275.7-1

ISO COMMERCIAL LIABILITY UMBRELLA COVERAGE FORM EXPOSURE ANALYSIS CHECKLIST

(April 2019)

INTRODUCTION

This checklist is designed to assist in beginning the analysis of the Insurance Services Office (ISO) Commercial Liability Umbrella Coverage Form. 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.

ISO Commercial Liability Umbrella Coverage Form Available Endorsements and Their Uses

ISO Commercial Liability Umbrella 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:	____________________________	______________

The applicant’s primary operations are:

____________________________________________________________________________________

The applicant’s secondary and 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.

UMBRELLA

List all policies that provide liability coverages for the applicant.

Insurance coverage	Primary carrier	Limits of Insurance

List countries where the applicant has locations and/or where employees regularly travel.

____________________________________________________________________________________

UNDERLYING GENERAL LIABILITY INFORMATION

List all the exclusion endorsements attached to the applicant’s underlying policy(ies).

____________________________________________________________________________________

List or describe any amendments or endorsements attached to the applicant’s underlying policy(ies).

____________________________________________________________________________________

Check the coverages that the underlying policy(ies) provide.

___ Employee Benefits	___ Care Custody and Control	___ Product Recall Expense
___ Employment-related Practice	___ Underground Storage Tank	___ Stop Gap

Does the applicant have any owned, hired, or leased watercraft exposures? ___ Yes ___ No

If yes, describe the watercraft including where it is kept and/or used and the duration of exposure.

____________________________________________________________________________________

Does the applicant have any owned, hired, or leased aircraft exposures? ___ Yes ___ No

If yes, describe the aircraft including its hanger location and/or where it is used and the duration of exposure.

____________________________________________________________________________________

What are the applicant’s total annual receipts? $____________________

What is the applicant’s annual cost for subcontractors? $___________________________________

UNDERLYING AUTOMOBILE LIABILITY INFORMATION

List all exclusion endorsements attached to the applicant’s underlying policy(ies).

____________________________________________________________________________________

List and/or describe any amendments or endorsements attached to the applicant’s underlying policy(ies).

____________________________________________________________________________________

How many vehicles of the following types does the applicant own or lease?

____ Private passenger	____ Small trucks	____ Medium trucks
____ Heavy trucks	____ Extra heavy	____ Bus
____ Mobile equipment subject to financial responsibility law

Are vehicles ever hired? ___ Yes ___ No

If yes, describe the vehicles hired, the annual cost, and the duration.

Type of vehicle	Annual cost of hire	Estimated time of hire
_________________________________	_________________________	____________________
_________________________________	_________________________	____________________
_________________________________	_________________________	____________________

UNDERLYING WORKERS COMPENSATION AND EMPLOYERS LIABILITY INFORMATION

List all exclusion endorsements attached to the applicant’s policy(ies).

____________________________________________________________________________________

List and/or describe amendments and endorsements attached to the applicant’s policy(ies).

____________________________________________________________________________________

Provide the number of the applicant’s employees by state.

State	# of employees	State	# of employees	State	# of employees

What is the applicant’s total annual payroll? _________________________