Producer Information Agency Name: Agency Address: Agency Phone: Contact Person and Phone #: Contact E-Mail: Is Agency appointed with any of the Zurich or The Maryland Companies? Yes: No: If yes, provide the numbers: If not, provide a copy of agent's license with your submission If you want to learn more about the compensation Zurich pays agents and brokers visit: http://www.zurichnaproducercompensation.com or call the following toll-free number: (866) 903-1192. This Notice is provided on behalf of Zurich American Insurance Company and its underwriting subsidiaries Please Provide the Following A. Complete ACORD applications for each line of coverage. B. Hard copy loss Information for the past 3 years plus current, 5 years preferred. C. Liquor liability application if coverage is requested. D. Current audited financial statement if available, mandatory for accounts of $350,000 or more. Name and address of Hotel: # of years in operation: Franchised? Yes No Which Franchise? Average Annual Occupancy Rate: % # of Guest Rooms: Average Room Rate: $ # of employees: If you want to learn more about the compensation Zurich pays agents and brokers visit: http://www.zurichnaproducercompensation.com or call the following toll-free number: (866) 903-1192. This Notice is provided on behalf of Zurich American Insurance Company and its underwriting subsidiaries ZAS - Hotel Page 1 of 9
AMENITIES PROVIDED FOR GUESTS ( AND/OR NUMBER) # or N Height Swimming Pools Diving Boards Water Slides Hot tub Spa/Health club List all spa amenities Tanning beds Exercise Room Playground Racquet Sports Golf Lake or Seaside Activities Water Parks Other activities (circle all that apply): Para-sailing, snowmobiles, white water rafting, snorkeling, scuba driving, renting motorboats, jet skiing, water skiing, cross country snow skiing, down hill skiing, hot air balloon rides, helicopter rides, other? Open to hotel guests only? Access to facilities/pool secured? List those activities owned and operated by the hotel. OTHER GUEST AMENITIES () Restaurant Bar/Lounge Facilities Drugstore/Gift Shop Beauty/Barber Shop Laundry/Dry Cleaning Child Care Video Arcade Pets Allowed Are certificates of insurance obtained from independently owned amenities? Are these facilities open to hotel guests only? ZAS - Hotel Page 2 of 9
FIRE PROTECTION Hallways and common areas Guest rooms sprinklered? sprinklered? Smoke detectors in hallways? Smoke detectors in rooms? - Hard-Wired? - Hard-Wired? - Battery Powered - Battery Powered Portable fire extinguishers? Central station hook-up of sprinkler alarm system? Is the building wired with a "pull" fire alarm system? - In hallways? - In common areas? Is there a central station hook-up for the fire alarm system? Other than elevators, are there at least two means of egress from each floor? - Is there an anunciator system to notify guests of an emergency? - Is there somebody at the front desk at all times? Are flammable liquids stored properly in appropriate containers and not close to sources of ignition? Are there guest rooms with kitchens or kitchen appliances? - Type of cooking appliances provided - gas, electric, microwave (circle all that apply) - Are there fire extinguishers in rooms that provide cooking appliances? - Is there a preventative maintenance schedule for cooking and refrigeration equipment? Do electrical amenities for guests, such as irons, hair dryers, and coffee makers, have automatic shutdown safety features? LIFE SAFETY Are employees trained in safety/evacuation procedures in the event of fire or other emergencies? Are evacuation procedures and floor plans posted in all: - Guest rooms - Meeting rooms - Public areas Are there illuminated fire exits? Is emergency lighting located in all rooms, hallways and common areas? Does the building have central heating and cooling systems? - If yes, are there ventilation dampers to prevent the spread of smoke? Bathrooms - Are bathrooms designed to minimize slip, trip, or falls in the shower or tub, or getting into or out of the shower or tub? - Are rooms with bathroom hand rails, non-slip services, and easy access available? Do the guest rooms have balconies? - Do the vertical balcony railings have an opening no greater than 4"? If facility accommodates conventions, trade shows, or exhibitions, are proper procedures followed in setting up exhibits with exits adequate to facilitate evacuation of capacity crowds when the exhibit hall is filled? CONDITION OF BUILDING ZAS - Hotel Page 3 of 9
