Armored Car Insurance Application

Transcription

1 Amoed Ca Insuance Application Applicant Details: Fist named insued: _ Please attach list of any additional insueds to be included fo coveage. Addess: City/State/Zip: Effective date: Expiation date: Additional Locations: Is vaulting done hee? Addess Ownes, Patnes, Senio Management: Name Position Yeas with Company Pio Expeience Business Desciption: 1. Legal Entity: Popietoship Patneship Copoation Othe: 2. Date of establishment: 3. Has thee been any change in owneship o management within the past thee yeas? Yes No If yes, please explain: 1

2 4. Detailed Desciption of Opeations and Exposues: ANNUAL GROSS RECEIPTS: Amoed: Coin Room: Money Room: Couie: Othe: Pio Insuance: 1. Has any simila insuance been declined o canceled duing the past thee yeas? Yes No 2. Cuent coveage: Yes No Effective date Expiation date Limit of insuance Caie Pemium Loss Histoy: Ente all claims o occuences that may give ise to claims fo the past five yeas. Check hee if none: Date of occuence Type/desciption Amount of loss Amount paid Claim status of occuence o claim (open o closed) Comments/coective action taken: Insuing Ageement: Limit of Insuance: Deductible: 1. Pemises 2. Tansit 3. Couie Total Employees: Dives: Vault Staff: Supevisos: Adminstative: Messenges: Mechanics: Sales: All Othe: 2

3 Intenal Contols: DO YOU INQUIRE INTO AND VERIFY THE FOLLOWING AS PART OF YOUR PRE-EMPLOYMENT SCREENING? 1. Ciminal? Yes No 2. Cedit? Yes No 3. Dug? Yes No 4. Polygaph? Yes No 5. Psychological? Yes No 6. Refeence? Yes No 7. Diving? Yes No 8. Medical Yes No EMPLOYEE CONTROLS: 9. Do you conduct andom cedit checks? Yes No 10. Do you conduct andom dug testing? Yes No 11. Ae employees equied to wea unifoms? Yes No 12. Ae employees equied to cay sideams? Yes No 13. Do you have a fomal taining pogam fo new hies? Yes No 14. Do you have a witten pocedues manual? Yes No 15. Do you use this manual as a basis fo taining? Yes No 16. Does management egulaly monito cew pefomance and keep ecods on file? Yes No PREMISES & VAULT: 17. Do the vaults have time locks? Yes No If yes, ae they set each night and ove the weekends? Yes No If no, please explain: _ 18. Ae all alams U.L. cetified? (please attach a copy of the U.L. alam cetificate) Yes No 19. Ae they maintained unde sevice contact? Yes No 20. Does any one peson have the complete combination and alam codes? Yes No If yes, please explain who they ae and why access contols ae not segegated: 21. Do you pactice joint custody in the opening & closing of all vaults/safes? Yes No 22. Ae all teminal openings done with at least 2 amed employees pesent? Yes No 23. Ae potable duess alams used duing teminal openings? Yes No 24. In the event of an attack at opening, do the alam systems have a duess code which is known by the opening employees that would send an alam? Yes No 25. In the event of an attack on the teminal, do you have a duess code which would instuct all vehicles in oute to disegad futhe odes fom that teminal and poceed diectly to the neaest police station? Yes No 3

4 26. Ae you pemises manned 24 hous pe day? Yes No 27. How often ae alam codes and combinations changed? 28. Do all of you teminals use CCTV cameas? Yes No 29. How many CCTV cameas ae used at each teminal? 30. Ae the cameas ecoded? Yes No 31. How long ae the tapes etained? 32. Ae tapes andomly eviewed by management? Yes No 33. Ae impope pocedues noted by management eviewed with the employee? Yes No ARMORED TRANSIT: 34. What is the total numbe of amoed vehicles is egula sevice? 35. How many spae vehicles? 36. Ae all amoed vehicles equipped with bulkheads? Yes No 37. What is the minimum numbe of cew assigned to each amoed vehicle? 38. Ae vehicles eve left unattended (all cewmembes ae exposed outside the vehicle) with liability aboad? Yes No 39. Ae amoed vehicles equipped with kill switches? Yes No 40. Ae amoed vehicles equipped with GPS tacking devices? Yes No 41. Do you use any locked cages o cago dops in you vehicles? Yes No 42. Ae you vehicles kept in secue locked and enclosed pemises when not in sevice? Yes No 43. Ae vehicle keys signed out by the cew in the moning and signed back in upon thei etun? Yes No 44. Does management egulaly conduct steet inspections of cew pefomance and keep these ecods on file? Yes No 45. Ae you vehicles equipped with a adio communications system? Yes No 46. Do you eve cay cuency o othe valuables in unamoed vehicles? Yes No If yes, please explain fequency and exposues: AUTOMATIC TELLER MACHINES: 47. How many ATMs do you cuently sevice? 48. What pecentage of the ATMs you sevice use Kaba-Mas locks? 49. Do you use amoed vehicles fo all you ATM cash eplenishment outes? Yes No 50. Ae you ATM vehicles eve left unattended? Yes No 51. Do you use a minimum of a 2 peson cew? Yes No 52. Ae all the ATMs you sevice equipped with cassettes? Yes No 53. Do you ATM cews pefom cassette swaps? Yes No 54. Do you ATM cews pefom cash adds? Yes No If yes, what pecentage of you ATM wok is done in this mano? 4

