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Your Name: |
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Business Name: |
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Phone: |
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Fax: |
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E-mail Address: |
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Business
Address: |
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Studio Location
(if different from above) |
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Status: |
Individual
Partnership
Corporation
Other |
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Interest in the Premise: |
Tenant
Owner-Occupant |
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Current/Prior Insurance: |
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Losses In The
Last
3 Years: |
Check Here If None |
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Payment Plan Desired: |
Annual
Four-pay
Six-pay
Ten-pay (Note: $6.00 fee added
each payment) |
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Square Feet Occupied By You: |
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Building Construction |
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ie., wood frame, brick, etc |
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Building Occupancy |
Single
Multiple |
Building 75% Sprinkler Protected |
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Building Built In The Year |
Number of Floors
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Building over 25 years old |
If building is more than 25 years
old, have electrical, plumbing and heating systems and surfaces
(roof,siding, parking lot, etc.) been inspected by a qualified
contractor or inspection service?
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In what year were
the following systems last updated?
Electrical
Plumbing
Heating Roof
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Smoke Detectors |
If Yes, are they hardwired
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Fire Extinguishers |
Fire Alarm
Type
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Burglar Alarm |
Type
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Security Guard Service |
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Surge Protectors on Computers |
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Dead Bolts |
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Barred Windows |
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In what year did you start this business?
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How many years of experience do you have in
photography?
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How many years have you been at this location? |
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Have you ever filed for bankruptcy? |
if yes, in what year
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What percent of your work is on location? |
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Total number of employees |
Full
Time Part
Time |
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What is your specialty (i.e.,
advertising, editorial) |
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Annual gross sales |
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Do you conduct any other business? |
if yes, occupation and company
name
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All-risk, worldwide coverage for your
cameras and accessories. Coverage is on a stated-value basis,
meaning you should insure each item for the full amount required
to replace it. For example, if you would replace a Canon EOS 30D by
buying it new but would replace your old Hasselblad 500C/M by
going to the used market, indicate the appropriate acquisition
costs on your
schedule. |
| $
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At your option, insure equipment which you
rent or borrow from others. Coverage is available on a blanket basis at limits of
$2,000, $5,000, $10,000,$20,000, $25,000 or $30,000. |
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All-risk coverage for
such items as darkroom equipment, studio furnishings, general
office contents and
computer equipment. The policy automatically provides a limit of $10,000.
Please indicate if you desire higher limits. |
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Pays you net
income and normal operating expenses while you restore your
business after a covered loss. Business income protection applies
more to studio photographers than to location
photographers.
Coverage is automatic up to the actual loss sustained for a
12-month period. |
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Covers the additional
costs, such as rental of studio space, in the event that your space is damaged. |
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Pays you amounts due from your
customers that you are unable to collect as a result
of
covered loss to your records of accounts receivable. The policy
automatically provides a limit of $25,000. |
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Insure property of others while in your custody, for up to fourteen days. This benefit is extremely valuable to advertising and
fashion photographers who
may be using expensive clothing or consumer products as the subject matter of their photographs. Temporary Custody Coverage is
available on a blanket basis at limits of $5,000, $10,000, $20,000 or $25,000. |
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Insure the cost to reproduce your
portfolios (assuming you have the original images) in the event of theft or
destruction by a covered loss. Also covers the portfolio case. Please indicate if you wish higher limits. |
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Covers the cost to rent
equipment while yours is being repaired or replaced as a result of theft or other covered loss. Limits available are $1,000 or
$2,500. |
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Protection for your acts, and those of
your assistants, against bodily injury and property damage claims. The policy automatically provides a limit of $1
million. Please indicate if you wish higher limits. |
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Provides
liability-only coverage for your business for claims involving
assistants personal vehicles or vehicles you rent or
hire. This coverage is excess over any primary coverage which the owner of the vehicle might have |
