Protective Services Liability Insurance Quote

 Protective Services Liability Insurance Quote
Business Name 
Contact Person Name *
Phone *
Email *
Principal(s) 
Subsidiaries, Partners and Joint Ventures: 
Mailing Address Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Website Address 
Applicant is: IndividualPartnershipCorporationJoint VentureOther
# of Years in Business: 
# of Years Experience: 
If new operation/company, describe work experience of the principals: 
Limit of Liability required: $1,000,000$2,000,000$5,000,000Other
Deductible: $1,000$2,500$5,000Other
Additional Coverage (A separate application is required for each coverage listed below)
Do you require Employee Dishonesty? YesNoOther
Do you require a Provincial Licensing Bond? YesNoOther
Do you require Property coverage? YesNoOther
Provide details of all liability insurance carried: 
Is renewal being offered? YesNo
If no explain: 
List current memberships in Security or Trade Associations: 
If yes, provide the insurer and reason given 
Has any insurer declined, cancelled or non - renewed any similar insurance in the past 5 years? YesNo
LIABILITY INFORMATION (Operations):
List locations and occupations: Address 
Owned/Rented 
Square Footage: 
% occupied by Applicant: 
Replacement Cost of Rented Portion 
Is Tenants Legal Liability required? YesNo
If Yes, state limits required for each location 
For the preceding 12 month period, what was your ACTUAL Revenue $ 
and ACTUAL payroll $ 
ESTIMATE your revenue and Payroll for the next 12 month period and fill in the appropriate categories below: If your Estimated Revenue differs great from your Actual Revenue, please provide reason for expected increase or decrease in Revenue:
Security Guard Service–Static type-Estimated annual sales or revenue, Estimated annual payroll, Actual number of employees 
Security Guard–Alarm Response-Estimated annual sales or revenue, Estimated annual payroll, Actual number of employees 
Special Events Security Concerts & Sporting Events) including Dogs with Handlers-Estimated annual sales or revenue, Estimated annual payroll, Actual number of employees: 
Armed Guards-Estimated annual sales or revenue, estimated annual payroll, Actual number of employees: 
Retail Store Security-Estimated annual sales or revenue, Estimated annual payroll, Actual number of employees: 
Telephone Answering including Paging-Estimated annual sales or revenue, Estimated annual payroll, Actual number of employees: 
Private Investigator-Estimated annual sales or revenue, Estimated annual payroll, Actual number of employees: 
Alarm Monitoring-Estimated annual sales or revenue, Estimated annual payroll, Actual number of employees: 
Fire & Burglary Alarm Sales & Service-Estimated annual sales or revenue, Estimated annual payroll, Actual number of employees: 
Fire Extinguishing Equipment excluding Sprinklers-Estimated annual sales or revenue, Estimated annual payroll, Actual number of employees: 
Sprinkler Systems-Estimated annual sales or revenue, Estimated annual payroll, Actual number of employees: 
Central Vac, Intercom & Audio Systems-Estimated annual sales or revenue, Estimated annual payroll, Actual number of employees: 
Locksmiths, Door Locks & Hardward-Estimated annual sales or revenue, Estimated annual payroll, Actual number of employees: 
Electrical Wiring, CCTV & Home Automation, Electronic Card Access-Estimated annual sales or revenue, Estimated annual payroll, Actual number of employees: 
mber of Employees by position: Management Supervisors Accredited workers Clerical/others 
Are all employees covered by Worker's Compensation? YesNo
Are all products U.L.C. approved or similar? YesNo
00% of the products used in your installations are from Canadian and/or USA manufacture? YesNo
If no, provide detailed split between different types of occupation/ number of employees/ payroll 
If no, please advise the following
a) List of products which are purchased from foreign manufacture. 
b)Which countries are products in a) manufactured in? 
Are foreign products purchased directly from the manufacturers, OR from a local distributor? 
d) Percentage of total products purchased from foreign manufacturers? 
e) Do you alter the products in any way, before installation? YesNo
f) Do you re-label the products? YesNo
Do you provide any services at Airports? YesNo
If yes, Revenue $ 
Describe services provide at Airports: 
If you or your employees drive vehicles for business that are NOT Owned or Leased in the Company Name, please provide
Highest value $ 
No. of vehicles: 
Total estimated number of day: 
Do you have any U.S. sales? YesNo
If yes, please indicate how much 
If U.S. Sales & Operations, which products or services? 
Do you sublet work? YesNo
If yes, please indicate annual gross cost $ 
Describe work sublet 
Do you secure Liability Certificates from sub-contractors? YesNo
Limit required: $ 
Are hold harmless agreements in favor of your company in place from supplier? YesNo
Do you ever act as a subcontractor? YesNo
If yes, are these projects insured separately under a wrap up? YesNo
If yes, estimated annual revenue? $ 
The completion of this form is for quote purpose and does not provide any insurance coverage. We may require more information in order to provide a quote. This quote request contains some information about coverage offered but it does not contain all
 
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