Chubb Group of Insurance Companies. Supplemental Application Commercial Insurance for Museums and Cultural Institutions

Transcription

1 Chubb Group of Insurance Companies Supplemental Application Commercial Insurance for Museums and Cultural Institutions

2 Chubb Group of Insurance Companies 15 Mountain View Road, Warren, NJ SUPPLEMENTAL APPLICATION COMMERCIAL INSURANCE FOR MUSEUMS AND CULTURAL INSTITUTIONS Ownership Private Government Other (specify) Number of years in operation Number of annual visitors Type of museum or cultural institution: Aquarium Library Average Daily Circulation Arboretum/botanical garden Acreage Nature center Art museum Planetarium or observatory Children s museum Science museum Historical site Zoo Historical society Other (specify) History museum Source of funding indicate percentage(s): Admission fees Gift shops or catalogs Restaurants Licensing Government grants Corporate donations Private donations Permanent foundations or trusts Membership fees Rental of premises Other (specify) Are any locations subject to Historic Preservation Act, National Register status or other landmark regulations? Yes No If yes, which location(s)? COLLECTIONS INSURANCE VALUES AND UNDERWRITING INFORMATION Location Location Location #1 #2 #3 PERMANENT COLLECTIONS Limit of Insurance Deductible Total Values Average Value Per Item Maximum Value Per Item TEMPORARY COLLECTIONS* Limit of Insurance Deductible Total Values Average Value Per Item Maximum Value Per Item BAILEE LEGAL LIABILITY** Limit of Insurance Deductible Total Values * collections belonging to others on your premises for which you are required to provide insurance ** collections belonging to others on your premises for which you are not required to provide insurance Page 1 of 6

3 Location Location Location #1 #2 #3 Climate/environmental controls Yes No Yes No Yes No (Describe) History of flooding or water damage? Yes No Yes No Yes No (Describe) History of vandalism? Yes No Yes No Yes No (Describe) Temporary Collections Are written agreements obtained for all collections loaned to you? Yes No Do they specify responsibility for damage and insurance? Yes No Is valuation agreed-upon for total loss? Yes No Partial loss? Yes No Is the condition documented upon receipt? Yes No Photographs? Yes No Permanent Collections Is your owned collection fully inventoried? Yes No Date values were last updated? Do you have standard procedures for controlling infestation? Yes No COLLECTIONS AT ANY OTHER LOCATION Limit of Insurance $ Deductible $ What were your average values on the premises of warehouses, auctions, restorers, framers, etc., during the previous 12 months? $ Projected for the next 12 months? $ Please list major facilities you plan to use during the next 12 months and your projected maximum values exposed: Name and Address of Facility Projected Maximum Exposure Do you have standard procedures for verifying the protection against fire, theft, water damage, flood, environmental hazards and other perils at any temporary locations? Yes No Page 2 of 6

4 COLLECTIONS IN TRANSIT Limit of Insurance $ Deductible $ Who does shipping? owned vehicles % air % carriers % registered mail % Name(s) of carriers? What percent of value is declared to carriers for hire? % How are items packed? Who is responsible for packing and unpacking? Who is responsible for insurance? Are collections shipped outside the U.S.? Yes No (Note: separate Customarq Global Extension may be necessary) GENERAL LIABILITY LIMITS AND UNDERWRITING INFORMATION Total square footage Location Location Location #1 #2 #3 Number of annual visitors Annual Sales $ $ $ (Gift shops, mail order, restaurants, etc. specify source) $ $ $ Annual receipts $ $ $ (Rental, catering, licensing, travel $ $ $ programs, etc. specify source) $ $ $ Are there any pools, streams or ponds on your premises? Yes No Do you have facilities that involve physical participation such as playgrounds, climbing exhibits, petting zoos, train or boat rides, monorails? Yes No Do you have volunteer workers? Yes No Average daily number? Describe their activities Page 3 of 6

5 Do you have guards? Yes No Are the guards armed? Yes No Are they provided by an independent contractor? Yes No Are hold harmless agreements and certificates of insurance obtained from the contractor? Yes No Are the guards trained in legal requirements for arrest or detention? Yes No Do you have a written procedure for responding to visitor injuries? Yes No Are staff instructed on those procedures? Yes No Do you have any foreign locations/activities? Yes No Do you perform any conservation or restoration work for others? Yes No Do you have a gift shop or licensing of products? Yes No Is the shop operated by an independent contractor? Yes No Are hold harmless agreements and certificates of insurance obtained from the contractor and all suppliers or licensees? Yes No Do you sponsor, promote or organize travel or expeditions for members or the general public? Yes No Are any of these trips outside of the country? Yes No Are there independent contractors making arrangements? Yes No Do they provide hold harmless agreements and certificates of insurance? Yes No Do you own, lease or charter aircraft or watercraft with a crew? Yes No Do you have a restaurant or cafeteria? Yes No Is it operated by an independent contractor? Yes No Are hold harmless agreements and certificates of insurance obtained from the contractor? Yes No Do you rent premises to others for events such as parties, weddings? Yes No Is liquor served? Yes No Is catering provided? Yes No Are hold harmless agreements and certificates of insurance obtained from all lessees and suppliers? Yes No Do you publish any research, catalogues or promotional items? Yes No Page 4 of 6

6 Special Events Are any special events for fundraising or public education organized, promoted or sponsored by you? Yes No Date(s): Type(s): Are they on your premises? Yes No Are hold harmless agreements and certificates of insurance obtained from other sponsors, promoters or organizers? Yes No Do you plan any special exhibitions that would generate an unusually large number of visitors? Yes No Do you desire a quotation for Event Cancellation insurance for any special events or exhibitions? Yes No Dates: Where held: Types: Expenses budgeted: $ Participants: Revenues anticipated: $ Co-sponsors: INNOCENT MISREPRESENTATION COVERAGE Limit of Insurance $ Deductible $ Average number of items deaccessioned annually? Type of items deaccessioned: Do you have a written policy disallowing curatorial authentication of items not owned by the museum or cultural institution? Yes No Do you require a release and indemnification form from the recipient prior to providing any authentication services? Yes No Are authentication services provided only to an owner or the owner s agent? Yes No Do you provide any authentication services in connection with a part or prospective sale of the article? Yes No Do you conform to the American Association of Museums (AAM) code of ethics for curators? Yes No Have you had any disputes in the past five years involving appraisal or authentication? Yes No Current coverage $ Limit of Insurance $ Deductible $ Premium Carrier Note: Coverage is claims-made, and defense is included as part of the limit in those states where permitted by law. Page 5 of 6

7 Declaration and signature The undersigned declares that to the best of his or her knowledge and belief the statements and information in this application are true. The company is hereby authorized to make any investigation and inquiry in connection with the application it deems necessary. False information Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals information for the purpose of misleading, concerning any fact material thereto, commits a fraudulent insurance act, which is a crime. Date Applicant/Officer Title Date Producer Page 6 of 6

8 Chubb Group of Insurance Companies Warren, New Jersey Form (Ed )