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Coverage Needed

Pre-selected coverage is based on the risk type. Adjust it if needed before submitting.

Effective Date

When do you want coverage to start? Expiration Date

Expiration auto-fills exactly one year after the requested start date.

Applicant Information

Contact

Contact Name Phone Email Best Time To Reach You

Named Insured

Legal Name / Named Insured DBA / Trade Name Mailing Street Address City State ZIP

Entity Type

What type of entity is this?

Locations / Operations

Add each operating location. All submitted locations will be included with the application for review.

Property Details

Property valuation basis We recommend RC when available. RC pays to replace the property with new materials; ACV pays the depreciated value. Do you want business income insurance? Business income can help replace lost income and pay continuing expenses if a covered property loss shuts down or slows the business.

RC means Replacement Cost. ACV means Actual Cash Value after depreciation.

If there is more than one building, complete each building separately so Johal can include a clean property schedule with the submission.

Self Storage Supplemental

Quote need by date Member of storage owners association? Years in self-storage industry Attend loss-prevention seminars / safety program? Employee dishonesty limit Customer goods legal liability limit Offer tenant/customer storage insurance? Sale & disposal liability limit Employment practices liability? Data compromise coverage? Non-storage buildings on premises Climate-controlled storage? Self-storage buildings Open lot spaces for RVs/boats Rental units Blanket building value BPP Business personal property: office contents, tools, supplies, and other property that is not the building itself. BI Business income: estimated lost income and continuing expenses after a covered property loss.

Premises Protection

Rental office on site? Originally designed/built for self-storage? Flood or surface water accumulation? Subscription fire dept. dues paid? Sprinkler maintenance agreement? Lightning arrestor system? Positive ID required when leasing? Manager resides on premises? Manager checks tenants' locks daily? Patrolled by police or security company? Hired armed security guard? Fully lighted at night? Gate open time Gate close time Gates locked at night? Complex fully fenced/enclosed? Gates visible from manager's office? Gate access/control system? Entire facility monitored by video cameras? Building perimeters monitored by video cameras? Each gate monitored by video cameras? How long is video archived?

Operations / Non-Storage Activities

Owner acts as manager? Employees/management self-storage experience Forklifts or loaders used? Elevators or lifts used? Duplicate keys retained by insured? Annual rental income at 100% occupancy Current occupancy rate Tenants conducting non-storage operations? Insured acts/acted as general contractor? Container storage operations? Cell towers on premises? Wine storage? Other business activities on premises? Mailbox rentals? Vault-style rentals? Truck/trailer rentals? Self-service car wash? Other activity description

Construction / Employee Dishonesty / Sale & Disposal

Construction beginning date Construction ending date Owner acting as general contractor for construction? Frequency of audits Total employees Other than owner, who has check-signing authority? Who completes audits? Owner actively involved in business? Written sale/disposal procedures conform to state law? Tenant property sales in last 12 months Sale/disposal claims or court actions in past 3 years?

These self-storage details are emailed and used to fill the self-storage supplemental PDF.

General Liability

Total annual company trucking revenue

Trucking Quick Quote

US DOT / MC number For hire? Limit of liability PIP / UM limit Personal injury protection / uninsured motorist coverage, if required or requested. Cargo limit Projected mileage for coming year

Radius of Operations Percentage

0-100 miles 101-300 miles 301-600 miles 601+ miles

Destinations / Commodities

Cities of destination and percent to each

Experience / Lease

Trucking experience in years Years of previous insurance Has insured been operating under a lease?

Power Units

Up to 5. Enter year, make/model, VIN, physical damage value, and whether each unit is leased to the insured.

Trailers

Up to 5 trailers. Enter year/make/model/VIN and physical damage value if coverage is needed.

Prior Carriers / Losses

Drivers

Filings / Hired & Non-Owned Auto

Agency renewal? Select Yes if Johal already handles this policy and this is a renewal. Expiring premium Federal or state filings? Policy canceled or non-renewed in past 3 years? Hired autos coverage? Non-owned coverage?

These trucking details are emailed and used to fill the truckers quick quote PDF.

