ Volunteer
CONSTRUCTION:             □ Brick        □ Frame          □ Stone         □ Masonry             □ Log          □ Others (Please describe)
FOUNDATION:               □ Concrete/Poured Concrete           □ Brick         □ Stone            □ Post & Pier          □ Preservative – Treated Lumber
AGE OF BUILDING:                                   NO. OF UNITS:                             NO. OF OCCUPANTS:                       NO. OF STORIES:

Is each unit a self-contained suite?               □ YES □ NO
Does property have fire extinguishers? ?    □ YES □ NO               Operable smoke detectors?           □ YES □ NO               Operable sprinklers?   □ YES □ NO
ELECTRICAL SYSTEM:            □ 60AMP □ 100AMP □ 200AMP                      □ CB’s                        □ Fuses                   □ Aluminum Wiring
                              □ Knob & Tube Wiring (location):
PLUMBING (type):                                                                                           AGE OF ROOF:

If Oil is used, please attach Oil Tank Questionnaire and photos of oil tank(s).

Does property have a central heating system?       □ YES □ NO                Type:

Is there a solid fuel heating unit?                □ YES □ NO                (If YES, please attach Questionnaire).


UPDATE INFO (YEAR):

             Electrical: __________________       Heating: ___________________           Plumbing: __________________             Roof: ______________________

Does owner have a professional property management co. responsible for property?                                                                □ YES □ NO
How often is property visited?                                  If so, by whom:

Does owner live within 100 miles?                                                                                                               □ YES □ NO
Is there a written rental agreement in place with all the tenants?                                                                              □ YES □ NO
Are tenants required to carry insurance?                                                                                                        □ YES □ NO
Is there a swimming pool on the premises?                       □ YES □ NO                   Explain:

Are there any business pursuits on the premises?                □ YES □ NO                   Explain:

Are there any farming pursuits on the premises?                 □ YES □ NO                   Explain:




PREMIER MARINE
                                                                                                                                                               6.4
CENTRAL & ATLANTIC CANADA                                                                                  WESTERN CANADA
T 416.365.0444 F 416.365.0446                                                                              T 604.669.5211 F 604.669.2667
www.premiermarine.com                                                                                      www.premiermarine.com
 
    RISK assist            Rented Dwelling Application                   [Please answer all questions]       Page 2 of 2           PREMIER MARINE

LIST ALL TENANTS
Name                                                            Age          Relation to other tenants                Occupation                Full time position?

                                                                                                                                                □ YES □ NO
                                                                                                                                                □ YES □ NO
                                                                                                                                                □ YES □ NO
                                                                                                                                                □ YES □ NO
Is the property viewable from a paved road?                                                                                                     □ YES □ NO
Has broker visited property, and if so, would broker recommend this risk?                                                                       □ YES □ NO
Has this risk been refused or cancelled by another insured?     □ YES □ NO                   Reason:

Previous insurer?                                                                   Policy number:                               Expiring Premium:

Five (5) Year Loss history (date; paid/estimated amount; cause; open/closed)?
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________

Target Premium: $

COVERAGE REQUIRED
Building:                                                                                    Contents (major appliances):
Rental Income:                                                                               Liability:
Other Coverages Required:


    Current Photos (front & back) required prior to binding.
PLEASE READ BEFORE SIGNING
This application will be incorporated in its entirety into any relevant policy of insurance where Insurers have relied upon the information contained herein. Any
misrepresentations or concealment in this application for insurance, will render insurance coverage null and void from inception. Please therefore check to make
sure that all questions have been fully answered and that all facts material to your insurance have been disclosed. Signing this form does not bind the Applicant
to purchase the insurance or the Insurer to accept the risk, but it is agreed that this form shall be the basis of the contract should a policy be issued. For purposes
of the Insurance Companies Act (Canada), any document would be issued in the course of Lloyd’s Underwriters’ insurance business in Canada.

I have provided personal information in this document and otherwise and I may in the future provide further personal information. Some of this personal
information may include, but is not limited to, my credit information and claims history. I authorize my broker or insurance company to collect, use and disclose
any of this personal information, subject to the law and broker’s or insurance company’s policy regarding personal information, for the purposes of
communicating with me, assessing my application for insurance and underwriting my policies, evaluating claims, detecting and preventing fraud, and analyzing
business results. I confirm that all individuals whose personal information is contained in this document have authorized that I agree to the above on their behalf.



NOTE: INSURANCE IS NOT IN EFFECT UNTIL PREMIER HAS ISSUED A BINDER NUMBER.

Signature of Applicants:                                                                       Date:

Signature of Broker:                                                                           Date:

Broker Firm:                                                                                   Broker AGT #:

Broker Email:                                                                                 Tel:                                 Fax #:




PREMIER MARINE                                                                                                                                                  6.4
CENTRAL & ATLANTIC CANADA                                                                                 WESTERN CANADA
T 416.365.0444 F 416.365.0446                                                                             T 604.669.5211 F 604.669.2667
www.premiermarine.com                                                                                     www.premiermarine.com
 
Vacancy Questionnaire                                                             Page 1 of 2                                          PREMIER MARINE
                                                                                                                               □ QUOTE ONLY □ PLEASE BIND
NAME OF INSURED:

MAILING ADDRESS:                                                                  City:                                Prov:               PC:

LOCATION OF RISK:                                                                 City:                                Prov:               PC:

PRINCIPALS (if in a company name):

MORTGAGEES (name & address in payment order):

________________________________________________________________________________________________________________________________

BUILDING DETAILS:

FIRE PROTECTION:               Hydrant: Within 300m?   □ YES □ NO                     Fire Hall: Within 8km? □ YES      □ NO                □ Paid □ Volunteer
CONSTRUCTION:                □ Brick      □ Frame         □ Stone       □ Masonry           □ Log         □ Others (Please describe)
FOUNDATION:                  □ Concrete/Poured Concrete       □ Brick      □ Stone            □ Post & Pier         □ Preservative – Treated Lumber
AGE OF BUILDING:                                    NO. OF UNITS:                         NO. OF OCCUPANTS:                     NO. OF STORIES:

Is each unit a self-contained suite?           □ YES □ NO
Does property have fire extinguishers? ? □ YES □ NO           Operable smoke detectors? □ YES □ NO                           Operable sprinklers?   □ YES □ NO
ELECTRICAL SYSTEM: □ 60AMP □ 100AMP □ 200AMP                         □ CB’s               □ Fuses                               □ Aluminum Wiring
                             □ Knob & Tube Wiring (location):
PLUMBING (type):                                                                                      AGE OF ROOF:

If Oil is used, please attach Oil Tank Questionnaire and photos of oil tank(s).

Does property have a central heating system?        □ YES □ NO            Type:

Is there a solid fuel heating unit?                 □ YES □ NO            (If YES, please attach Questionnaire).

UPDATE INFO (YEAR):
              Electrical: __________________       Heating: ___________________       Plumbing: __________________           Roof: ______________________

Vacancy
How long has the property been vacant?                        Why?
What is the anticipated future of this building?
What will be the approximate duration of vacancy?

Is a key in the hands of a competent person who checks the building within every 72 hours?                                                 □ YES □ NO
If so, who is this person and how often is the property checked?

Is the property easily viewed from the road?                  □ YES □ NO                                                                   Size of lot:

Is the property on a paved road?                                                                                                           □ YES □ NO
Maintenance

                              □ Hydro □ Water □ Telephone □ Gas
Public utilities left in service:                                                         Reason:

Have all electrical appliances, if any, been disconnected? □ YES □ NO                     Are there curtains in the windows?               □ YES □ NO
If not, what means have been taken to prevent building from looking unoccupied?




PREMIER MARINE                                                                                                                                            6.5
CENTRAL & ATLANTIC CANADA                                                                             WESTERN CANADA
T 416.365.0444 F 416.365.0446                                                                         T 604.669.5211 F 604.669.2667
www.premiermarine.com                                                                                 www.premiermarine.com
Vacancy Questionnaire                                                               Page 2 of 2                                           PREMIER MARINE

Is the property being maintained in a usable and salable condition at all times?                                                             □ YES □ NO
What arrangements have been made to maintain the property and attend the grounds?



Have you visited the property to verify the above answers?                                                                                   □ YES     □ NO
Is the general maintenance, overall appearance and prospects for re-occupancy such that you recommend this property for insurance?           □ YES     □ NO
Is this an existing client of your office?                                                                                                   □ YES     □ NO
Are any renovations being performed on the building?                                                                                         □ YES     □ NO
If so, by whom?
Details of renovation (extent and budget of renovation):



Previous Insurance

Type of insurance?

Previous insurance company, Policy #:

Loss history (date; paid/estimated amount; cause; open/closed)?

________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________

Target Premium: $


Limits Required

Building:                                          Contents (appliances only):                                     Liability (OL&T):


Current photos ( front & back) required prior to binding.

PLEASE READ BEFORE SIGNING
This application will be incorporated in its entirety into any relevant policy of insurance where Insurers have relied upon the information contained herein. Any
misrepresentations or concealment in this application for insurance, will render insurance coverage null and void from inception. Please therefore check to make
sure that all questions have been fully answered and that all facts material to your insurance have been disclosed. Signing this form does not bind the Applicant
to purchase the insurance or the Insurer to accept the risk, but it is agreed that this form shall be the basis of the contract should a policy be issued. For purposes
of the Insurance Companies Act (Canada), any document would be issued in the course of Lloyd’s Underwriters’ insurance business in Canada.

I have provided personal information in this document and otherwise and I may in the future provide further personal information. Some of this personal
information may include, but is not limited to, my credit information and claims history. I authorize my broker or insurance company to collect, use and disclose
any of this personal information, subject to the law and broker’s or insurance company’s policy regarding personal information, for the purposes of
communicating with me, assessing my application for insurance and underwriting my policies, evaluating claims, detecting and preventing fraud, and analyzing
business results. I confirm that all individuals whose personal information is contained in this document have authorized that I agree to the above on their behalf.

NOTE: INSURANCE IS NOT IN EFFECT UNTIL PREMIER HAS ISSUED A BINDER NUMBER.

Signature of Applicants:                                                                   Date:

Signature of Broker:                                                                       Date:

Broker Firm:                                                                               Broker AGT #:

Broker Email:                                                                              Tel:                                  Fax #:




PREMIER MARINE                                                                                                                                                  6.5
CENTRAL & ATLANTIC CANADA                                                                             WESTERN CANADA
T 416.365.0444 F 416.365.0446                                                                         T 604.669.5211 F 604.669.2667
www.premiermarine.com                                                                                 www.premiermarine.com
    Solid Fuel Heating Questionnaire                                                                                                 PREMIER MARINE
 
Insured:                                                                                                Policy No:
Address:
Broker:                                                                                                 Broker Email:______________________________________

STOVE OR OTHER NON CENTRAL HEATING APPLIANCE                                                                                                           YES NO
1. Do you use your unit as a:                       □ Primary heat source                  □ Auxiliary heating source
2. Type                                             □ Ordinary Stove                       □ Airtight Stove                     □ Cooking Stove
3 .Is the appliance:                                □ C.S.A.                               □ U.L.C.                             □ Warnock Hersey
4. Manufacturer:                                                 Model:                                                         □ Age:
5. Is there at least 18 inches clearance between the unit and any shielded combustible material?                                                       □         □
6. Is the floor shield extending at least 18 inches from the loading-side door and 8 inches on the other three sides?                                  □         □
7.The floor construction supporting the stove is: □ Concrete only         □ Frame Only                  □ Frame Covered with a Non-Combustible Material
8. Distance between stove and combustibles (furniture, drapes, carpet, etc.):

FLUE PIPE                                                                                                                                              YES NO
1. Is there at least 18 inches between the pipe and any combustible material?                                                                          □         □
2. If the pipe goes through the wall or ceiling, is there a metal thimble of at least 18 inches in diameter?                                           □         □
3. How often are the pipes cleaned?

CHIMNEY
1. The chimney is:                     □ Factory built           □ Other (describe)                                              Who installed?
2. Is chimney:                         □ C.S.A                   □ U.L.C.                                                       □ Warnock Hersey
3. If a metal chimney, is there at least 2 inches clearance between the chimney and any combustible material?                                          □         □
4. Does the appliance share chimney with any other heating appliance?                                                                                  □         □
5. Is the chimney professionally cleaned annually?                                         If no, how often?

