ISO EQUIPMENT BREAKDOWN PROTECTION COVERAGE FORM EXPOSURE ANALYSIS CHECKLIST

(June 2020)

This checklist is designed to begin the analysis of equipment breakdown coverage. This is only a starting point, and additional risk specific questions may arise as the exposures are developed. This analysis should be combined with exposure analysis checklists for other coverages to develop a complete picture of the insured’s operations.

This checklist is designed to supplement the ACORD application.

ISO Equipment Breakdown Protection Coverage Form ACORD Forms Considerations

A list of endorsements may be helpful as you discuss exposures with your client.

ISO Equipment Breakdown Protection Coverage Form Available Endorsements and Their Uses

ISO Equipment Breakdown Protection Coverage Form Endorsements Checklist

GENERAL CLIENT INFORMATION

Legal business name(s)

____________________________________________________________________________________

Mailing address:

____________________________________________________________________________________

Email: _______________________________________________________________________________

Website: _____________________________________________________________________________

Type of entity:

___ Individual	___ Corporation	___ Sub-S Corp.
___ Partnership	___ Joint Venture
___ Not-for-profit	___ Limited Liability Company

SIC Code(s): _________________________________________________________________________

NAICS Code(s):_______________________________________________________________________

Federal ID Number: ____________________________

When did the applicant start business operations? ___________________________________________

When did the present management assume control? _________________________________________

How many years experience does the owner have in this type of business? _______________________

How many years experience does the manager have in this type of business? _____________________

Has the applicant ever been involved in a bankruptcy procedure? ___ Yes ___ No

If yes, explain including the type of bankruptcy, the filing date, and the resolution.

____________________________________________________________________________________

Names of subsidiary companies or joint ventures that are not part of this application:

____________________________________________________________________________________

Important People	Name	Phone Number
Owner/Principal
Other Decision Makers
Plant and Grounds
Financial
Legal
Claims

The applicant’s primary operations are:

____________________________________________________________________________________

The applicant’s secondary and/or incidental operations are:

____________________________________________________________________________________

The applicant used to be involved in the following operations, but they have been discontinued:

____________________________________________________________________________________

The hours of operations are: _____________________________________________________________

How many days per week is the applicant open? ___

Is this a seasonal operation? ___ Yes ___ No

If yes, what is the season? From: _____________ to: _____________

Does the applicant have a safety program? ___ Yes ___ No

If yes, answer the following:

Name of safety director: __________________________________________________________

Safety director phone number: _____________________________________________________

Safety director email address: ______________________________________________________

Attach a copy of the safety program.

Does the applicant have a disaster plan? ___ Yes ___ No

If yes, answer the following:

Name of disaster coordinator: ___________________________________________________________

Disaster coordinator phone number: ______________________________________________________

Disaster coordinator email address: ______________________________________________________

Attach a copy of the disaster plan.

EQUIPMENT BREAKDOWN PROTECTION COVERAGE

Premises # _______ Building # _______

Location address: ___________________________________________________________________________

Does the applicant own the premises? ___ Yes ___ No

Is the applicant responsible for maintaining the boilers and pressure vessels in the building?
___ Yes ___ No

If yes, answer the following:

Do the boilers provide heat to the building? ___ Yes ___ No

How often is the equipment required to be inspected by a certified inspector? ____________________

Have all of the inspector’s recommendations been implemented? ___ Yes ___ No

Where is the equipment located?

___ Separate reinforced furnace room ___ Throughout the building ___ Other

Describe other.

_________________________________________________________________________________

Describe what would probably happen if the boiler failed.

_________________________________________________________________________________

Is the applicant responsible for maintaining the electrical system including the miscellaneous electrical apparatus? ___ Yes ___ No

If yes, answer the following:

Provide the date when the electrical system was last updated?

______ Control panels/circuit breakers ______ All other parts of the system

Does the applicant generate any of its own power? ___ Yes ___ No

How long can the applicant continue operations if a public utility power source is disrupted? ____ Days

Is the applicant responsible for maintaining pumps and compressors for cooling? ___ Yes ___ No

If yes, answer the following:

Describe the system.

_________________________________________________________________________________

What would probably happen if the system failed?

_________________________________________________________________________________

Is the applicant responsible for maintaining refrigeration systems? ___ Yes ___ No

If yes, answer the following:

Where are the units located?

___ Basement ___ Production areas ___ Storage areas ___ Other

Describe other.

_________________________________________________________________________________

What would probably happen if the system failed?

_________________________________________________________________________________

Does the applicant have communication equipment, computer equipment, or other similar electronic equipment? ___ Yes ___ No

If yes, answer the following:

What would probably happen if the equipment broke down?

_________________________________________________________________________________

Does the applicant have production equipment? ___ Yes ___ No

If yes, answer the following:

What would probably happen if the equipment broke down?

__________________________________________________________________________________

If equipment breaks down, what is maximum period of time over which business income could be lost?
____ Days

Is there any part of the applicant's operation where a specific temperature or humidity level must be maintained? ___ Yes ___ No

If yes, answer the following:

Describe the temperature/humidity-controlled operation.

_________________________________________________________________________________

How long can the temperature/humidity range be maintained following a breakdown? _____ Hours

Are backup systems in place to help control the temperature/humidity? ___ Yes ___ No

What probably happens when the temperature/humidity are outside the controlled boundaries?

_________________________________________________________________________________