Security Guard

Company

Policy #

Premium

Losses
Paid

Losses
Reserved

Description


Security Guard & Related Operations Insurance Quote		We would like to provide you with a free, no-obligation Security Guard insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

General Information
Name of Business:
Contact Name:
Address:
City:	State: Zip:
Business Phone:	Fax:
Best Time To Call:	AM PM
Contact Email Address:
Applicant is:	Individual Corporation Partnership Joint Venture Other:

Limits of Liability
Limits of Liability Requested
General Aggregate	$	Each Occurrence	$
Products & Completed Operations Aggregate	$	Fire Damage (any one fire)	$
Personal & Advertising Injury	$	Medical Expense (any one person)	$
Deductible			$

A.	How long has applicant been in business?

B.	Branch offices and locations: 1. 2. 3.

C.	Operations conducted in the following states: State: Licensed with state? Yes No License #: State: Licensed with state? Yes No License #: State: Licensed with state? Yes No License #:

D.	Risk contact, title, phone number:

E.	Total number of employees:

F.	# of unarmed employees Estimated payroll $ Gross sales $ # of armed employees Estimated payroll $ Gross sales $ Any armed guards in retail stores? Yes No Arrest authority? Yes No

G.	Total number of hours billed to clients annually:

H.	Are ALL armed personnel certified for use of firearms by a state agency or a firearms certification school? Yes No

I.	Does applicant have Workers' Compensation coverage in force? Yes No

J.	Does applicant lease employees? Yes No

K.	Does applicant subcontract work? Yes No If yes, what type? Are certificates of insurance required from all subcontractors? Yes No Annual cost of subcontracted work: $

L.	Are background investigations and checks conducted on new employees? Yes No If yes, describe procedures used for pre-employment checks:

M.	Does the applicant have a training program for employees? Yes No If yes, describe: Does applicant have a training manual? Yes No

N.	Does applicant use a record keeping log for each job? Yes No

O.	Does applicant use dogs? Yes No If yes, number with handlers: without handlers:

P.	List the applicant's ten largest clients. Indicate type of operation performed and duties involved: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Q.	Number of supervisors: Describe duties below: Do they perform investigative or guard duties? Yes No Does the applicant bill hours to the client? Yes No

R.	Is applicant involved in any other operations or business? Yes No If yes, describe:

S.	Does applicant conduct any operations involving nuclear power plants? Yes No

Provide ANNUAL PAYROLL by listed operation (include subcontractor payroll not covered by other insurance):

Guard Services	Armed Payroll	Unarmed Payroll
Airport security	$	$
Alarm Monitoring: Burglary/fire	$	$
Medical emergency	$	$
Alarm response	$	$
Baggage handling security	$	$
Banks	$	$
Construction sites	$	$
Criminal detention centers	$	$
Fast food restaurants	$	$
Housing: Apartments--Public Housing authorities, Section 8, HUD	$	$
Apartments--middle to high income	$	$
Condominiums	$	$
Homeowners associations	$	$
Private residences	$	$
Immigration detention centers	$	$
Manufacturing/warehousing	$	$
Motels/hotels	$	$
Offices, hospitals, churches	$	$
Parking lot security	$	$
Restaurants, night clubs, discos, bars	$	$
Bouncers	$	$
Retail operations: Clothing	$	$
Department Stores	$	$
Liquor stores	$	$
Shopping centers	$	$
Supermarket/convenience stores	$	$
All other	$	$
Schools	$	$
Special events: Athletic events--describe type:	$	$
Concerts--describe: Rock & Roll Hard Rock Rap Country Other	$	$
Other--describe:	$	$
Strike work	$	$
Utility property security	$	$
Other--describe:	$	$

Provide ANNUAL PAYROLL by listed operation (include subcontractor payroll not covered by other insurance):

Private Investigation	Armed Payroll	Unarmed Payroll
Arson investigation	$	$
Computer fraud	$	$
Corporate--employee dishonesty	$	$
Credit pre-employment screening	$	$
Domestic	$	$
Insurance claim investigation	$	$
Legal	$	$
Missing Person	$	$
Records check	$	$
Surveillance--describe:	$	$
Undercover operations	$	$
Other--describe:	$	$

Provide ANNUAL PAYROLL by listed operation (include subcontractor payroll not covered by other insurance):

Miscellaneous Services	Armed Payroll	Unarmed Payroll
Alarm installation, service or repair	$	$
Auto repossession	$	$
Bail bond operations	$	$
Bounty hunters	$	$
Bodyguards	$	$
Courier or escort services: Armored car service	$	$
Courier--nonnegotiable securities	$	$
Courier--negotiable securities	$	$
Courier escort	$	$
Funeral escort	$	$
Dog services: With handler	$	$
Without handler	$	$
Drug surveillance	$	$
Drug testing	$	$
Firearms certification school	$	$
Insurance adjusters	$	$
Polygraph work	$	$
Process servers	$	$
Repossession/collection work	$	$
School crossing guards	$	$
Security consulting	$	$
Security guard school/training for others	$	$
Shopping service	$	$
Traffic Control	$	$
Other--describe:	$	$

U.	During the past three years has any company ever cancelled, declined or refused to renew similar insurance for the applicant? (Not applicable to Missouri applicants.) Yes No If yes, explain:

Additional Comments

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