MURRICK COMMERICAL LINES APPLICATION - Murrick Group

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About
- About Murrick
- Frequently Asked Questions
Locations
- Turn-by-Turn Directions
- By Office
Insurance
Planning
News

Preferred Agent/Broker*
Business' Primary Phone*
Business' Fax
Names of Principals (one per line)*
Mailing Address*
Street Address Address Line 2 City Province/Territory Postal Code Country
Policy Period*
- Day
- Month
- Year
12:01 am Standard Time at the Postal Address of the Named Applicant
New Business?*
- Yes
- No
Replacing Policy No.
Loss Payee/Mortgagee
Loss Payee’s/Mortgagee’s Mailing Address
Description of Business Premises and Occupancy
Loc. No.
Address of Applicant’s Business Premises (if different from Mailing Address)*
Street Address Address Line 2 City Province/Territory Postal Code Country
Construction Details
Walls*
Roof*
Floors*
Building Construction Class (if 'Other' please describe)*
- A-Fire Resistive
- B-Non-Combustible
- C-Masonry
- D-Frame
Occupied by Applicant as:*
Occupied by Others as:*
Number of Storeys*
Basement?*
- Yes
- No
Floor Area Sq. Ft.*
Year Built: (if over 25yrs provide updating info)*
Building Heated By:*
General Information
Is risk within 500 feet of a fire hydrant?*
- Yes
- No
Is risk within 3 miles of a fire hall?*
- Yes
- No
Is the risk sprinklered?*
- Yes
- No
Are all doors fitted with dead locks and windows fixed and equipped with locking devices or metal screens or bars, in sound condition?*
- Yes
- No
If “no”, do existing locks etc. adequately protect this risk?*
- Yes
- No
Does risk have burglar alarm protecting all accessible openings? If yes, please answer the following:*
- Yes
- No
Name of installing company*
Type of alarm system*
- Central station
- Monitoring station
- Local
Does the existing alarm system adequately protect the risk?*
- Yes
- No
Does risk have Security Guard Protection? (if 'yes' explain below)*
- Yes
- No
Name of Security Company:*
Has Applicant ever had insurance decline or cancelled? If “yes”, explain below.*
- Yes
- No
Decline/Cancellation Explanation
List details of any losses in last 5 years:
Previous Insurer and policy no.
Expiry rates/prem.
Coverages
Property Insurance
Business Contents
Stock
Equipment
Tenant Improvements
Business Interruption
Tools
Other:
Liability
Limit Required*
Other Coverages
Please include any other desired coverages (if any)
LIABILITY
Gross Receipts
Payroll
Cost of Work Sublet
U.S. Sales
Other Foreign Sales
Are any of the following associated with the applicant’s operations (if yes, describe in comments)
Asbestos, Chemicals, Radioactive Materials*
- Yes
- No
Spray Painting, Welding, Hot Tarring*
- Yes
- No
Liquefied Petroleum, Natural Gas, Gases*
- Yes
- No
Explosives, Blasting, Pile Driving
- Yes
- No
Watercraft, Dock, Wharfs, Aircraft*
- Yes
- No
Digging, Excavation*
- Yes
- No
Underground Storage Tanks*
- Yes
- No
Shoring, Underpinning, Caissons*
- Yes
- No
Renovations, Demolition, Raising/Moving*
- Yes
- No
Exports or Operations in Foreign Country
- Yes
- No
Are there any Liquid, Gaseous or Waste Discharge or Operations performed at sites where discharge occurs?*
- Yes
- No
Are Sub-Contractors requested to carry liability insurance and provide proof of insurance?*
- Yes
- No
Are formal contractual agreements entered into with sub-contractors?*
- Yes
- No
Comments
Please use a narrative description of process, special hazards and protection for same:
Application Signature
Date*
MM slash DD slash YYYY
Please type your name in capitals to signify your verification that all the information supplied is correct.*
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About Us

Murrick Group Advisors provide insurance, comprehensive financial advice and quality products to individuals, families, and business owners. With numerous offices throughout the Lower Mainland, we are able to provide high quality service combined with innovative and personalized solutions.

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Our Locations
Murrick Head Office
Murrick Downtown
Murrick Financial Planning
Murrick West End
Murrick Oakridge
Murrick Killarney
Murrick Langley
Murrick New Westminster
Murrick Surrey
Murrick Victoria
Wilfred Leong, Vancouver

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