FIREPLACE
1. The fireplace is: □ Masonry         □ Fireplace insert (o Clearance)       □ Freestanding metal fireplace         □ Prefabricated □ Fireplace insert (Other)
2.Provide installation date:                                     Make:                                  Model No.:
3.The chimney is:                                   □ Masonry lined                        □Masonry unlined                     □ Factory built metal chimney
4.If a metal chimney, is it:                        □ C.S.A.                               □ U.L.C.                             □ Warnock Hersey
5.Is the chimney professionally cleaned annually?                                          If no, how often?

INSTALLATION OF UNIT AND CHIMNEY                                                                                                                       YES NO
1. Was appliances installed by:      □ Yourself (Provide picture showing complete installation) □ A Qualified installer
2. Has the installation been inspected and approved by: □ Fire Department Official □ Building Inspector
3. Has the heating appliance been installed with at least the recommended clearances shown on diagram (see over)?                                      □         □
4. If no, please provide details:

MISCELLANEOUS INFORMATION                                                                                                                              YES NO
1.Do you use a metal container for ash removal?                                                                                                        □         □
2. Approx. hours/day appliance is used:                          Approx. days/week appliance is used:                           __          ________
3.Approx. number of woodcords (2x4x6) used annually:                                                                                        ________

4.Have you ever had a chimney fire?                                                                                                                    □         □
5.No. of fire extinguishers                                      Distance to fire extinguishers                                             ________




PREMIER MARINE
                                                                                                                                                           6.6
CENTRAL & ATLANTIC CANADA                                                                               WESTERN CANADA
T 416.365.0444 F 416.365.0446                                                                           T 604.669.5211 F 604.669.2667
www.premiermarine.com                                                                                   www.premiermarine.com
 Oil Tank Questionnaire                                                                                                 PREMIER MARINE

BROKER NAME:                                                                          BROKER EMAIL: ___________________________________________
POLICY NO:
NAME OF INSURED:
PROPERTY ADDRESS:


PLEASE COMPELTE THE FOLLOWING QUESTIONS


1. What is the age of the Oil Tank?                                       years,               - tank over 25 years not acceptable


2. Where is the Oil Tank located?                                         ABOVE GROUND (do no write underground tanks)
                                                                          - Outside home   □ YES     □ NO
                                                                          - Inside home              □ YES      □ NO
                                                                          Describe where ____________________________________

3. Is there any rust, dents or evidence of corrosion?                                                    □ YES         □N O
  If YES, where is it located on the tank?

4. Are there any sings of leaks at tank connectors or anywhere else?                                                   □ YES         □ NO
5. Is the fuel supply line protected?                                                                                  □ YES         □ NO
6. Is the fuel supply line supported in a stable manner off the ground?                                                □ YES         □ NO
7. Is the tank resting on a non-flammable base?                                                                        □ YES         □ NO
  If no, describe the type of base

8. Is there a clear air space around the entire Oil Tank?                                                              □ YES         □ NO
  (helps provide condensation relief)
9. Does a qualified person service the Oil Tank yearly?                                                                □ YES         □ NO
  Date of last service

10. Was the Oil Tank professionally installed?                                                                         □ YES         □ NO
11. Is the Oil Tank manufactured, CSA, or ULC approved unit?                                                           □ YES         □ NO
12. Photo of Oil Tank attached?                                                                                        □ YES         □ NO

THE ABOVE QUESTIONS HAVE BEEN COMPLETED TO THE BEST OF MY KNOWLEDGE

THIS         D A Y OF                              , 20



INSURED (please print name)                                               SIGNATURE OF INSURED


BROKER (please print name)                                                SIGNATURE OF BROKER




PREMIER MARINE                                                                                                                              6.7

CENTRAL & ATLANTIC CANADA                                                                      WESTERN CANADA
T 416.365.0444 F 416.365.0446                                                                  T 604.669.5211 F 604.669.2667
www.premiermarine.com                                                                          www.premiermarine.com
 

 

 

 

 

 

 

 




    7.0 EVENT LIABILITY
 

 

          

 

 
                                                              7.0 event liability




program overview


Eligible Short Term Special Events:

Auctions                   Banquets/Luncheons   Concerts (Classical/Jazz)
Conventions                Dinner Theatre       Festivals
Job Fairs                  Meetings             Picnics
Reunions                   Boat/RV Shows        Speaking Engagements
Sports Events              Stage Shows          Weddings and Receptions


Host Liquor Liability available
Non-Owned Automobiles
Up to $5 million limit
Medical expense coverage
Low deductibles


Hobby / Enthusiasts Clubs – Annual CGL:

Eligible Risks include:

Antique Car Clubs          Bowling Clubs        Basketball Clubs
Chess Clubs                Choir Groups         Cricket Clubs
Gardening Clubs            Hockey Clubs         Model Airplane Clubs
Rugby Clubs                Squash Clubs         Walking Clubs

Non-Profit groups only
Non-Owned Automobiles
Low minimum premium




PREMIER MARINE                                                              ON Feb 9/06
                                                                                    7.1
                                             EVENT LIABILITY INSURANCE- APPLICATION
                                                                FOR BOOTH/KIOSKS
APPLICANT INFORMATION:
Name of Applicant:_______________________________________________________________________________________
Address: __________________________________City:________________Province:_______Postal Code: ________________
Additional Insured: (Please attach a list of all Additional Insured(s) required) _________________________________________
Have you ever had insurance refused or cancelled?  Yes  No            Reason? ________________________________________

EVENT DESCRIPTION:
Name of Event: _________________________________________________________________________________________
Full address of Event (No PO Boxes):________________________________________________________________________
Description of Location:___________________________________________________________________________________
Effective Date – Fr: ______________Time: ________ AM  PM To: _____________ Time: ____________ AM  PM

Describe (in detail) all products/services being sold or provided by you at this event: __________________________________
______________________________________________________________________________________________________
*** INSURANCE IS NOT IN EFFECT UNTIL PREMIER HAS ISSUED A BINDER NUMBER. ***

Request to bind 
  Limit of Liability: $1,000,000                                                                     Limit of Liability: $2,000,000

 Up to 7 days:     $ 95 Premium + $35 Policy Fee                                                    Up to 7 days:            $105 Premium + $35 Policy Fee                       
 8 -14 days:       $119 Premium + $35 Policy Fee                                                    8 -14 days:              $132 Premium + $35 Policy Fee                       
Premium is fully earned and retained.$35Policy Fee
 15-30 days:       $142 Premium +                                                                   15-30 days:              $158 Premium + $35Policy Fee                        
 31-90 days:       $203 Premium + $35Policy Fee                                                     31-90 days:              $225 Premium + $35Policy Fee                        

15% Broker Commission on Premiums.
Premiums are fully earned and retained once binder number issued by Premier Marine.
Minimum Premium for booths/kiosks that serve food and/or beverages is $200
For limits greater than 2 million or longer booth durations, please submit to Premier Marine
PLEASE READ BEFORE SIGNING APPLICATION: This application will be incorporated in its entirety into any relevant policy of insurance where insurers have relied
upon the information contained herein. Any misrepresentations or concealment in this application for insurance will render insurance coverage null and void at inception. Please therefore
check to make sure all questions have been fully answered and that all facts material to your insurance have been disclosed, if necessary by a supplement to the application. The
Applicants have reviewed all parts and attachments of this application and acknowledge that all information is true and correct and understand that this application for insurance is based
on the truth and completeness of this information. I have provided personal information in this document and otherwise and I may in the future provide further personal information.
Some of this personal information may include, but is not limited to, my credit information and claims history. I authorize my broker or insurance company to collect, use and disclose
any of this personal information, subject to the law of and to my broker’s or insurance company’s policy regarding personal information, for the purposes of communicating with me,
assessing my application for insurance and underwriting my policies, evaluating claims, detecting and preventing fraud, and analyzing business results. I can confirm that all individuals
whose personal information is contained in this document have authorized that I agree to the above on their behalf. Signing of this form does not bind the Applicant to purchase the
insurance or the insurer to accept the risk, but is agreed that this form shall be the basis of the contract should a policy be issued.


Applicant’s Signature: ___________________________Date:__________________Brokerage Firm:____________________.

Broker’s Signature:__________________(Print):___________________Ph#:_________________Fax.#:________________ _.

Broker Email:____________________________________________________
                                       625 Howe Street, Suite 650, Vancouver, B.C. V6C 2T6 Tel: 604 669 5211 Fax: 604 669 2667
                                      40 University Avenue, Suite 201, Toronto, ON M5J 1T1 Tel: 416 365 0444 Fax: 416 365 0446
                                                                                                                                                                                     7.2
                                                                       www.premiermarine.com
                                                                                                                         Binder Number - For Premier Use Only
                                             EVENT LIABILITY INSURANCE- APPLICATION
                                   FOR PRIVATE FUNCTIONS (Weddings, Parties, etc)
     (This application and published rates are for invitation only functions, for non-invitation type
APPLICANT INFORMATION:
                         functions, please refer to our Long Form Application)
APPLICANT INFORMATION:
Name of Applicant:________________________________________________________________________________________
Address: __________________________________City: ________________Province:_______Postal Code:_________________
Additional Insured: (Please attach a list if required): ______________________________________________________________
Have you ever had insurance refused or cancelled?  Yes  No         Reason? _________________________________________
EVENT DESCRIPTION:
Name of Event: ___________________________________________________________________________________________
Full address of Event (No PO Boxes):_________________________________________________________________________
Description of Location (i.e. church, hall, etc):___________________________________________________________________
Effective Date – Fr: ____________Time: __________ AM  PM To: ____________ Time: ____________ AM  PM
EVENTS LONGER THAN 48 HOURS IN DURATION MUST BE SUBMITTED TO UNDERWRITERS FOR APPROVAL
Describe (in detail) all activities taking place at Event: ___________________________________________________________
________________________________________________________________________________________________________
        *** INSURANCE IS NOT IN EFFECT UNTIL PREMIER HAS ISSUED A BINDER NUMBER. ***
Request to bind 
  Function - located at a private Residence ONLY.                                                Functions – not held at a private Residence)
  $1,000,000 limit
                                                                                             $1,000,000 limit
  1-100 guests              $ 90 Premium + $35 Policy Fee                                   1-100 guests                   $115 Premium + $35 Policy Fee                  
  101-500 guests            $115 Premium + $35 Policy Fee                                   101-500 guests                 $130 Premium + $35 Policy Fee                  
  $2,000,000 limit                                                                           501-750 guests                 $150 Premium + $35 Policy Fee                  
  1-100 guests              $125 Premium + 35 Policy Fee                                    $2,000,000 limit
  101-500 guests            $145 Premium + 35 Policy Fee                                    1-100 guests                   $150 Premium + $35 Policy Fee                  
                                                                                             101-500 guests                 $180 Premium + $35 Policy Fee                  
                                                                                             501-750 guests                 $215 Premium + $35 Policy Fee                  
15% Broker Commission on Premiums.
Premiums are fully earned and retained once binder number issued by Premier Marine.
Premiums include Liquor Liability, but ONLY when liquor permit is obtained. NO BYOB PERMITTED.
For limits greater than 2 million or larger groups, please submit to Premier Marine
PLEASE READ BEFORE SIGNING APPLICATION: This application will be incorporated in its entirety into any relevant policy of insurance where insurers have relied
upon the information contained herein. Any misrepresentations or concealment in this application for insurance will render insurance coverage null and void at inception. Please therefore
check to make sure all questions have been fully answered and that all facts material to your insurance have been disclosed, if necessary by a supplement to the application. The
Applicants have reviewed all parts and attachments of this application and acknowledge that all information is true and correct and understand that this application for insurance is based
on the truth and completeness of this information. I have provided personal information in this document and otherwise and I may in the future provide further personal information.
Some of this personal information may include, but is not limited to, my credit information and claims history. I authorize my broker or insurance company to collect, use and disclose
any of this personal information, subject to the law of and to my broker’s or insurance company’s policy regarding personal information, for the purposes of communicating with me,
assessing my application for insurance and underwriting my policies, evaluating claims, detecting and preventing fraud, and analyzing business results. I can confirm that all individuals
whose personal information is contained in this document have authorized that I agree to the above on their behalf. Signing of this form does not bind the Applicant to purchase the
insurance or the insurer to accept the risk, but is agreed that this form shall be the basis of the contract should a policy be issued.


Applicant’s Signature: ___________________________Date:__________________Brokerage Firm:____________________________.

Broker’s Signature:__________________(Print):___________________Ph#:_________________Fax.#:________________________ _.

