Canadian Virtual Assistant Connection Program Policy Term:
September 5 2007
th
______________________ to __________________________
0 - 3 months 25% 4 - 6 months 50% 7 - 9 months 75% 10 – 12 months 100% Core coverage: “All Risks” subject to exclusions, 90% co-insurance clause, Replacement Cost except on Stock & Tools Actual Cash Value will apply, $ 1,000.00 Deductible except 2,500.00 Deductible Sewer Backup, including various extensions as provided under Business Plus End’t 10,000.00 Office Contents 5,000.00 Contractors Tools including EDP Extension for off-premises use. Subject to Locked Vehicle Warranty. 2,000,000.00 Comprehensive General Liability subject to $1000 Bodily Injury/Property Damage Deductible including Non-Owned Automobile. Excluding Professional Liability. Named Insured: Location Address: Phone # / Fax # / E-mail ___________________________________________________ ___________________________________________________ ___________________________________________________ ________________________________
Mid-term adjustments as follows:
Operations (what services do you provide your clients)
_____________________________________________________________________________ Loss Payable / Mortgagee / Additional Insured (on any office tools or equipment) ____________ _____________________________________________________________________________ Insurance History: Number of years of Experience: Number of years in Business: Name of Previous Insurer / Policy # / Expiry Date ________________________________ ________________________________ ________________________________ _________________
Any losses or insurance claims in the last 5 years. If yes, please explain:
_____________________________________________________________________________ Has any Insurer ever cancelled, declined or refused to renew ___________________________ Premises info including – Year built: __________ No. # of stories: __________________ Square feet (total & insured portion) _______ / _______ Basement: ______________________ Wall construction & exterior finish: _________________ Type of building (single, industrial mall, strip mall, enclosed mall, apartment, residence) ________ Hydrant within _________ feet Firehall within __________ miles Security: Burglar Alarm / Fire Alarm / Both __________ Monitored / Local: _________________ If residence over 20 years old: please provide year the following services were updated: Wiring: _________ amp breakers subject to copper wiring Heating: (nat. gas, electric, oil, other) ______________________________________________ Plumbing: copper/plastic ________________________________________________________ Roof: (asphalt / tar & gravel / metal / other) __________________________________________ Any auxiliary heating: (woodstove, insert) ___________________________________________ If oil tank: in-ground / above ground _____________________ Age: ___________________ SIGNED & ACCEPTED: _________________________________ DATED: _______________