5 55. When pefoming cash adds does the cew econcile and veify the amount of money in the ATM is accuate each time? Yes No UNARMORED COURIER: 56. Do you have any unamoed couie opeations that you wish to cove heeunde? Yes No (If yes, complete the following) 57. How many unamoed couie outes do you opeate pe week? 58. Ae the outes one peson o two peson cews? 59. Ae cewmembes amed? Yes No 60. Is liability eve left in an unattended vehicle? Yes No 61. What is the natue of the liability these outes tanspot? Cash? % Secuities % 62. What is the maximum liability fo any one oute? 63. What is the aveage liability fo any one oute? ADDITIONAL INFORMATION: Please use the space below to povide any additional infomation you feel will help the undewite evaluate the secuity and exposues associated with you company: 5

6 Tansit Exposue Sheet (Please complete one fo each location): Location: SECTION #1: STANDARD TRANSIT EXPOSURE (EXCLUDING FEDERAL RESERVE AND BANK SHUTTLES) EXPOSURE PER VEHICLE PAVEMENT EXPOSURE Day # of Routes Total # of Stops Maximum Aveage Maximum Aveage Monday Tuesday Wednesday Thusday Fiday Satuday Sunday Fo the Standad Tansit Exposues above, please fill in what pecentage of the exposue coelates to the type of outes below. The total should equal 100%. ATM Routes: Commecial Routes: Bank Routes: % % % SECTION #2: FEDERAL RESERVE SHUTTLES (SECURE LOCATION TO SECURE LOCATION, NO STOPS) EXPOSURE PER VEHICLE Day # of Routes Maximum Aveage Monday Tuesday Wednesday Thusday Fiday Satuday Sunday SECTION #3: BANK SHUTTLES (SECURE LOCATION TO SECURE LOCATION, NO STOPS) EXPOSURE PER VEHICLE Day # of Routes Maximum Aveage Monday Tuesday Wednesday Thusday Fiday Satuday Sunday 6

7 Pemises & Vault Exposue Sheet (Please complete one fo each location): Location: SECTION #1: PREMISES EXPOSURE Day Maximum Values Stoed in Vault # of Times pe Month Maximum is Exposed AveageValues Stoed in Vault Monday Tuesday Wednesday Thusday Fiday Satuday Sunday What pecent of the amount stoed in the vault is the following? The total should equal 100%. Cuency: Secuities: Coin: % % % Please descibe all Vaults & Safes at this location: Identify as Vault o Safe Manufactue U.L. Rating Dual Combinations Used? SECTION #2: ALARMS Please povide details fo the alam systems at this location: Pemises: Specify # of Systems Alam Company Cental Station? U.L. Extent 2? U.L. Gade AA? Vaults & Safes: Specify Each Vault/Safe Alam Company Cental Station? U.L. Vault/Safe Complete? U.L. Gade AA? 7