Broker Email:___________________________________________________________
                                       625 Howe Street, Suite 650, Vancouver, B.C. V6C 2T6 Tel: 604 669 5211 Fax: 604 669 2667
                                      40 University Avenue, Suite 201, Toronto, ON M5J 1T1 Tel: 416 365 0444 Fax: 416 365 0446                                                    7.2
                                                                       www.premiermarine.com
                                                                                                                                 Binder Number - For Premier Use Only
                      EVENT LIABILITY INSURANCE- LONG FORM APPLICATION
                                    For Events Open to the Public

1. APPLICANT INFORMATION:

Name of Applicant:________________________________________________________________________________________

Address: __________________________________City: ________________Province:_______Postal Code: ________________

Additional Insured: (Please attach a list of all additional insured (s) required):_________________________________________

Have you ever had insurance refused or cancelled?  Yes  No          Reason? _________________________________________

Prior Insurer: ____________________________________ Five-Year Loss History:___________________________________

2. EVENT DESCRIPTION (please attach any Brochures, Flyers or Promotional Materials for the Event):
Name/Type of Event: ______________________________________________________________________________________

Website of Event (if applicable):______________________________________________________________________________

Has Event been held before:       YES        NO              If Yes, for how many years?:______________________________

Expiring Insurance Limit and Premium:________________________________________________________________________

Estimated Gross revenues for entire Event _________________________________________

Describe (in detail) all activities taking place at the Event:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
 _______________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
**(Please attach a separate sheet if required

Full address of Event: ______________________________________________________________________________________

Description of Location:____________________________________________________________________________________
Does the facility carry insurance :  YES    NO

Describe seating: (Folding chairs, bleachers, permanent?) __________________________  Indoors or  Outdoors
Distance to Spectators:____________________________

Will there be a stage set up for the Event:  Permanent      Temporary
(If Temporary, a certificate of insurance will be required by installers)

Will there be music played at the Event:  NO MUSIC        D.J.           LIVE MUSIC
If Live Band, please provide name and type of music:_____________________________________________________________
________________________________________________________________________________________________________

Estimated attendance per day:______________ Total attendance for Event:______________ Age range: __________________

Describe Security measures: ________________________________________________________________________________
Describe measures in place in respect to evacuating/missing persons precaution for children, as well as any i.d. procedures if there
are designated children’s areas:_______________________________________________________________________________
________________________________________________________________________________________________________

Will there be any vendors or exhibitors at the Event:  YES        NO
Are the vendors / exhibitors required to show proof of liability:  YES  NO
List all (if any) products sold at Event: ________________________________________________________________________
                                                                                                                            7.2
                                                                                                                   Page 2
Does the Event involve a parade:  YES           NO
If yes, please specify the number of units in the parade:____________(a marching band, a float, a car..= 1 unit)
Length of Parade:___________________km                 Length in time:________________________________________________
Are there any horses:  YES         NO
Police Escort:      YES       NO
Please describe security measures in place for crowd control (ex: barriers):____________________________________________
________________________________________________________________________________________________________

Will there be Fireworks or any other special effects?:                                                  YES             NO
(If yes, a certificate of insurance is required)

Will there be a petting zoo or any other animals involved in the Event:  YES                                            NO
(If yes, a certificate of insurance is required)

Is there overnight camping or other accommodations?:                                                    YES             NO

3. LIQUOR LIABILITY:
Is Liquor Liability required:      YES        NO
Estimated liquor sales for Event: $ __________________ Estimated attendance of liquor Event : ________________________
Who will serve liquor at Event?: ____________________ Do they have a “Serving it Right” # ?: ________________________
Liquor License Permit Number:______________________
List types of alcohol to be served: ________________ What limit is placed on drinks served at one time per person: __________
                                                        (Our maximum is no more than 2 drinks at once)
Is there a designated driver program in place ?  Yes  No Describe: _____________________________________________
Describe security measures at host liquor function: _______________________________________________________________

4. COVERAGE REQUIRED
LIMITS REQUIRED:                   $1 million    $2 million  $3 million  $4 million   $5 million
Effective Date – Fr: ____________Time: __________ AM  PM To: _____________ Time: _____________ AM  PM
Target Premium:_______________

PLEASE READ BEFORE SIGNING APPLICATION: This application will be incorporated in its entirety into any relevant policy of insurance where insurers have relied
upon the information contained herein. Any misrepresentations or concealment in this application for insurance will render insurance coverage null and void at inception. Please therefore
check to make sure all questions have been fully answered and that all facts material to your insurance have been disclosed, if necessary by a supplement to the application. The
Applicants have reviewed all parts and attachments of this application and acknowledge that all information is true and correct and understand that this application for insurance is based
on the truth and completeness of this information. I have provided personal information in this document and otherwise and I may in the future provide further personal information.
Some of this personal information may include, but is not limited to, my credit information and claims history. I authorize my broker or insurance company to collect, use and disclose
any of this personal information, subject to the law of and to my broker’s or insurance company’s policy regarding personal information, for the purposes of communicating with me,
assessing my application for insurance and underwriting my policies, evaluating claims, detecting and preventing fraud, and analyzing business results. I can confirm that all individuals
whose personal information is contained in this document have authorized that I agree to the above on their behalf. Signing of this form does not bind the Applicant to purchase the
insurance or the insurer to accept the risk, but is agreed that this form shall be the basis of the contract should a policy be issued.



INSURANCE IS NOT IN EFFECT UNTIL PREMIER MARINE HAS ISSUED A BINDER NUMBER

PREMIUM IS FULLY EARNED AND RETAINED
EXCLUDES ALL PARTICIPANT’S LIABILITY
EXCLUDES ALL PRODUCTS LIABILITY (OTHER THAN FOOD & DRINK)
INCOMPLETE APPLICATION FORMS WILL DELAY THE QUOTE

Applicant’s Signature: ___________________________Date:__________________Brokerage Firm:_________________________________

Broker’s Name:__________________Signature:___________________ Ph#:_________________                                                    Fax#____________________________

Broker Email: _____________________________________________________________

                                       625 Howe Street, Suite 650, Vancouver, B.C. V6C 2T6 Tel: 604 669 5211 Fax: 604 669 2667                                                    7.2
                                      40 University Avenue, Suite 201, Toronto, ON M5J 1T1 Tel: 416 365 0444 Fax: 416 365 0446
                                                                       www.premiermarine.com
                                                                                                                             Binder Number - For Premier Use Only
               HOLE-IN-ONE INSURANCE APPLICATION
1. APPLICANT INFORMATION:

Name of Applicant:________________________________________________________________________________________

Address: __________________________________City: ________________Province:_______Postal Code: ________________

Tournament to be Insured:___________________________________________________________________________________

Golf Club/Course:_________________________________________________________________________________________

Golf Club/Course Location:_________________________________________________________________________________

Date(s) of Tournament:_____________________________________________________________________________________

2. TOURNAMENT DESCRIPTION (please attach any Brochures, Flyers or Promotional Materials for the Tournament):

Participants (Over 144 players, please call for a quote). Coverage restricted to Amateurs only.
Number of Players:_____________

Hole(s) to be Insured (Minimum length – Amateur – 160 yards for men and 145 yards for women)
Hole Number(s):_______________                     Yardage on Each Hole as Stated on Scorecard:_____________________
Number of Rounds on Insured Hole(s):____________ (How many times each golfer tees off at the insured hole(s))
Prize Value of the Insured Hole(s):_______________

Request to bind 
PLEASE READ BEFORE SIGNING APPLICATION: This application will be incorporated in its entirety into any relevant policy of insurance where insurers have relied
upon the information contained herein. Any misrepresentations or concealment in this application for insurance will render insurance coverage null and void at inception. Please therefore
check to make sure all questions have been fully answered and that all facts material to your insurance have been disclosed, if necessary by a supplement to the application. The
Applicants have reviewed all parts and attachments of this application and acknowledge that all information is true and correct and understand that this application for insurance is based
on the truth and completeness of this information. I have provided personal information in this document and otherwise and I may in the future provide further personal information.
Some of this personal information may include, but is not limited to, my credit information and claims history. I authorize my broker or insurance company to collect, use and disclose
any of this personal information, subject to the law of and to my broker’s or insurance company’s policy regarding personal information, for the purposes of communicating with me,
assessing my application for insurance and underwriting my policies, evaluating claims, detecting and preventing fraud, and analyzing business results. I can confirm that all individuals
whose personal information is contained in this document have authorized that I agree to the above on their behalf. Signing of this form does not bind the Applicant to purchase the
insurance or the insurer to accept the risk, but is agreed that this form shall be the basis of the contract should a policy be issued.



INSURANCE IS NOT IN EFFECT UNTIL PREMIER MARINE HAS ISSUED A BINDER NUMBER

BROKER COMMISSION IS 15%.
$25 POLICY FEE APPLIES IN ADDITION TO PREMIUM.
PREMIUM IS FULLY EARNED AND RETAINED ONCE BINDER NUMBER ISSUED BY PREMIER MARINE
EXCLUDES ALL PARTICIPANT’S LIABILITY
INCOMPLETE APPLICATION FORMS WILL DELAY THE QUOTE

Applicant’s Signature: _________________________________________                                       Date: _______________________________________________

Brokerage Firm: ______________________________________________                                         Broker’s Name: ______________________________________

Broker’s Email: ______________________________________________                                         Signature: ___________________________________________

Tel#: _______________________________________________________                                          Fax#: ______________________________________________

       WESTERN CANADA: 625 Howe Street, Suite 650, Vancouver, B.C. V6C 2T6 Tel: 604 669 5211 Fax: 604 669 2667 – www.premiermarine.com
       EASTERN CANADA: 40 University Avenue, Suite 201, Toronto, ON M5J 1T1 Tel: 416 365 0444 Fax: 416 365 0446 – www.premiermarine.com
                                                                                                                                                                                         7.2
                                                                                                                             Binder Number - For Premier Use Only
ANNUAL CGL INSURANCE APPLICATION – For Enthusiast/Hobby Clubs, & Non-Profit Societies

Full name of Organization: _____________________________________________________________________
Mailing Address: _____________________________________________________________________________
City: _____________________________ Province: _________________________ Postal Code: _____________
Hobby/ Purpose of Club: _______________________________________________________________________
Date Established: ______________________________ Has the group ever carried insurance?                                                          Yes      No
Prior Carrier: __________________________________ Expiry Date: ___________________________________
List any incident that has or could have resulted in a claim against the group in the last 5 years:
___________________________________________________________________________________________
___________________________________________________________________________________________
Number of current members: _________________ Average age of members in group: _____________________
Is the group registered? Yes               No          Explain: ______________________________________________________
Please provide details of meetings held (How often, Where, Why, etc.): _________________________________
___________________________________________________________________________________________
Total membership fee income: $_______________
Other income:                               $________________ (Explain: ______________________________________)
TOTAL INCOME:                               $________________
**Please attach any brochures, mission statement and printed information on group.
Does the group hold events that the public can attend?        Yes No
List all of those possible events for the next 12 months:
   Date:        Location/Venue:                 # of Attendants: Gross Receipts: Activities at Event:
1. __________________________________#______________$_______________________________________
2. __________________________________#______________$_______________________________________
3. __________________________________#______________$_______________________________________
4. __________________________________#______________$_______________________________________
5. __________________________________#______________$_______________________________________
(Please attach the list if there is not sufficient space on this form)
Is Liquor consumed at any of the events or meetings?               Yes No
Note: Liquor Liability is excluded under this product. Separate coverage can be requested -
      (available on a specific event basis - see the Special Event Liability form).
Does the group have a permanent office (open to the public)?                                   Yes       No
CGL Limit Required:                       $1 Million                      $2 Million                      Effective Date: __________________
PLEASE READ BEFORE SIGNING APPLICATION: This application will be incorporated in its entirety into any relevant policy of insurance where Insurers
have relied upon the information contained herein. Any misrepresentations or concealment in this application for insurance
will render insurance coverage null and void from inception. Please therefore check to make sure all questions have been fully answered and that all facts
material to your insurance have been disclosed, if necessary by a supplement to the application. A consumer report containing personal, credit, factual or
investigative information about the applicant may be sought in connection with this application for insurance or any renewal, extension or variation thereof.
Signing of this form does not bind the Applicant to purchase the insurance or the Insurer to accept the risk, but it is agreed that this form shall be the basis of the
contract should a policy be issued.
ORIGINAL APPLICATION FORM REQUIRED WITHIN 15 DAYS OF BINDING.
NOTE: INSURANCE IS NOT IN EFFECT UNTIL PREMIER HAS ISSUED A BINDER.

