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Self-Storage Supplemental Application
COMPANY DETAILS
Insured Name
Mailing Address
City
State
Zip Code
Country
Contat Name
Phone
Fax
Email
Website
Effetive Date
Prior Carrier
Expiring Premium
COVERAGE
Business Property – Buildings
Business Personal Property
Loss of Rental Income & Extra Expense
Employee Dishonesty
Money & Securities
Select if applicable
$15,000
$25,000
$50,000
$75,000
$100,000
SECTION II – BUSINESS LIABILITY
Comprehensive Business Liability
Liability and Medical Limit
Medical Expenses (includes $10,000 per person)
Hired Non-owned Auto (included at no charge)
Customer's Goods-Legal Liability
Sales & Disposal (includes $10,000)
Deductible (Each Claim Limit)
Select
$1,000,000/$2,000,000
$2,000,000/$4,000,000
Select
$10,000
Select
$1,000,000
Select if Applicable
$25,000
$50,000
$100,000
$250,000
$500,000
$1,000,000
Select
$10,000
$25,000
$50,000
$100,000
$250,000
$500,000
$1,000,000
Select
$250
$500
$1,000
$2,500
$5,000
$10,000
$25,000
OPTIONAL COVERAGES
Vacant Land
For self-storage operations
# of acres
Other than self-storage operations
# of acres
O -site Rental O ce
# of o -site rental o ces
Total Insured Values
Incidential Occupancies
Owner operated car washes
# of stalls
Lessor’s Risk Only
Square Feet
Employee Benefit Liability
# of employees
Are all employee benefits programs in writing?
Yes
No
Employee’s Practices Liability
Employee Personal Liability
Employee Dishonesty
Employee Property ($10,000 included)
Fine Arts ($10,000 included)
Valuable Papers and Records ($25,000 included)
Accounts Receivable ($25,000 included)
Limited Pollutant Removal
Mini-Computer Coverage ($20,000 included)
Pollution Clean-up & Removal ($25,000 included)
System Protection
Extended Business Income (15 months actual loss sustained included)
Blanket Building Limits
Open Lot Storage
Garage Keepers
Select if Applicable
$300,000
$500,000
$1,000,000
Select
$15,000
$25,000
$50,000
$75,000
$100,000
Select
$10,000
$10,500
$11,000
$12,000
$12,500
$13,000
$13,500
$14,000
$14,500
$15,000
Select
$10,000
$25,000
$50,000
$100,000
$250,000
Select
$25,000
$50,000
$100,000
$250,000
Select
$25,000
$50,000
$100,000
$250,000
Select if pplicable
$25,000 Occ/$100,000 Agg/0$ Ded
$50,000 Occ/$200,000 Agg/0$ Ded
Select
$20,000
$50,000
$100,000
$250,000
Select
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$55,000
$60,000
$65,000
$70,000
$75,000
$80,000
$85,000
$90,000
$95,000
$100,000
Select
Yes
No
Select
15 Months
18 Months
24 Months
Select
Yes
No
Select if Applicable
$300,000
$500,000
$1,000,000
$2,000,000
$5,000
$10,000
$25,000
Select if Applicable
$25,000
$50,000
$75,000
$100,000
$150,000
$200,000
$250,000
$500,000
