Professional-Liability

Residential Cleaning Services

Professional Cleaning – Residential

General Information

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* PLEASE ATTACH COPIES OF YOUR CURRENT POLICY DECLARATIONS PAGES FOR MOST ACCURATE QUOTE *

Policy Limits | PROPERTY

► Contents may include, but is not limited to: Leasehold Improvements, Leased Property, Inventory, Furniture/Fixtures, Equipment, Printed Materials, Consumables, and Property of Others in Your Care. Please consult your lease requirements when choosing the coverage and limits for this location.

Policy Limits | CRIME

Policy Limits | GENERAL LIABILITY

WORKERS COMPENSATION | OWNERS | List below all owners of the business, whether active or inactive.


WORKERS COMPENSATION | List below payroll for all employees EXCEPT OWNERS

Residential Cleaning – Labor

Office – Inside

Sales – Outside

Policy Limits – AUTOMOBILE

Policy Limits – UMBRELLA

PROPERTY – Underwriting Questions

GENERAL LIABILITY – Underwriting Questions

Do Subs provide Certificates with limits at least equal to yours?
Is a formal safety program in operation?
Any exposure to flammables, explosives, chemicals?
Do you install, service, or demonstrate products?
Do you provide guarantee, warranty, or hold harmless?
Any exposure to radioactive / nuclear materials?
Any operations involving storing, treating, discharging, applying, disposing, or transporting of hazardous material?
Do you lease employees to or from other employers?
Have any crimes occurred or been attempted on your premises within the last three years?
Is there a formal, written safety and security policy in effect for your location?
Does your promotional literature make any representations about the safety or security of the premises?
Do you install, service, or demonstrate products?

AUTOMOBILE – Underwriting Questions

Do over 50% of employees use their autos in the business?
Is there a vehicle maintenance program in operation?
Are any vehicles leased to others?
Any vehicles customized, altered or have special equipment?
Do operations involve transporting hazardous material?
Any vehicles used by family members? If so, identify below.
Do you obtain motor vehicle records for new drivers?
Do you have a specific driver recruiting method?
Any drivers with moving traffic violations?

WORKERS COMPENSATION – Underwriting Questions

Do you have an Experience Modification Factor?
Any work performed underground or above 15 feet?
Are you engaged in any other type of business?
Any group transportation provided?
Any seasonal employees?
Do employees travel out of state?
Are physicals required after offers of employment are made?
Are employee health plans provided?
Do any employees predominantly work at home?
Any prior coverage declined, cancelled or non‐renewed in the last 3 years?

UMBRELLA – Underwriting Questions

Is bridge, dam, or marine work performed?
Is contract or agreement made with customer? If so, attach copy
Do you own, rent, or otherwise use cranes or scaffolds?

VEHICLE SCHEDULE – Please complete the below or attach a separate schedule of your own

** Titled/Leased in business name?

DRIVER SCHEDULE – Please complete the below or attach a separate schedule of your own

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GENERAL UNDERWRITING QUESTIONS

Do employees work in pairs?
Are employees supervised on the job?
Are single‐person jobs limited to experienced staff?
Are periodic unannounced job site management checks performed?
Are written applications completed by all prospective employees?
Are references checked?
Does employment application ask about prior criminal acts?
Are criminal background checks performed on all employees?
Any bid or performance bonding needed?

OTHER COVERAGE TO CONSIDER – Please type any comments or requests below

PLEASE CONTACT YOUR CURRENT AGENT OR INSURANCE COMPANY FOR A CURRENTLY‐VALUED LISTING OF YOUR CLAIMS HISTORY (“LOSS RUNS”) FOR THE PAST 3 YEARS.