Applicant’s Sig: X                                         Date:                             __Brokerage Firm:_____________________________________.

Broker’s Sig: X                             (Print):                        Broker Ph #:________________________Fax.#:__________________________.

Broker Email: X_____________________________________________________________________                                                                      7.3


                                                               PREMIER MARINE
                               625 Howe Street, Suite 650, Vancouver, B.C. V6C 2T6 Tel: (604) 669-5211 Fax: (604) 669-2667
                                                                   www.premiermarine.com
 

 

 

 

 

 

 

 




    8.0 CONSTRUCTION
 

 

          

 

 
                                                                                           8.0   C O N ST R U C TI O N  
 
P R O GR A M   O V E R V I E W  
Construction projects valued $100,000 up to $25 million (in-house facility) on any one risk
Non-combustible / Fire resistive
Wrap up Liability
CGL and OL&T (Projects specific or annual policy for home builders)

Single Projects:    - policy period tailored to length of project (monthly extensions available)

Blanket Projects: -   Annual policy
                  -   Limit per structure
                  -   Catastrophe Limit
                  -   Deposit premium collected at inception
                  -   Monthly reporting

Projects already started can be considered (see supplement form)


TYPICAL PROJECTS 
    Condominium projects
    Apartment Blocks
    Townhouse developments
    Single family homes (single home or entire sub-division projects)
    Schools and various other institutional projects
    Renovations or additions


STANDARD COVERAGES 
    All Risk or Fire & EC


OPTIONAL COVERAGES 
    Transit (up to $250,000)
    Off-site storage (up to $250,000)
    Soft Costs
    Delayed opening / loss of income endorsement
    Coverage for existing structure available on renovation type projects




PREMIER MARINE                                                                                                CAN Mar 2011 

                                                                                                                       8.1 
                                                                                                 8.0   C O N ST R U C TI O N  
SELF-RATE PROGRAM
FOR HOMES VALUED UP TO $2 MILLION
                                                                         Values    4 mon      5 mon        6 mon       7 mon         per mon
Premier insures builders risk accounts valued from $100,000 to
$100 million across Canada. For homes valued up to $2 million
we have developed a Self-Rate Program catered for these                $150,000      500         500          540         630             90
risks featuring:                                                       $175,000      500         525          630         735            105
•   Competitive Rates                                                  $200,000      500         600          720         840            120
•   Lower Deductibles
•   Easy to use Rating Table                                           $225,000      540         675          810         945            135
                                                                       $250,000      600         750          900       1,050            150
ELIGIBILITY (FOR SELF-RATE):                                           $275,000      660         825          990       1,155            165
• Residential risks up to 4-plex in size
• Risks valued from $100,000 to $2 million                             $300,000      720         900        1,080       1,260            180
• Standard frame construction                                          $325,000      780         975        1,170       1,365            195
• All major sub-trades must carry a CGL (min $1 million limit)         $350,000      840       1,050        1,260       1,470            210
• All major subs must show proof of insurance
                                                                       $375,000      900       1,125        1,350       1,575            225
REFER TO PREMIER:                                                      $400,000      960       1,200        1,440       1,680            240
• Projects already started*                                            $425,000    1,020       1,275        1,530       1,785            255
• Homeowner managing project (must have construction
   related experience)                                                 $450,000    1,080       1,350        1,620       1,890            270
• Unprotected risks                                                    $475,000    1,140       1,425        1,710       1,995            285
• General contractor suffered more than 1 loss in 3 years              $500,000    1,200       1,500        1,800       2,100            300
• Renovations
Note: Risk is not bound until Premier has issued a binder              $525,000    1,260       1,575        1,890       2,205            315
number. Please fax to your Premier underwriter for                     $550,000    1,320       1,650        1,980       2,310            330
confirmation.                                                          $575,000    1,380       1,725        2,070       2,415            345
COVERAGE:                                                              $600,000    1,440       1,800        2,160       2,520            360
• All risks including flood and quake (except for Cresta Zone 1        $625,000    1,500       1,875        2,250       2,625            375
   – and no flood in regions with flooding history)                    $650,000    1,560       1,950        2,340       2,730            390
• $10,000 transit/offsite storage limit included
• BPM 300-D Standard Schedule of Endorsements                          $675,000    1,620       2,025        2,430       2,835            405
• BPM 301-D Standard Warranties                                        $700,000    1,680       2,100        2,520       2,940            420
• Form 500 – General Contractor CGL Warranty                           $725,000    1,740       2,175        2,610       3,045            435
• 15% of TIV included for By-Laws
• Debris removal – 25% (sub-limit)                                     $750,000    1,800       2,250        2,700       3,150            450
Note: Signed copies of application and warranties must                 $775,000    1,860       2,325        2,790       3,255            465
accompany request to bind. Wordings / Warranties can be                $800,000    1,920       2,400        2,880       3,360            480
downloaded from our web site: www.premiermarine.com
                                                                       $825,000    1,980       2,475        2,970       3,465            495
DEDUCTIBLE:                                                            $850,000    2,040       2,550        3,060       3,570            510
• $25,000 Flood                                                        $875,000    2,100       2,625        3,150       3,675            525
• 10% of TIV, minimum $50,000, for Earthquake damage
• $2,500 for all losses resulting from theft and vandalism             $900,000    2,160       2,700        3,240       3,780            540
• $1,000 deductible for all other losses                               $925,000    2,220       2,775        3,330       3,885            555
• For risks over $1.5 million – $5,000 deductible applies              $950,000    2,280       2,850        3,420       3,990            570
LIABILITY:                                                             $975,000    2,340       2,925        3,510       4,095            585
• OL&T – $1 million (Additional Premium $250)                         $1,000,000   2,400       3,000        3,600       4,200            600
• OL&T – $2 million (Additional Premium $375)                         $1,100,000   2,640       3,300        3,960       4,620            660
• OL&T – $5 million – refer to Premier
• CGL – refer to Premier                                              $1,200,000   2,880       3,600        4,320       5,040            720
• Deductible $2,500                                                   $1,300,000   3,120       3,900        4,680       5,460            780
                                                                      $1,400,000   3,360       4,200        5,040       5,880            840
RATING FACTORS:
- Fire & EC – discount 15%                                            $1,500,000   3,600       4,500        5,400       6,300            900
- Semi-protected – surcharge 20%                                      $1,600,000   3,840       4,800        5,760       6,720            960
- Unprotected – refer                                                 $1,700,000   4,080       5,100        6,120       7,140          1,020
- Log construction – surcharge 20% - $5,000 deductible
- Minimum $500 premium (liability charges in addition)                $1,800,000   4,320       5,400        6,480       7,560          1,080
                                                                      $1,900,000   4,560       5,700        6,840       7,980          1,140
BROKER COMMISSION:                                                    $2,000,000   4,800       6,000        7,200       8,400          1,200
- 15%
- A flat policy fee of $135 is levied in addition to
  above at inception.                                                               * Higher Values – Refer to Premier Underwriter




PREMIER MARINE                                                                                                               CAN Mar 2011 

                                                                                                                                         8.2 
 BUILDERS RISK FAST QUOTE APPLICATION – For Residential Projects
 GENERAL INFORMATION
                                                                                                                                                                 1 of 2


 GENERAL INFORMATION

APPLICANT’S NAME:

MAILING ADDRESS:                                                                CITY:                   PROVINCE:                P O S T A L C O DE :


FIVE-YEAR CLAIMS HISTORY               □ Y E S □ N ON E         If yes, list:

MOR T GA GE E :

ADDRESS:                                                                        CITY:                   PROVINCE:              P OS T A L C OD E :

 GENERAL CONTRACTOR

Name (if not assured):                                                                                                          Years in Business:

Five-Year Claims History:                                                                   CGL Insurer:

Last 3 projects (value and type):




 PROJECT


Address:                                                                        City:                   Province:               Postal Code:


Description of Project:                □ Ho u s e               □ Duplex                    □ Triplex               □ Other (Describe):


New Construction?         □ YES □ NO                            □ Speculation               □ Pre-sold / owner occupied

Renovation?               □ YES □ NO         If YES, complete RENOVATION QUESTIONNAIRE.


Is this a Heritage Building or Site?   □ YES □ NO                     Cost of renovations: $                        ACV Value of existing structure: $

 DESCRIPTION OF CONSTRUCTION

           WALLS                  SIDING                    FLOORS                      TYPE OF ROOF                FOUNDATION               SOIL TYPE ON BUILDING SITE

  Wood               □       Wood          □        Wood                   □       Wood                    □    Concrete             □       Clay                   □
  Non Combustible    □       Brick         □        Non Combustible        □       Non Combustible         □    Other                □       Rock                   □
  Log                □       Other         □        Other                  □       Tar and Gravel          □    Feet Below Grade:            Landfill               □
  Other              □                                                             Shakes                  □                 feet            Other                  □
                                                                                   Other                   □

Hot Tar roofing:                       □ YES         □ NO                                   Torch on application:               □ YES         □ NO

Standard Frame Construction Techniques:              □ YES      □ NO
If no, explain:




                                                                                                                                                          8.3
PREMIER MARINE                                                                  T OR ON T O                                     V A N C OU V E R
                                                                                T 416.365.0444 F 416.365.0446                   T 604.669.5211 F 604.669.2667
                                                                                www.premiermarine.com                           www.premiermarine.com         
  BUILDERS RISK FAST QUOTE APPLICATION – For Residential Projects                                                                                                 2 of 2


  COVERAGE


Perils Required:              □ All risk               □ Fire and EC              □ Flood / Earthquake

Start Date of foundations:                                                        Completion Date:
If already started – Complete PROJECT ALREADY STARTED QUESTIONNAIRE.

Replacement Costs:                         $                                      (Replacement Cost to Rebuild: Labour, Materials, Professional Fees, Etc)

Soft Cost:                                 $                                      (Finance Costs, Leasing, Marketing, Legal, Accounting, Interest, Other Carrying Cost)

T.I.V Sum Insured:                         $                                      Deductible:

Extension: Off site/Transit coverage:$                                            Other:


Total Square footage:                                        sq ft.                        Cost per Square foot: $                   Attach RCT:        □ Y ES □ NO
If Flood is a required:                    Distance from nearest body of water:                                           Height above body of water:


Is it in a Federal flood zone?             □ YES       □ NO

  PROTECTION

Hydrant:         □ YES □ NO                            Distance to fire hall                    k m.                      □ Volunteer              □ Fully paid
Private fire protections (sprinklers/extinguishers/water tanks etc):


Type of Neighborhood:                      □ Residential              □ Commercial              □ Mixed                   □ Other

Crime:           □ Low Crime               □ High Crime               □ Declining               □ Improving               □ Other

Distance to closest occupied area in feet?                                                      Is project viewable from road?       □ YES         □ NO

Site lighting:     Is site well lit?       □ YES       □ NO            Street only:             Additional lighting dusk to dawn     □ YES         □ NO

Fencing 6 feet height:          □ YES □ NO                             Monitored Alarm at lock up?           □ YES        □ NO

Have you ever had insurance refused or cancelled?                     □ YES       □ NO          If yes, please explain:


It is understood that the personal information, furnished through this request, will be used by the Premier Marine Insurance Managers for the
investigation and determination of the possibly applicability of insurance, and for such other lawful purposes in accordance with any federal or
provincial laws that may apply.

Applicant’s Name:                                                                               Applicant’s Signature:


Brokerage:                                                                                      Broker Signature:


Date:                                                                                           Email:


Fax No:                                                                                         Tel No:




                                                                                                                                                              8.3
PREMIER MARINE                                                                    T OR ON T O                                        V A N C OU V E R
                                                                                  T 416.365.0444 F 416.365.0446                      T 604.669.5211 F 604.669.2667
                                                                                  www.premiermarine.com                              www.premiermarine.com 
 BUILDERS RISK APPLICATION – All Commercial Projects and Projects requiring CGL or Wrap Up Liability                                                                    1 of 5

Please complete section A for all quotes (Complete section B also if CGL or WRAP-UP coverage is required.)

