OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM EXPOSURE ANALYSIS CHECKLIST

(November 2019)

INTRODUCTION

This checklist is designed to assist in beginning the analysis of the Insurance Services Office (ISO) Owners and Contractors Protective Liability Coverage Form–Coverage for Operations of Designated Contractor. 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.

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

Owners and Contractors Protective Liability Coverage Form Available Endorsements and Their Uses

Owners and Contractors Protective Liability Coverage Form Endorsements Checklist

GENERAL 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	____________________________	______________

LIABILITY – OWNERS AND CONTRACTORS PROTECTIVE LIABILITY

The named insured is: ____ Project owner ____ Project general contractor

Project address:

____________________________________________________________________________________

Name of entity purchasing the policy:

____________________________________________________________________________________

Purchaser’s mailing address:

____________________________________________________________________________________

Purchaser is: ___ General contractor ___ Subcontractor

Describe the project and include the location(s) of the job site(s):

____________________________________________________________________________________

Estimated project cost: _______________________________________________________________

Estimated project duration: From ______ to ______

Limits of liability the named insured requires:

____________________________________________________________________________________