Apartment Supplemental

Any mercantile or non-residential occupancy? Mercantile means retail, office, restaurant, or other non-apartment use. Occupancy percentage Credit checks on tenants? Background checks on tenants? Reference checks on tenants? Has building been gut rehabbed? Gut rehab means major interior reconstruction down to structural systems. Converted from prior occupancy? Units rented daily Units rented weekly Units rented monthly Number occupied Number vacant Annual lease only units Average studio rent Average single rent Average double rent Average triple rent On-site manager? Annual turnover rate Pets allowed? Elevator on premises? Any major renovation plans? Historical register? Select Yes if the property is officially listed as historic or has historic-building restrictions. Special occupancy types and unit counts Sliding glass doors have additional locks? Entry doors have peepholes and keyless deadbolts? Windows/doors have security bars? Security guards on premises? Lease says no security warranty and tenants should call 911? Fences/gates around property? Criminal checks on employees? References checked on employees? Prior physical or sexual assault incidents? Space heaters used or allowed? Wood/pellet stoves or fireplaces? Hallways/stairwells open or closed? Number of exits Fire doors and panic hardware? Emergency lighting? Heat/smoke detectors in each unit? Detector type How often are detectors tested? How often are batteries replaced? CO detectors in each unit? Aluminum wiring? Compliant with housing codes? Building code violations in past 10 years? Amenities/exposures and counts Subcontracted services Require COIs from service providers? Written contracts with service providers? Work orders used? Required insurance limits Named Additional Insured on provider policies? Known facts/incidents/issues that could lead to a claim?

These apartment supplemental details are emailed to Johal and used for the apartment supplemental PDF.

Gas Station Operations

Number of fuel pumps Annual fuel sales in gallons Fuel types sold Convenience store area Do they sell liquor? Underground storage tanks? UST means underground storage tank. Any auto repair/service? Any car wash? Any cooking/deli on premises? Years in this type of business Years at this location Business opens Business closes Days open per week Sell fireworks? Sell firearms/ammunition? LPG tank filling? LPG tank swapping? Alcohol consumed on premises? Cash checks for a fee? Video rental operation? Storage area square feet Apartment units on premises? Area leased to others? Security guards on premises? Entire premises well lit at night? Security cameras covering both interior and exterior areas? Assault and/or battery claim? Fiscal date Food sales Tobacco sales Gross annual income/sales Protective barriers/poles around fuel pumps? Fire extinguishers? Burglary alarm? Interior motion detection throughout building? Panic button to police/alarm company? Any surveillance camera system on premises? Fire alarm? Smoke alarm? Type of wiring Wood-burning devices on premises? Roofing material Any wood shingles? Property values by type Parking lot area square feet Responsible for parking lot maintenance? Parking lot surface Number of exits All exits marked with exit signs? All exits have panic door hardware? If no panic hardware, exits unlocked during business hours? Any weapons/firearms on premises? Health or safety violations?

These gas station details are emailed and used for the C-store supplemental PDF.

Hotel Operations

Hotel type If other, describe Total guest rooms Occupancy ratio Average daily room rate Franchise with national chain? Hourly rates offered? Extended stay offered? Owners/family live on premises? Swimming pool, hot tub, or water exposure? Security doors? Peep holes for doors? Doors use key cards or keys? Restaurant/lounge on premises? Sell liquor on premises, like a small store? Exercise facilities or sport courts? Any mercantile/gift shop? Mercantile means retail sales such as a gift shop, market, or similar store area. Parks or trails? Parking lot? Valet services? Vehicles used for guest transport? Elevator on premises? Any playground equipment? Any construction/renovation planned?

These hotel details are included with the application for underwriting review.

Restaurant & Bar Operations

Restaurant type If other, describe Seating capacity Annual food sales Liquor/alcohol served? Type of cooking Automatic extinguishing system? Hoods/ducts/filters cleaned at least every six months? Delivery offered? Catering offered? Outdoor seating? Live entertainment? Security or bouncers? Valet offered? Health or safety violations?

These restaurant/bar details are emailed to Johal for underwriting review.

Additional Insureds

Add up to 2 additional insureds. The ACORD 125 has room for two additional named insured entries on page one.

Anything Else We Should Know?

Notes for Johal Lease requirements, lender requests, renewal date, current carrier, claims, special coverage needs, or anything the carrier should understand.

Review & Submit

Review the submission before sending it to Johal Insurance Brokers.

What are we insuring?

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