SIGNATURES ARE REQUIRED ON PAGE 5. We may require the following documents in order to finalize the quote:

                   1.    Site Plan
                   2.    Break down of Values
                   3.    Summary and Recommendations for the Geotechnical Report

 SECTION A : BUILDERS RISK APPLICATION

APPLICANT’S NAME:

MAILING ADDRESS:                                                                   CITY:                     PROVINCE:                  P O S T A L C O DE :


FIVE-YEAR CLAIMS HISTORY              □ Y E S □ N ON E            If yes, list:


Have you ever had insurance refused, or cancelled?                □ YES □ NO               If yes, please explain:

MOR T GA GE E :

ADDRESS:                                                                           CITY:                     PROVINCE:                 P OS T A L C OD E :


 GENERAL CONTRACTOR

Name (if not assured):                                                                                                     Years in Business:

List Project Manager’s 3 recent large projects in past 5 years:

 NAME                                     TYPE                                              LOCATION                                   VALUE

 1.
 2.
 3.


Is the General Contractor bonder?     □ YES □ NO                                                Member of Canadian Home Builder’s Association:           □ YES □ NO
CGL Insurer:                                                      Policy Number:

Details of all claims over $5,000 by general contractor or developer during past 5 years:




Details of any loss control program to be implemented:




 GENERAL CONTRACTOR

Is blasting or demolition involved?   □ YES        □ NO           If yes, will operations be completed prior to commencement of project?             □ YES        □ NO

Is shoring, underpinning or pile driving involved? □ YES          □ NO            If yes, provide details for each activity including nature, duration, contract price and
relationship to both the project and to adjacent structures:




PREMIER MARINE                                                                     T OR ON T O                                          V A N C OU V E R          8.4
                                                                                   T 416.365.0444 F 416.365.0446                        T 604.669.5211 F 604.669.2667
                                                                                   www.premiermarine.com                                www.premiermarine.com 
 BUILDERS RISK APPLICATION – All Commercial Projects and Projects requiring CGL or Wrap Up Liability                                                              2 of 5

 PROJECT
Name of Owner:

Name of Project Manager:

Name of General Contractor:

Description of Project:

Address of Project:

City:                                                             Province:                                         Postal Code:


New Construction:     □ YES □ NO                    Renovation:     □ YES □ NO                Is this a Heritage Building or Site?       □ YES □ NO
If Renovation, complete RENOVATION QUESTIONNAIRE.


Value of existing structure: $                                                            Cost of renovations: $


No. Of Stories:                        No. of Buildings:                      No. Of Units:                     Attach site plan:       □ YES       □ NO
If more than one building, please advise value of each building and distance between each building:




 DESCRIPTION OF CONSTRUCTION

            WALLS                         SIDING                       FLOORS                          TYPE OF ROOF                            FOUNDATION
  Wood                     □      Wood                □     Wood                      □       Wood                            □       Concrete                     □
  Non Combustible          □      Brick               □     Non Combustible           □       Non Combustible                 □       Other                        □
  Fire Resistive           □       Fire Resistive     □      Fire Resistive           □       Tar and Gravel                  □               Feet Below Grade:

  Other                    □      Other               □     Other                     □       Shakes                          □
                                                                                              Other                           □

Underground parking?             □ YES      □ NO                              How many levels of underground parking:


Hot Tar roofing:          □ YES        □ NO                                   Torch on application:    □ YES        □ NO
If yes, describe procedure:


 ADJACENT STRUCTIONS (site plan if available)


                                           TYPE OF CONSTRUCTION                       OCCUPANCY                                     DISTANCE (FEET)
  North
  East
  South
  West


                                                                                                                                                              8.4
PREMIER MARINE                                                                T OR ON T O                                           V A N C OU V E R
                                                                              T 416.365.0444 F 416.365.0446                         T 604.669.5211 F 604.669.2667
                                                                              www.premiermarine.com                                 www.premiermarine.com 
 BUILDERS RISK APPLICATION – All Commercial Projects and Projects requiring CGL or Wrap Up Liability                                                                     3 of 5

 COVERAGE (see worksheet)

Perils Required:                       □ All risk                  □ Fire and EC               □ Deductible:               □ Flood / Earthquake
Start Date of foundations:                                         Completion Date:

Insurance Period: From:                                            To:

Hard Costs:                            $                                         (Replacement Cost to Rebuild: Labour, Materials, Professional Fees, Etc)


Soft Cost:                             $                                         (Finance Costs, Leasing, Marketing, Legal, Accounting, Interest, Other Carrying Cost)

Delayed Opening:                       $                                         Limit per month $                      Time Period:              months

T.I.V Sum Insured:                     $                                         Deductible:

Extension: Offsite/Transit coverage: $                                           Other Property to be insured? $

Describe:                                                          Total Square footage                                 sq ft. Cost per Square foot: $

If Flood is required:                                 Distance from nearest body of water:                              Height above body of water:


Is it in a Federal Flood zone?         □ YES □ NO

 PROTECTION

Hydrant:         □ YES □ NO                           Distance to fire hall                    k m.                     □ Volunteer               □ Fully paid
Private fire protections (sprinklers / extinguishers, water tanks etc):

If sprinklers, when will they be operational?


Type of Neighborhood:                  □ Residential               □ Commercial                □ Mixed                  □ Other

Crime:                                 □ Low Crime                 □ High Crime                □ Declining              □ Improving               □ Other

Distance to closest occupied area in feet?                         Is project viewable from road?          □ YES        □ NO

Site lighting:    Is site well lit?    □ YES          □ NO        Street only:                 Additional lighting dusk to dawn      □ YES        □ NO

Fencing 6 feet height:                 □ YES          □ NO        Monitored Alarm at lock up?              □ YES        □ NO

On Site Watchman service (full-time 24/7):                       □ YES □ NO            Security Patrol:    □ YES        □ NO

Soil type on building site:                □ Ro c k             □ Clay                □ Landfill          □ Other

Standard Construction Techniques:          □ YES □ NO

If no, explain:




                                                                                                                                                               8.4
PREMIER MARINE                                                                   T OR ON T O                                         V A N C OU V E R
                                                                                 T 416.365.0444 F 416.365.0446                       T 604.669.5211 F 604.669.2667
                                                                                 www.premiermarine.com                               www.premiermarine.com 
BUILDERS RISK APPLICATION – All Commercial Projects and Projects requiring CGL or Wrap Up Liability                                                         4 of 5

Any past flood history at project site?          □ YES        □ NO
Explosion (detail use of any flammable or explosive materials):




 SUBCONTRACTORS (Proof of insurance of $1,000,000 CGL to be on file with the general contractor)

Name of Framing Firm:                                                                                 CGL insurer:

Name of Roofing Firm:                                                                                 CGL insurer:

Name of Plumbing Firm:                                                                                CGL insurer:

Name of Heating Firm:                                                                                 CGL insurer:

Name of Electrical Firm:                                                                              CGL insurer:

Name of Architecture Firm:

Name of Engineering Firm:

Name of Geo-technical Firm:


Project in compliance with geo-technical recommendations:     □ YES □ NO                If no, explain:


Any potential exposure to adjacent structures from excavating?    □ YES □ NO            If yes, explain:


Any claim over $5,000 by these subcontractors or consultant in past 5 years?    □ Y ES □ NO
If yes, provide details:


 TESTING

Electrical / mechanical breakdown during commissioning:       □ YES □ NO                                         No . o f wk s :

Who will perform the testing operation?                                                 Describe operation involved in testing:


Will installation involve used equipment?        □ YES        □ NO

 SECTION B : CGL AND WRAP-UP LIABILITY

1. Total Estimated Project Value: $                           (Attach breakdown if available)


2. Completed Operations Period:           □ 12 months         □ 24 months
3. Limits of Liability:                                       Deductible Options:

              $                                                                     $

              $                                                                     $




                                                                                                                                                             8.4
PREMIER MARINE                                                            T OR ON T O                                              V A N C OU V E R
                                                                          T 416.365.0444 F 416.365.0446                            T 604.669.5211 F 604.669.2667
                                                                          www.premiermarine.com                                    www.premiermarine.com 
BUILDERS RISK APPLICATION – All Commercial Projects and Projects requiring CGL or Wrap Up Liability                                                          5 of 5

4.a) Does the project attach to or communicate with an existing structure?              □ YES           □ NO
    Manner in which structures will connect or communicate:


 b) Occupancy of existing structure during construction:


 c) Business Interruption/Loss of use for damages to existing structure:


 d) Is coverage required for damage to existing structure?       □ YES        □ NO

5. If any portion of the project will be occupied prior to completion, provide details (Period, Extent and Nature of Occupancy):




6. Detail the exposures to the property (other than the project) resulting from demolition, blasting, pile driving, shoring,


  and underpinning:


7. Detail exposures to utilities, including relocation thereof (Both below and above grade):




8. Describe any offsite operations or locations, which require insurance:




9. Provide details of LOOS CONTROL PROGRAM to be implemented to protect others from operations (i.e. traffic control, reconstruction surveys, vibration
   monitoring preconstruction location of utilities and notification to others of interrupting thereof, etc):




10. Detail any liability claims (exceeding $10,000 per accident) incurred by any of the following which resulted from construction operations in the past three (3)
years (owner, general contractor project/construction manager, Indicate Date, Amount, Nature of Claim):




It is understood that the personal information, furnished through this request, will be used by the Premier Marine Insurance Managers for the
investigation and determination of the possibly applicability of insurance, and for such other lawful purposes in accordance with any federal or
provincial laws that may apply.


Applicant’s Name:                                                                          Applicant’s Signature:


Brokerage:                                                                                 Broker Signature:


Date:                                                                                      Email:


Fax No:                                                                                    Tel No:




                                                                                                                                                           8.4
PREMIER MARINE                                                                T OR ON T O                                      V A N C OU V E R
                                                                              T 416.365.0444 F 416.365.0446                    T 604.669.5211 F 604.669.2667
                                                                              www.premiermarine.com                            www.premiermarine.com 
BUILDERS RISK APPLICATION – Blanket Coverage for Residential Builders                                                                                            1 of 2


We may require the following documents in order to finalize the quote:
                   1.     Site Plan
                   2.     Break down of Values
                   3.     Summary and Recommendations for the Geotechnical Report

GENERAL INFORMATION
APPLICANT’S NAME:

MAILING ADDRESS:                                                                CITY:                    PROVINCE:               P O S T A L C O DE :


FIVE-YEAR CLAIMS HISTORY               □ Y E S □ N ON E         If yes, list:

MOR T GA GE E :

ADDRESS:                                                                        CITY:                    PROVINCE:              P OS T A L C OD E :


GENERAL CONTRACTOR

Name (if not assured):                                                                                                           Years in Business:

Five-Year Claims History:                                                                    CGL Insurer:

Last 3 projects (value and type):




PROJECT
Address:                                                        City:                                    Province:               Postal Code:


Description of Project:                □ Ho u s e               □ Duplex                     □ Triplex               □ Other (Describe):

New Construction?         □ YES □ NO                            □ Speculation                □ Pre-sold / owner occupied

DESCRIPTION OF CONSTRUCTION
           WALLS                 SIDING                     FLOORS                      TYPE OF ROOF                 FOUNDATION              SOIL TYPE ON BUILDING SITE

 Wood                □       Wood          □        Wood                   □       Wood                     □    Concrete            □       Clay                   □
 Non Combustible     □       Brick         □        Non Combustible        □       Non Combustible          □    Other               □       Rock                   □
 Other               □       Other         □        Other                  □       Tar and Gravel           □    Feet Below Grade:           Landfill               □
                                                                                   Shakes                   □                 feet           Other                  □
                                                                                   Other                    □

Hot Tar roofing:                       □ YES         □ NO                                    Torch on application:               □ YES        □ NO

Standard Frame Construction Techniques:              □ YES      □ NO            If no, explain:


COVERAGE

Perils Required:          □ All risk       □ Fire and EC         □ Flood / Earthquake
If Flood is required:                  Distance from nearest body of water:                                          Height above body of water:


Is it in a Federal flood zone?         □ YES         □ NO

                                                                                                                                                           8.5
PREMIER MARINE                                                                  T OR ON T O                                      V A N C OU V E R
                                                                                T 416.365.0444 F 416.365.0446                    T 604.669.5211 F 604.669.2667
                                                                                www.premiermarine.com                            www.premiermarine.com
 BUILDERS RISK APPLICATION – Blanket Coverage for Residential Builders                                                                                     2 of 2


 LIMITS REQUIRED – TOWNHOUSE UNITS

Average cost to build each townhouse unit: $                                            Number of townhouse units to be built in next 12 months:

Total value of townhouse to be built in next 12 months: $                               Average time to build each unit:                    months

Percentage pre sold:                   %                                                Number of units currently under construction:

Maximum number of townhouse units in one building:                                      Total value of townhouse units in one building: $

Limits of Coverage for one building (POLICY LIMIT): $


 LIMITS REQUIRED – DETACHED OR DUPLEXES

Average cost to build each dwelling: $                                                  Number of dwellings to be built in next 12 months:

Total value of dwellings to be built in next 12 months: $                               Average time to build each dwelling:                months

Percentage of dwellings that are pre sold              %                                Number of dwellings currently under construction:

Maximum value of a dwelling: $

Limits of Coverage for one building (POLICY LIMIT): $


 LIMITS REQUIRED – CATASTROPHE LIMIT

POLICY LOSS LIMIT: Maximum Loss from a single event: $


 PROTECTION

Hydrant:         □ YES □ NO                         Distance to fire hall               k m.                      □ Volunteer               □ Fully paid
Private fire protections (sprinklers/extinguishers/water tanks etc):


Type of Neighborhood:                  □ Residential             □ Commercial           □ Mixed                   □ Other

Crime:           □ Low Crime           □ High Crime              □ Declining            □ Improving               □ Other

Distance to closest occupied area in feet?                                              Is project viewable from road?         □ YES        □ NO

Site lighting:     Is site well lit?   □ YES        □ NO           Street only:         Additional lighting dusk to dawn       □ YES        □ NO

Fencing 6 feet height:          □ YES □ NO                        Monitored Alarm at lock up?        □ YES        □ NO

Have you ever had insurance refused or cancelled?                □ YES       □ NO       If yes, please explain:


It is understood that the personal information, furnished through this request, will be used by the Premier Marine Insurance Managers for the
investigation and determination of the possibly applicability of insurance, and for such other lawful purposes in accordance with any federal or
provincial laws that may apply.