Age of Building? If building over 15 years old, year of renovation and/or inspection by certified contractors for: - Plumbing - Heating/cooling - Electrical systems - Safety systems What type of roof? (In Comments include type of materials, age, physical condition, year of updating, and maintenance inspection program.) What is the construction of the building? - Any EIFS (Exterior Insulation Finish Systems) aka Dryvit, Synthetic Stucco, Surewall, Hardi Plank Are there any renovations planned? - If yes, please list SECURITY Are all guest rooms accessed by interior entry only? If no, explain in Comments. Include percentage of exposures with exterior building access. Are security guards on premises? - Employed or contracted (Circle one) - If employed, are criminal background checks required? - If contracted, is a Certificate of Insurance provided? - If contracted, are hold harmless agreements obtained? Is surveillance sufficient to deter vandalism? Is entry to all guest rooms done by electronic key cards? If no, explain in Comments. Include percentage of exposures with key locks. Are keyless lock systems programmed to change room access codes frequently? In the event of lost or misplaced keys, are door locks and keys replaced? If a guest loses a key or key card, what procedure is followed for the guest to receive a replacement? Do guest rooms have: - Deadbolt locks? - Night locks or door chain guards? - Eye holes? Explain procedures for releasing guest room numbers or key cards: Does Housekeeping avoid having guests' names or room numbers on housekeeping carts? Are perimeter doors accessible only by key cards, 24 hours a day? If no, explain in Comments. Are common areas - Secured? - Monitored? - Adequately lighted? Do any areas require unusual or heavy security precautions? Explain in Comments. ZAS - Hotel Page 4 of 9
Hotel and Restaurant Supplemental Application CRIME PREVENTION Are pre-employment checks made on all hires? Are criminal background checks made on employees who work at the front desk and on employees handling checks or cash? If facility does not have 100% interior guest room access and locked exterior doors at night, does it avoid having a sole front desk clerk during evening and early morning hours? Is the amount of cash kept on hand limited by having daily pickup or deposits of cash and receipts? Are all checks received marked "for deposit only" and countersigned? For limits in excess of $100,000, is a Fidelity application requested at least every other year? Are cash registers/drawers in view of patrons and/or employees? Are there provisions to securely store guests' valuables at their request? Are fine arts and business personal property secured, with attention given to mitigate theft? Is there a system for reporting on-premises claims and incidents affecting guests to management, including any incident involving police or security personnel? ZAS - Hotel Page 5 of 9
POOL SAFETY For each swimming pool: - Indoor or outdoor (circle or if completing electronically highlight in bold) - Maximum depth - Height of diving board (should be less than 3 meters) - Slide present?* - Pool rules and warning signs posted? - Lifeguard hours posted? - Depth clearly marked? Do pools have multiple drains to reduce suction pressure? Do drains have approved filter covers? Does pool have anti-vortex drain? Is there a telephone in the pool area? Are doors and gates locked when pool is closed? For outside pools, is there a proper fence and self-locking gate? Pool water: - How often checked and tested? - Who does the testing? - If done by independent contractor, is a Certificate of Insurance obtained? Is alcohol served in the pool area? Are there anti-skid surfaces around "wet areas"? Where are the pool chemicals stored? Is the pool open to the public or guests only? * RESTAURANT Is the restaurant in the same fire division as the guest rooms? What are hours of operation? Do all cooking surfaces and deep fat fryers have an exhaust hood equipped with filters, a grease trap, and an automatic extinguishing system? - Name of system: - Date of last inspection: - Frequency of maintenance: - Frequency of filter cleaning: - Is cleaning of all other components weekly with semi-annual professional cleaning? - Are there automatic shut off valves to shut off fuel when temperature limits are exceeded? - Is there a manual release located in path of exit from cooking area? Is there a preventative maintenance schedule for cooking and refrigeration equipment? Is refuse contained in a covered, metal container located outside and away from the building? Are combustibles kept clear of the refrigeration equipment? Are guidelines in place for: - Proper support of infant seats/carriers? - Use of children s highchairs? Do guidelines prohibit use of highchairs to support infant seats/carriers? LOUNGE/BAR ZAS - Hotel Page 6 of 9
Is there a lounge/bar in conjunction with the restaurant? Is there a lounge/bar in conjunction with the hotel? Is there live entertainment? Is there a dance floor? Is there a happy hour? Are the bartenders and wait staff trained in Alcohol Awareness? What training program is used? Are there written procedures for: - Obtaining proof of age from young patrons? - Avoiding selling liquor to intoxicated persons? Is there a complementary cocktail hour? - What is served? - How long is the complementary cocktail hour? What are the hours of operation? OTHER STRUCTURES, EQUIPMENT, AND MATERIALS Are there structures other than the main building with exposure to property perils, such as cabanas, docks, piers, dams, bridges, or tents? Are chemicals for pools, lawns, and the golf course kept in separate sealed containers, following labeled