8 Any peson who knowingly pesents a false o faudulent claim fo payment of a loss o benefit o knowingly pesents false infomation in an application fo insuance is guilty of a cime and may be subject to fines and confinement in pison. Applicant s Signatue: Date: ALASKA A peson who knowingly and with intent to injue, defaud, o deceive an insuance company files a claim containing false, incomplete, o misleading infomation may be posecuted unde state law. ARIZONA Fo you potection Aizona law equies the following statement to appea on this fom. Any peson who knowingly pesents a false o faudulent claim fo payment of a loss is subject to ciminal and civil penalties. ARKANSAS Any peson who knowingly pesents a false o faudulent claim fo payment of a loss o benefit o knowingly pesents false infomation in an application fo insuance is guilty of a cime and may be subject to fines and confinement in pison. CALIFORNIA Fo you potection, Califonia law equies that you be made awae of the following: Any peson who knowingly pesents false o faudulent claim fo the payment of a loss is guilty of a cime and may be subject to fines and confinement in state pison. COLORADO It is unlawful to knowingly povide false, incomplete, o misleading facts o infomation to an insuance company fo the pupose of defauding o attempting to defaud the company. Penalties may include impisonment, fines, denial of insuance, and civil damages. Any insuance company o agent of an insuance company who knowingly povides false, incomplete, o misleading facts o infomation to a policyholde o claimant fo the pupose of defauding o attempting to defaud the policyholde o claimant with egad to a settlement o awad payable fom insuance poceeds shall be epoted to the Coloado division of insuance within the depatment of egulatoy agencies. DISTRICT OF COLUMBIA WARNING: It is a cime to povide false, o misleading infomation to an insue fo the pupose of defauding the insue o any othe peson. Penalties include impisonment and/o fines. In addition, an insue may deny insuance benefits if false infomation mateially elated to a claim was povided by the applicant. HAWAII Fo you potection, Hawaii law equies you to be infomed that any peson who pesents a faudulent claim fo payment of a loss o benefit is guilty of a cime punishable by fines o impisonment, o both. IDAHO Any peson who knowingly, and with intent to defaud o deceive any insuance company, files a statement of claim containing any false, incomplete o misleading infomation is guilty of a felony. INDIANA Any peson who knowingly and with intent to defaud an insue files a statement of claim containing any false, incomplete, o misleading infomation commits a felony. LOUISIANA Any peson who knowingly pesents a false o faudulent claim fo payment of a loss o benefit o knowingly pesents false infomation in an application fo insuance is guilty of a cime and may be subject to fines and confinement in pison. MAINE It is a cime to knowingly povide false, incomplete o misleading infomation to an insuance company fo the pupose of defauding the company. Penalties may include impisonment, fines, o a denial of insuance benefits. MINNESOTA Any peson who files a claim with intent to defaud o helps commit a faud against an insue is guilty of a cime. NEW HAMPSHIRE Any peson who, with a pupose to injue, defaud o deceive any insuance company, files a statement of claim containing any false, incomplete o misleading infomation is subject to posecution and punishment fo insuance faud, as povided in RSA 638:20. NEW MEXICO Any peson who knowingly pesents a false o faudulent claim fo payment of a loss o benefit o knowingly pesents false infomation in an application fo insuance is guilty of a cime and may be subject to civil fines and ciminal penalties. NEW YORK Any peson who knowingly and with intent to defaud any insuance company o othe peson files an application fo insuance o statement of claim containing any mateially false infomation, o conceals fo the pupose of misleading, infomation concening any fact mateial theeto, commits a faudulent insuance act, which is a cime, and shall also be subject to a civil penalty not to exceed five thousand dollas and the stated value of the claim fo each such violation. OHIO Any peson who, with intent to defaud o knowing that he is facilitating a faud against an insue, submits an application o files a claim containing a false o deceptive statement is guilty of insuance faud. OKLAHOMA WARNING Any peson who knowingly, and with intent to injue, defaud o deceive any insue, makes any claim fo the poceeds of an insuance policy containing any false, incomplete o misleading infomation is guilty of a felony. OREGON Any peson who knowingly pesents a false o faudulent claim fo payment of a loss o benefit o knowingly pesents mateially false infomation in an application fo insuance may be guilty of a cime and may be subject to fines and confinement in pison. 8

9 PENNSYLVANIA Any peson who knowingly and with intent to defaud any insuance company o othe peson files an application fo insuance o statement of claim containing any mateially false infomation, o conceals fo the pupose of misleading, infomation concening any fact mateial theeto commits a faudulent insuance act, which is a cime and subjects such peson to ciminal and civil penalties. TENNESSEE It is a cime to knowingly povide false, incomplete o misleading infomation to an insuance company fo the pupose of defauding the company. Penalties include impisonment, fines and denial of insuance benefits. VIRGINIA It is a cime to knowingly povide false, incomplete o misleading infomation to an insuance company fo the pupose of defauding the company. Penalties include impisonment, fines and denial of insuance benefits. WASHINGTON It is a cime to knowingly povide false, incomplete, o misleading infomation to an insuance company fo the pupose of defauding the company. Penalties include impisonment, fines, and denial of insuance benefits. 9