Applicant’s Name:                                                                       Applicant’s Signature:
Brokerage:                                                                              Broker Signature:
Date:                                                                                   Email:

                                                                                                                                                        8.5
PREMIER MARINE                                                               T OR ON T O                                       V A N C OU V E R
                                                                             T 416.365.0444 F 416.365.0446                     T 604.669.5211 F 604.669.2667
                                                                             www.premiermarine.com                             www.premiermarine.com
The

BUILDER
Brought to you by:   PREMIER MARINE                                                                Page 1 of 3


          New Homebuilders – CGL Insurance - APPLICATION

Name of applicant: _______________________________________________________________________

Address: _______________________________________________________________________________

City: _______________________________________ Province ___________ Postal Code ______________

Website address: ______________________________

Name of all Principals: ____________________________________________________________________

Contact Name and Tel and Fax # for loss control inspection_______________________________________

Are you a member of your Provincial Home Builder’s Association: Yes ___       No ____

Are you a member of your Provincial Home Warranty Program: Yes ____           No ____

Number of Employees ___        Are all your employees covered by workers compensation? Yes__           No___

Years in operation: _____      Years building homes ___    Owner operated? Yes__     No__

How many years have you been building homes in the current geographic area? Yes_         No_

Years in business under current name: ____      List all business names used in past 5 yrs: ______________

______________________________________________________________________________________

Do you or have you done business out side of Canada: Yes__ No__
If yes: explain __________________________________________________________________________

                                    Operations                                              Est. Revenue
New housing residential construction (up to 4 plex)
New apartment construction
Renovations
Commercial
Other – Describe:

Gross Receipts for last 5 years:
 Year              Gross Receipts       Subcontract costs         No. of employees      Payroll
 Next year
 Last year




Has your operation changed since it started (type of jobs you do): Yes____ No ___
If yes, explain ___________________________________________________________________________

Percentage of work that is typically delegated to a sub-contractor: _______%

Is 100% of your work building new homes? Yes__         No__

Homes built in metropolitan areas ______%           Homes built in rural areas ______%

Percentage of homes are presold?______%         Do you build in existing subdivisions (infill housing)? Yes__ No__

Are all homes built within a 75 kms radius? Yes__         No__

What is the maximum construction cost of any home you build? $______________

Number of new home starts expected in next 12 months? ________

Standard construction materials used? Yes__ No__            Standard construction techniques used? Yes__    No__

Do you do any underground work (other than foundations)? Yes__            No__



                                                                                                                     8.6
    The

    BUILDER
    Brought to you by:   PREMIER MARINE                                                                           Page 2 of 3

    Is all excavation work sublet? Yes__          No__          Do you use explosives/any blasting? Yes__         No__

    Do you ensure the sub-trade doing the excavation work has insurance? Yes__                  No__

    Do you manufacture any products? Yes__                  No__           Explain:______________________________________

    Do you do any design work?          Yes __     No__       Do you do the landscaping? Yes__           No__

    Are all building sites fenced and gated? Yes__                  No__

    Do you do any building envelope repair work? Yes__ No__                  Number of stories you will perform work: _____

    Have you been involved or will you or your subcontractors be involved in application or removal of asbestos, EYES,
    or other hazardous materials? Yes ____        No ___

    Do you keep records of certificates and agreements with subcontractors? Yes __                  No ___    Length of time:_____

Has or will any of your work involve:
                             Yes                                                       Yes                                      Yes
Air ports                                    Gas Stations                                      Radioactive Materials
Alarm installations                          Logging                                           Work on ships
Asbestos Removal                             Mine work                                         Sprinkler Systems
Blasting/ Explosives                         Moving buildings                                  Tunnel work
Bridge Work                                  Natural Gas Works                                 Waste sites
Building Envelope                            Petrol-Chemical plants                            Welding
Crane repairs                                Pile driving                                      Piers/ docks
Dam work                                     Pollutant Clean up                                Hillsides / Land fills
Demolition / wrecking                        Propane Facilities                                Subsistence areas
Gas / Oil field work

If yes, explain all activities in these areas: _____________________________________________________________
_______________________________________________________________________________________________

Is your company aware of any facts, circumstances, incidents, situations, damages, or accidents (including but not
limited to faulty workmanship, product failure, construction dispute, property damage, or construction worker injury)
that a reasonably prudent person might expect to give rise to a claim or lawsuit, whether valid or not, which might
directly or indirectly involve the company? Yes __         No __       If yes, explain:


Current Carrier: ________________                        Policy #: _____________________________

Claims History last 5 years
Date             Cause                                               Insurer                       Paid or Reserve




Have you been cancelled, declined or refused renewal of your insurance? Yes ____ No ___
If yes explain ________________________________________________________________

Has any licensing authority taken any action against you? Yes __                     No _ Explain___________________________

                                                    Construction Risk Management

    Risk management is important because it reduces the likelihood of a claim being successfully made against you. In
    calculating the premium, your risk management has a material influence on any terms offered by Premier Marine.
    PLEASE COMPLETE THIS SECTION OF THE APPLICATION IN FULL. The following list includes the causes of many
    claims made against Contractors. To improve your defence against claims it is best practice to comply with the
    suggested frequency and also maintain a record of the checks that have taken place.

                                                                                      Suggested Frequency
    Dust and Debris and Painting
    In respect of dust, debris and painting , do you:
    Minimise exposure to surrounding property and persons by maintaining perimeter   Before any work is started   Yes / No
    screening and sheeting?


                                                                                                                                      8.6
    The

    BUILDER
    Brought to you by:   PREMIER MARINE                                                                 Page 3 of 3




     Warning Signs, Lights and Barriers                                     Suggested Frequency
     In respect of all areas to which the public has access, do you:
     Place signs that clearly warn people of the existence of the             From the start of the     Yes / No
     works and that surfaces may be hazardous?                                       works
     Clearly light the walkways and surrounding areas at times of             From the start of the      Yes / No
     poor visibility and during the hours of darkness?                               works
     Regularly check the works to ensure that the signs, barriers and              Twice Daily           Yes / No
     lighting remain in place and working order?
     Ensure there are in place barriers of a strength and height              From the start of the      Yes / No
     sufficient to prevent a person tripping or falling into the                     works
     excavation?


                                                                            Suggested Frequency
    Surfaces and Obstructions
    In respect of all areas to which the public has access.
    do you:
    Ensure that any floor covering is regularly checked to be safe,                Twice Daily          Yes / No
    and uneven surfaces are kept to a minimum grade?
    Regularly check and remove any obstacle that could cause a                     Twice daily           Yes / No
    person to trip and keep the surface of walkways even.


                                                                            Suggested Frequency
    Equipment
    For your own equipment, do you:
    Check on a regular basis that it is safe to operate?                            Ongoing             Yes / No



Limits Required:______________               Deductible: _____________       Target Premium: ________________



The applicant agrees to notify the company of any material changes in the answers to the questions on this
questionnaire which may arise during the course of this policy issued and further understands that claims may be
denied if information regarding these material changes were not provided.

The purpose of this questionnaire is to assist in the underwriting process. Information contained herein is specifically
relied on in determination of insurability. The under-signed, therefore, warrants that the information contained herein is
true and accurate to the best of his / her knowledge, information, and belief. This questionnaire and the application
shall be the basis of any insurance policy that be issued and will be part of such policy.
Note: No Risk is bound until Premier has issued a binder number.


    Title of Applicant __________________________________________________________

    Signature __________________________                  Date _______________________________

    Brokerage:              ________________________________________________________

    Broker Contact name: ___________________ Signature:_______________________

    Broker telephone ________________________ Broker fax ______________________

    Broker email                   _________________________________



    Rev. Sep 05 2005                                                                             www.premiermarine.com



                                                                                                                             8.6
                                                                                      The
                                                                                      BUILDER
                                                                                            PROGRAM
BUILDERS RISK SUPPLEMENTAL APPLICATION – Projects already commenced

Along with this Supplemental Application, please provide the following:

                        N A completed Builders Risk Fast Quote Application
                        N Photographs of existing structure

NOTE:         C.O.C. not normally written if project has already commenced.
              The following information is required for underwriters to consider quoting.

GENERAL INFORMATION

Name of Applicant: ______________________________________________________________

Broker: _______________________________________________________________________

REQUIRED INFORMATION

Is this applicant a current client of your brokerage? ____________________________________

What was the date framing for the foundations was started? _____________________________

Why was insurance not placed at the time construction started? __________________________

Are there any known or reported claims or losses to this project? _________________________

Are there any potential liens on the property? ________________________________________

Any changes in the financial status of the contractor or site owner? _______________________

Name of General Contractor (Must carry his own CGL): _______________________________

If applicant is acting as General Contractor, please provide detailed history of prior experience as

General Contractor: ____________________________________________________________

_____________________________________________________________________________

On what date did the municipality issue the building permit? _____________________________


Applicant’s Signature: ______________________________Date: ________________________

Broker’s Signature: ___________________________ Brokerage: ________________________

Tel No: ____________________________________ Fax No: ___________________________

Western Canada                                          Central & Eastern Canada
T 604 669 5211 F 604 669 2667                           T 416 365 0444 F 416 365 0446

www.premiermarine.com                                                                             8.7
The

BUILDER
Brought to you by:   PREMIER MARINE

                            COC Renovation – supplemental questionnaire
Attached to and forming part of Application for Construction Insurance.

