CONTRACTORS’ EQUIPMENT INSURANCE APPLICATION

Applicant’s Name (Legal and Operating):	Broker:
Principal’s Name:	How Long in Business:
Principal Business Address:	Normal territory where work is performed:
Business of Applicant (Describe use of equipment to be insured):
Coverage Desired: Named Perils: All Risk:	Deductible Amount Desired:
Policy Period: to (12:01 AM)

Is loss payable clause necessary? Yes, No If yes, to whom payable:

Description of Property to be Insured:
Item	Description	Manufacturer & Serial #	Amount
Total:

Catastrophe Limit Required:

Do you lease, or contemplate leasing equipment? Yes, No If yes, provide details:

List of Storage and Repair Locations
Maximum Value ($)
Location	Construction & Occupancy	In building	In Yard
Loss and Policy History
Yes, No Previous claims in the last 5 years? Yes, No Describe:
Previous Insurer:	Policy #:
Has any insurer cancelled, declined, or refused to renew Commercial Insurance in the past 5 years? Yes, No
Supporting business: Policy #:	Company:

Signature:	Date: