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Municipal Entity Underwriting Application

FIRE DEPARTMENT

1.

Number Paid Professionals

2.

Number Volunteers

3.

Annual Calls - Emergency

4.

Annual Calls - Non-Emergency

5.

What kind of training is required?  

6.

Are all emergency vehicle operators given special training?

 Yes

 No

7.

Are designated drivers used?

 Yes

 No

8.

What is the department policy as to entering intersections against red lights, stop signs or yield signs?  

9.

Is the department a party to any contractual agreements? ( mutual aid or private service contracts)

 Yes

 No

10.

Are physical examinations required before admission to the department?

 Yes

 No

11.

Once hired are annual physicals required?

 Yes

 No

12.

Is any unusually hazardous occupancy located in the service area?

 Yes

 No

MISCELLANEOUS EXPOSURES

1.

Are there any dams, levee or dike exposures?

If yes, please complete a supplemental questionnaire

 Yes

 No

2.

Are there any penal institutions or jail exposures?

If yes, please complete a supplemental questionnaire.

 Yes

 No

3.

Are there any stadiums operated by the insured?

If yes, please provide receipts and seating capacity.                                                                                                 

 Yes

 No

Sexual Abuse & Molestation Coverage

Claims-Made Coverage:  Retro Date  - Occurrence Coverage

n/a

General Information

Expiring Information

Renewal Information

Premium

18 of 3410/23/2007

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