Project description: ____________________________________________________________________________________
Address: ___________________________________________________________City ___________________________
Replacement Value of Total Renovations                   ________________________
Value of Existing Building                               ________________________ Actual Cash Value
1.    Extent of asbestos removal:_________________________________________________________________________
2.    Describe structural support changes: _____________________________________________________________________
      ________________________________________________________________________________________________
      ________________________________________________________________________________________________
3.    (a) Has a professional engineer or consultant approved these structural support changes?          Yes       No
      (b) Name of professional engineer: ___________________________________________________________________
4.    (a) Is the building currently sprinklered?                                                        Yes       No
      (b) Percentage of building sprinklered?                                                            ________ %
      (c) Extent that sprinkler protection will be maintained during the renovation period:
          _____________________________________________________________________________________________
      (d) Is the sprinkler alarm connected to      a monitoring station?                                    Yes No
      (e) Age of sprinklers? ______________________________________________________________________________
      (f) Will a new sprinkler system be installed?                                                     Yes       No
5. (a) Describe the extent to which the building will be “gutted” prior to renovation being started:
          _____________________________________________________________________________________________
          _____________________________________________________________________________________________
      (b) What has been done so far? ______________________________________________________________________
          _____________________________________________________________________________________________
      (c) Will debris be removed daily?                                                                 Yes       No
6.    Details of the type of watchman service or fire / intrusion alarm system used during the project: _____________________
      ________________________________________________________________________________________________
7.    Describe what type of fire protection (i.e. extinguishers/standpipe and hose will be available at the project site:
      ________________________________________________________________________________________________
      _______________________________________________________________________________________________
8.    Will any stories be added to the building?                                                        Yes       No
      If yes, please provide a copy of the structural engineering report.
9.    List the mortgagees providing financing for the project: ___________________________________________________
      ________________________________________________________________________________________________
10. If this is a condominium development, how many units are there and how many have been sold?
   ________________________________________________________________________________________________
Renovation supplemental questionnaire.doc

                                                                                                                            8.8
The

BUILDER
Brought to you by: PREMIER         MARINE

                           COC Renovation – supplemental questionnaire
11. Detail similar projects the general contractor or project manager have done in the past: __________________________
      ________________________________________________________________________________________________
12. Will there be any torch cutting or welding in the project?                                         Yes   No
      If yes, will a “Hot Work” Permit system be required by the general contractor or project manager so that anyone doing this
      type of work will be required to get prior approval before starting the torch, cutting, or welding?    Yes      No
13. Describe the percentage to which the following building systems will be replaced:
      Plumbing      __________ %               Electrical         __________ %
      Roof          __________ %               Heating            __________ %
14. If the building is of mixed construction, what percentage of the following is constructed of wood?
      Roof          __________ %               Floors    __________ %               Walls     __________ %
15. Age of building: ______________________              Heritage Building                   Yes             No
16. (a) Square footage of the finished areas : ______________________________________________________________
      (b) Square footage of the unfinished areas (i.e. unfinished basement): _______________________________________
17. What amount of insurance was carried on the building in the last policy year prior to the date of this Questionnaire?
      ________________________________________________________________________________________________
18. Has or will a building permit be obtained for this renovation project?                             Yes   No
19. Will the building be partially occupied during renovation activities?                              Yes   No
       If yes, what percentage of the building will be occupied? _________________________________________________
       If yes, please give a good description of the occupancy: _________________________________________________
      ________________________________________________________________________________________________
       If yes, what safety measures are being taken to prevent occupants from entering the work areas: _________________
      ________________________________________________________________________________________________
20. Does the existing building currently contain property such as furniture or stock?                 Yes    No
      If yes,      (a) Please provide a description of these contents:
                         _________________________________________________________________________________
                   (b) Where will the contents be stored during the renovation work?
                         _________________________________________________________________________________
                   (c) Are there any special safety precautions being taken to prevent damage to these contents?
                         _________________________________________________________________________________




Signed: ______________________________________                             Dated: ___________________________________




Renovation supplemental questionnaire.doc
                                                                                                                                   8.8
 

 

 

 

 

 

 

 




        COMMERCIAL LINES
 

 

         

 

 
 
                                      COMMERCIAL LINES 
 


PROFESSIONAL LIABILITY                                        
   Info. Technology Risks 
    [Software, Computer Technicians, etc.]                        
   Media Professionals 
   Architects & Engineers 
   Miscellaneous Professionals 
    [CGL, E&O, and Office Pak] 
   Pollution Contractors/Environmental 
   D&O [For Profit and Non‐Profit] 
 
 
COMMERCIAL LINES 
   Construction [COC & Wrap‐Up] 
   Protection Services [Guards, Alarm, etc.] 
   Contractors Pollution Liability 
    [Asbestos, Mould, Environmental, etc.] 
   Pubs and Restaurants [Host Liquor] 
   Special Event Liability 
   Non‐Standard Property [Vacant, etc.] 
   Tanning, Beauty, Spas [incl. Lasers] 
   Fitness 
 
 
COMMERCIAL MARINE 
   Hull, Cargo, and Marine Liabilities 
   Boat Dealer’s/Marina Package 
   Visit ww.oceanicunderwriters.com 
 
 
SPORTS & ADVENTURE TOURISM 
   Amateur Sports 
   Adventure Risk 
 
 
 
IT P ROFESSIONALS – CGL and E&O

TARGET RISKS – START UPS OR LARGE ESTABLISHED FIRMS
    •   IT Consultants
    •   Website Developers
    •   Computer Hardware Sales/Support
    •   Network Support Services
    •   Software Developers
    •   Data Storage/Retrieval Services
    •   Web Hosting Services


PROGRAM FEATURES
    •   Premiums start at $1,250
    •   CGL and E&O Package
    •   B.I. and P.D. safety net built into the E&O policy form
    •   Full limits on Intellectual Property Infringement
    •   No problem with U.S. Receipts. 100% acceptable



POLICY FEATURES - CGL
    •   Limit options of $1 million up to $5 million
    •   Occurrence based policy with Products/Completed Operations Aggregate
    •   World-wide coverage, subject to suits brought in Canada or the USA



POLICY FEATURES – E&O
    •   Limit options of $250,000 up to $5,000,000
    •   IT E&O insurance is intended to cover two basic risks:
        - the financial loss of a third party arising from the failure of the IT Professional's product to perform as
           intended or expected
        - the financial loss of a third party that arises from an act, error or omission committed in the course of
           the IT Professional's performance of services for a third party
    •   World-wide coverage, subject to suits brought in Canada or the USA
    •   Provides liability against damages resulting from a failure to prevent unauthorized access to or use of any software,
         computer, network or unauthorized introduction of a computer virus or similar program due to an error or omission
         on the part of the IT Professional
    •   Delay in the performance of a contract (due to wrongful act)
    •   First dollar defense coverage (deductible does not apply to defense costs)
    •   Broad definition of insured including contract employees
    •   Automatic 60 day extended reporting period, and option to extend further at Premier's discretion
    •   Claims-made policy – The retroactive date can be “back dated” if proof of prior insurance is provided (with no gaps
         in coverage) at Premier’s discretion




NATIONALLY UNDERWRITTEN IN WESTERN CANADA                         ONTARIO BROKERS
T 604 669 5211 F 604 669 2667                                     T 866 316 2622
www.premiermarine.com




PREMIER MARINE                                                                                                      CAN Mar 11
A RCHITECTS AND E NGINEERS – E & O

TARGET RISKS

  •   Architects
  •   Structural Engineers
  •   Mechanical Engineers
  •   Electrical Engineers
  •   Engineering Technologists and Technicians (including Laboratory and Material Testing)
  •   Civil Engineer
  •   Other Engineering and Design Disciplines:
      - Project and Construction Management
      - Chemical
      - Interior Design
      - Forensic
      - Acoustic
      - Landscape
      - Hydrologist
      - Industrial Process


FEATURES

  •   Claims-made form
  •   Industry-specific Errors and Omissions form
  •   Expanded definition of Insured’s Professional Services
  •   Each and Every Claim limit and Policy Aggregate
  •   Broad definition of Insured
  •   Disciplinary Action Coverage
  •   Occupational Health and Safety Coverage
  •   Loss of Documents Coverage
  •   Supplementary Payments
  •   Efficient and accurate underwriting, processing of applications, and quoting services
  •   Precise and professional claims service
  •   The security of first-class insurers




NATIONALLY UNDERWRITTEN IN WESTERN CANADA                         ONTARIO BROKERS
T 604 669 5211 F 604 669 2667                                     T 866 316 2622
www.premiermarine.com




PREMIER MARINE                                                                                CAN Mar 11
M ISCELLANEOUS P ROFESSIONALS - CGL and E&O
TARGET RISKS
•   Advertising Agencies
•   Bookkeepers
•   Collection Agents
•   Claims Adjusters
•   Employment Agencies
•   Event Planners
•   Graphic Designers
•   Interior Designers
•   Management Consultants
•   Marketing Consultants
•   Non-destructive Testing Firms
•   Property Management
•   Safety Consultants
•   Travel Agents
•   And various other Professionals
    - Refer to Premier for eligibility

POLICY FEATURES – E&O
• Limit options of $250,000 up to $5,000,000
• E&O insurance is intended to cover two basic risks:
  - the financial loss of a third party arising from the failure
    of the IT Professional's product/service to perform as
    intended or expected
  - the financial loss of a third party that arises from an
    act, error or omission committed in the course of the
    Professional's performance of services for a third party
• World-wide coverage, subject to suits brought in Canada
  or the USA
• Delay in the performance of a contract (due to wrongful act)
• First dollar defense coverage (deductible does not apply to
  defense costs)
• Broad definition of insured including contract employees
• Automatic 30 day extended reporting period, and option to
  extend further at Premier's discretion
• Claims-made policy – The retroactive date can be "back
  dated" if proof of prior insurance is provided (with no gaps
  in coverage) at Premier's discretion

PROGRAM FEATURES
• Min Premium $850 for package GL and E&O
• 100% U.S. Receipts

POLICY FEATURES - CGL
• Limit options of $1 million up to $5 million
• Occurrence based policy with Products/Completed
  Operations Aggregate
• World-wide coverage, subject to suits brought in
  Canada or the USA




NATIONALLY UNDERWRITTEN IN WESTERN CANADA                          ONTARIO BROKERS
T 604 669 5211 F 604 669 2667                                      T 866 316 2622
www.premiermarine.com




PREMIER MARINE                                                                       CAN Mar 11
E NVIRONMENTAL/ P OLLUTION C OVERAGE

TARGET RISKS
     •    Construction
     •    Environmental remediation, abatement and design remediation
     •    Restoration and emergency spill response
     •    Demolition
     •    Environmental engineering, consulting, and site assessment (Phase 1, 2, 3, and 4)
     •    Above ground and underground storage tank installation and maintenance
     •    Construction and renovation of water treatment plants


PROGRAM FEATURES
     •    Combined Package wording for Contractors’ Pollution Liability and Commercial General Liability
     •    Errors and Omissions Coverage is optional and features separate limits
     •    $5 million Liability Limits Available
     •    Contractors’ Pollution can be written on a single project basis and includes features such as Completed
           Operations Period and expanded Insured definition
     •    Occurrence form for Contractors’ Pollution Liability available for select operations
     •    Contractors’ Pollution Liability, when claims-made form applies, includes an automatic Extended Reporting
           Period of 60 days at no cost if the Policy is cancelled or non-renewed
     •    Mould Coverage available and the definition includes viral and bacterial matter


COVERAGES
Contractors’ Pollution Liability:
   • Coverage for sudden and gradual pollution conditions
   • Emergency Response Costs
   • Incidental Transit
   • Supplementary Payments -they do not reduce Limits of Liability

Commercial General Liability:
   • Personal and Advertising Injury
   • Medical Payments
   • Non-Owned Automobile
   • Tenants’ Legal Liability

Errors and Omissions:
    • Claims-made form and Occurrence form (for select operations)
    • Limits up to $5 million

Optional Coverages:
    • Employee Benefits
    • Mould Coverage
    • Non-Owned Disposal Sites
    • Project specific coverage for Contractors’ Pollution Liability




Western Canada:                                        Ontario and Eastern Canada:
T 604 669 5211 F 604 669 2667                          T 416 365 0444 F 416 365 0446
www.premiermarine.com




PREMIER MARINE                                                                                                    CAN Mar 11
 


D IRECTORS  &  O FFICERS  L IABILITY 
 
 
TARGET RISKS

The Premier Program is focused on writing all types of firms, and all sizes, including:
     For Profit Organizations
     Private Firms
     Non-Profit Groups & Associations
     Strata/Condo Corp



PROGRAM FEATURES

        Simple short-form application
        Minimum premium $500
        Financial statements are NOT required if organization is less than $25 million in assets and less than
         $50 million in revenue
        E.P.L. coverage available
        Minimum Deductible -NIL



OPTIONAL EXTENSIONS

         Entity Securities Coverage
         Entity Defence Costs
         Priority of Payments Extension
         Prior Acts Coverage Extension
         Loss of Reputation Extension
         Occupational Health and Safety Extension


 
 
 
 




Western Canada:                                         Ontario and Eastern Canada:
T 604 669 5211 F 604 669 2667                           T 416 365 0444 F 416 365 0446
www.premiermarine.com




PREMIER MARINE                                                                                                    CAN Mar 11 

                                                                                                                             
C ONSTRUCTION                     [Projects from $100,000 to $100,000,000 in size]


TARGET RISKS
     •    Condominium Projects
     •    Apartment Blocks
     •    Town-home Developments
     •    Single Family Homes (single home or entire sub-division projects)
     •    Schools and Various Other Institution Projects
     •    All Types of Commercial Building (office, mercantile or industrial)
     •    Renovations or Additions – Large or Small – Coverage for Existing Building Available
     •    Projects already started are acceptable -refer to Underwriter