storage instructions, and locked in a storage facility? Do washer and dryer units have automatic shutdown safety features? Are dryer units routinely inspected so that lint traps are kept clean and ventilation tubing does not have excess buildup of trapped lint? Are phone, fax, and cash register equipment protected against electrical surge or lightning loss? Does the hotel furnish or sell products/toiletries, etc. under their own label? Beaches, lake exposures, or water-park type activities? - Supervised by lifeguards? - Warning signs posted? - Lifeguard hours posted? Golf carts? - Clearly marked cart paths? - Waivers signed by cart renter to hold management harmless for negligence of operator? - Limited to persons over 17 years old? Bicycles made available to guests? - Written bicycle maintenance program? - Helmets provided to each guest with helmets meeting standards? - Waivers signed by each rider and by parents for children under 18 years old? Health club facilities? - For guests only? - Nautilus type machines? - Free standing or bar bell weights? - Tanning booth? Is proper certification and training documented for: - Life guards? - Health club trainers? - Masseurs? Do playgrounds have cushion surfaces of sand or wood chips at least 6 inches thick under all equipment or thick rubber mats designed for playgrounds? ZAS - Hotel Page 7 of 9
Children's programs: - Are run by employees who are properly trained and state certified? - Employees have procedures manual? Housekeeping and maintenance staff: - OSHA requirements met? - Pre- or post-physical examinations required? - Documented training for blood-born pathogens for housekeeping staff? - Outside contractors who do maintenance have Certificates of Insurance? In areas of the country where there are hazards from snow and ice, is there a snow and ice removal plan for parking lots and building entrances? AUTOMOBILE Is transportation of guests provided? If yes, is this done by: - Hotel staff? - Independent contractor? - Is a Certificate of Insurance obtained from independent contractor? - Does Certificate of Insurance have limits for at least $1,000,000? If the transportation is provided by the hotel: - Vehicle maintenance program with documented schedule of maintenance on file? - Is there dedicated staff for the driving? - Driver profiles and MVRs obtained for all drivers? - Explain in Comments the driver selection process. Are driver profiles and MVRs obtained for all possible drivers of personal automobiles for business use? Does the facility provide limousine service for a charge? If tour bus service is provided by outside contractor: - Is a Certificate of Insurance obtained from independent contractor? - Does Certificate of Insurance show liability limits of at least $1,000,000? Are facility parking areas: - Secured? - Monitored? - Well-lighted? Is there valet parking for guests? - Explain key control for valet parking in Comments section. - For valet parking, is there an inspection of vehicle before taking possession and all damages noted on valet ticket? - Are MVRs and background checks required of all valet parking attendants? If there is no valet parking, explain guest parking facilities in Comments. For parking services contracted out: - Is a Certificate of Insurance obtained from independent contractor? - Does Certificate of Insurance show liability limits of at least $1,000,000? * ZAS - Hotel Page 8 of 9
WORKERS COMPENSATION Does the Insured have any material handling safety programs available. For example, many back strains are caused by the lack of an adequate mattress turning procedure. Does the Insured have material handling safety training addressing issues such as this? (if applicable) Do Insured's employees perform the following functions: Landscaping: Premises Maintenance: Snow Removal: Pesticide/Herbicide Application: What is Turnover (number of positions vs. number of W2's filed for the last year? Does Insured have a pre-employment drug testing program in place? Are pre-employment physicals required? Is a blood borne pathogen safety program in place? Is front desk employee ever the only employee on premises? Describe any hazardous substances used by employees and any handling and storage procedures in place. Which of the following does the Insured have in place: Safety Organization Emergency Planning Loss investigation/incident reporting procedures Problem identification/self Inspection procedures Corrective Action Follow up procedures Selection/Training and Placement procedures for employees New employee orientation program Workforce Stability Measures ( for example, methods to improve morale) Supervisory training Rule Enforcement procedures Does the Insured have one person responsible for filing WC claims with the Insurance Company? On average, how many days after an injury does a claim get reported to the Insurance Company? Does the insured use preferred providers and encourage injured employees to access those medical providers who participate in the preferred provider program? Does Insured have a return to work program? ZAS - Hotel Page 9 of 9