PROGRAM FEATURES
     •    In house capacity up to $100 million for high-rise construction
     •    In house capacity for wood frame risks up to $35 million
     •    Manuscript warranties that are reasonable and achievable for general contractors


COVERAGES
Property:
    • Single Projects
        - Period of policy tailored to length of project, with monthly extensions available at a predetermined rate
    • Blanket Basis
        - Annual policy
        - Limit per structure
        - Catastrophe limit
        - Deposit premium collected at inception
        - Monthly reporting

Liability:
    • Wrap Up Liability Policies Available
    • Single Project CGL Coverage Available
    • Annual CGL Cover Available for Homebuilders

Standard Coverages:
    • All Risk or Fire & EC (refer to individual terms)

Optional Coverages:
    • Transit (Up to $250,000)
    • Off-site Storage (Up to $250,000)
    • Soft Costs Coverage
    • Delayed Opening/Loss of Income Endorsement
    • Coverage for existing structure available on renovation type projects




Western Canada:                                        Ontario and Eastern Canada:
T 604 669 5211 F 604 669 2667                          T 416 365 0444 F 416 365 0446
www.premiermarine.com




PREMIER MARINE                                                                                                        CAN Mar 11
P ROTECTION S ERVICES

TARGET RISKS

     •    Security Guards
     •    Private Investigators
     •    Alarm Installation Firms
     •    Alarm Monitoring Firms
     •    Fire Suppression Systems Installers
     •    Automatic Sprinkler Systems Contractors
     •    Locksmiths and Card Access Installers
     •    Concierge Services
     •    Armed Guards
     •    Guard Dog Services




COVERAGES
     •    NEW – Limits up to $20,000,000 available
     •    Annual CGL Policy [occurrence form]
     •    Failure to Perform Coverage
     •    Failure to Provide Warranted Protection
     •    Lock and Key Replacement – $25,000
     •    Loss of Extinguishing Agent – $25,000
     •    Employee Dishonesty Coverage Available
     •    E&O Coverage Upon Request




Western Canada:                                      Ontario and Eastern Canada:
T 604 669 5211 F 604 669 2667                        T 416 365 0444 F 416 365 0446
www.premiermarine.com




PREMIER MARINE                                                                       CAN Mar 11
T HE H OST – Liquor Liability for Small Pubs & Restaurants


TARGET RISKS
     •    Up To 85% Liquor Receipts
     •    Neighbourhood Pub/Tavern
     •    Casual Restaurants
     •    Cafes
     •    Fine Dining Restaurants



PROGRAM FEATURES
     •    NEW -up to $5 million Liability Limits Now Available
     •    NEW -Lower Rates
     •    Stand Alone Liability Policies Available
     •    Prompt Service on Quotes and Policy Issuance



COVERAGES
Commercial General Liability:
   • Host Liquor Liability
   • Forcible Ejection Coverage
   • Medical Payments
   • Tenants Legal Liability
   • Non-Owned Automobile


Crime:
   • Employee Dishonesty
   • Loss Inside and Outside


Business Interruption:
   • Gross Earnings
   • Profits
   • Extra Expense


Building & Contents:
    • Broad Form or Named Perils




Western Canada:                                         Ontario and Eastern Canada:
T 604 669 5211 F 604 669 2667                           T 416 365 0444 F 416 365 0446
www.premiermarine.com




PREMIER MARINE                                                                          CAN Mar 11
S PECIAL E VENTS L IABILITY
TARGET RISKS
     •    Auctions
     •    Award Presentations
     •    Banquets/Luncheons
     •    Bazaars
     •    Charity Auctions/Benefits/Dance/Sale
     •    Concerts (classical/jazz)
     •    Conventions
     •    Dinner Theatre
     •    Festivals
     •    Job Fairs
     •    Meetings
     •    Pageants
     •    Phone-A-Thons
     •    Picnics
     •    Religious Assemblies
     •    Reunions
     •    Rummage Sales
     •    Shows (boat, RV, etc.)
     •    Social Gatherings/Receptions
     •    Speaking Engagements
     •    Sports Events
     •    Stage Shows
     •    Theatrical Performances/Musicals
     •    Weddings and Receptions
     •    And many other types of events

COVERAGES
     •    Single Event Policy
     •    Annual Policies available – please contact your Underwriter to discuss
     •    Up to $5 Million CGL Limit
     •    Liquor Liability Available
     •    Medical Expense Coverage
     •    Non-owned Automobile

APPLICATIONS
     •    Booths/Kiosks -1 page, self rating
     •    Private Functions -1 page, self rating
     •    Events open to the public -simple 2 page application

HOBBY CLUBS/ENTHUSIAST GROUPS
     •    Annual CGL Policy
     •    Premium as low as $250
     •    We can write clubs such as: Automobile Clubs, Bird Watcher Clubs, Model Train Clubs, etc.
     •    Most types of hobby clubs are acceptable




Western Canada:                                         Ontario and Eastern Canada:
T 604 669 5211 F 604 669 2667                           T 416 365 0444 F 416 365 0446
www.premiermarine.com




PREMIER MARINE                                                                                        CAN Mar 11
R ISK A SSIST – Non Standard Commercial Property


TARGET RISKS
     •    Stand-alone Rented Dwellings
     •    Rented Condos
     •    Student Housing
     •    Vacant Buildings & Homes
     •    Rooming Houses
     •    Multi Family Residential
     •    Seasonal Rentals
     •    Older Structures
     •    Risks declined by Standard Markets due to undesirable occupancies, claims, non-pay, etc.



PROGRAM FEATURES
     •    Competitive Pricing
     •    Prompt Service on Quotes and Policy Issuance
     •    Broad Form/Replacement Cost Coverage available on homes constructed after 1985
     •    Building, Stock, Equipment, Business Interruption & Liability coverages available for most accounts




Western Canada:                                         Ontario and Eastern Canada:
T 604 669 5211 F 604 669 2667                           T 416 365 0444 F 416 365 0446
www.premiermarine.com




PREMIER MARINE                                                                                                  CAN Mar 11
B EAUTICIAN                     &   S PAS
TARGET RISKS
     •    Hair and Esthetic Operations
     •    Spa Operations (incl Laser Treatments)
     •    Lipo-Laser Operations
     •    Laser Hair Reduction, and Replacement
     •    Laser Treatments for Weight Reduction
     •    Laser Hair Reduction Studios
     •    Health & Wellness Retreats
     •    Tanning Salons
     •    Injectable Treatments (ex. Botox and Collagen)
     •    Teeth Whitening



PROGRAM FEATURES
     •    Competitive Pricing

NEW – Associations of Practitioners
  • Provincial or National Programs can be arranged
  • Certificate Issuance within the hour



COVERAGES
A full composite package designed for the Beauty and Spa industry:

Property:
    • All Risk/Broad R/C Form Wordings
    • No Co-insurance Penalty
    • Business Interruption/Extra Expense
    • 5 Point Crime Coverage
    • Boiler

Liability:
    • Manuscript CGL (occurrence form)
    • Professional Liability Wording
    • Limits Up to $5,000,000 Available
    • Tenants Liability $1,000,000
    • Related Contract Hair Technicians Included
    • Employers Liability Included
    • Advertisers Liability Included
    • Non-Owned Auto Included




Western Canada:                                            Ontario and Eastern Canada:
T 604 669 5211 F 604 669 2667                              T 519 850 1610 F 519 850 1614
www.premiermarine.com




PREMIER MARINE                                                                             CAN Mar 11
F ITNESS/ T ANNING/ M ARTIAL A RTS/ D ANCE S TUDIOS

TARGET RISKS
     •    Health & Fitness Clubs
     •    Individual Personal Trainers
     •    Training Studios
     •    Martial Arts Studios
     •    MMA -Mixed Martial Arts
     •    Dance Studios
     •    Tanning -Both Bulb and Spray Salons
     •    Association Programs



PROGRAM FEATURES
     •    Stand Alone Liability Policies Available
     •    Competitive Pricing
     •    Special Pricing for Members of Smart Tan Canada



COVERAGES
A Composite package designed for the Fitness Industry:
     •    All Risk/Broad R/C Form Wordings
     •    No Co-insurance Penalty
     •    Business Interruption/Extra Expense
     •    5 Point Crime Coverage
     •    Boiler Liability
     •    Manuscript CGL with a Professional Liability Extension [occurrence form]
     •    Limits up to $5,000,000 Available
     •    Related Fitness Volunteers Included
     •    Related Contract Trainers Included
     •    Employers Liability Included
     •    Tenants Liability $1,000,000
     •    Advertisers Liability Included
     •    Non-Owned Auto Included




Western Canada:                                                   Ontario and Eastern Canada:
T 604 669 5211 F 604 669 2667                                     T 519 850 1610 F 519 850 1614
www.premiermarine.com




PREMIER MARINE                                                                                    CAN Mar 11
C OMMERCIAL M ARINE
As a Premier broker, you can access Oceanic Underwriters Ltd, (a wholly-owned subsidiary of Premier) for all of your
commercial marine needs, including:


CARGO
     •    Ocean and Air Shipments
     •    Imports or Exports
     •    Barge and Scow Movements
     •    Open Cover or Single Shipment Policies


HULL & MACHINERY
     •    Tug Boats, Barges
     •    Workboats, Crew Boats
     •    Tour/Charters
     •    Water Taxis/Ferries
     •    Builders Risk
     •    Participation on Subscription Policies, or 100% placements depending on size of account


COMMERCIAL MARINE LIABILITIES
     •    P&I
     •    Ship Repairers Legal Liability
     •    And various other marine liabilities


MARINAS, BOAT DEALERS, & YACHT CLUB PACKAGE
     •    CGL
     •    Marine Liabilities
     •    Pollution Liability
     •    Boat Dealer Stock
     •    Buildings, Contents, Equipment
     •    Business Interruption
     •    Crime
     •    Glass, Signs
     •    Boiler
     •    Non-Profit D&O for Clubs
     •    Docks and Wharfs Coverage
     •    Owned and Rental Vessels


YACHTS
     •    Powerboats or Sailboats
     •    Yacht Charter Operations


One application form... one policy package -No hassle and no worries!




Western Canada:                                        Ontario and Eastern Canada:
T 604 669 5211 F 604 669 2667                          T 416 365 0444 F 416 365 0446
www.premiermarine.com




PREMIER MARINE                                                                                                   CAN Mar 11
S PORTguard
Liability & Accident Medical Insurance for a variety of sports



Oceanic Underwriters is proud to announce the launch of its newest specialty product – full participant liability combined
with accident medical for Sport and Recreational Risks.


SPORT TEAMS, LEAGUES & ASSOCIATIONS
Soccer, baseball, hockey, volleyball and a multitude of other sport risks.


SHORT TERM SPORTING EVENTS
Recreational triathlons, hockey tournaments, softball tournaments, skateboard competitions, fun runs, hockey schools & off
season sport training and similar events.


SPORT FACILITIES
Arenas, painball & laser tag facilities, indoor skateboard parks, indoor climbing walls.


COVERAGES
Commercial General Liability (Occurrence) combined with Accident/Medical; our own manuscript wordings ensure maximum
coverage for your insured.


15% COMMISSION


Nationally Underwritten in Western Canada
T 604.689.1501 F 604.689.5663
www.oceanicunderwriters.com




                                                                                                                    CAN Mar 11
A DVENTUREguard
Liability & Accident Medical Insurance for Adventure Tourism & Recreational Risks



Oceanic Underwriters is proud to announce the launch of its newest specialty product – full participant liability for Adventure
Tourism Operators, Adventure Rentals and similar recreational risks.


GUIDED ADVENTURE TOUR OPERATORS & LESSON PROVIDERS
Hiking, canoeing/kayaking, surfing, snowmobile & ATV, outdoor climbing, skiing, among many other exposures.


ADVENTURE INDUSTRY ASSOCIATIONS & CLUBS
Mountain bike associations, surf clubs, adventure racing clubs, instructor certification.


THIRD PARTY RENTALS
Canoe/kayaks, bikes, snowmobile & ATV.


COVERAGES
Commercial General Liability (Occurrence) combined with Accident/Medical; our own manuscript wordings ensure
maximum coverage for your insured.


15% COMMISSION


Nationally Underwritten in Western Canada
T 604.689.1501 F 604.689.5663
www.oceanicunderwriters.com




                                                                                                                     CAN Mar 11

								
To top