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Municipal Entity Underwriting Application

8.

Does your entity have an accident investigation program in place?

Please explain.  

 Yes

 No

9.

Does the investigation document include description of cause of accident?

 Yes

 No

10.

Does your entity complete and distribute annual loss analysis to its management team?

 Yes

 No

11.

Does your entity allocate its losses back to the appropriate departments?

 Yes

 No

TERRORISM Information

A.PROPERTY

1.

Please list every location where that location's Total Insured Values (inclusive of ALL coverages, e.g. Business Interruption, Extra Expense, etc.) is GREATER THAN $50 Million.

Property Address

Description

TIV

% Of Total

B.CASUALTY

FOR ANY QUESTION ANSWERED yes, ADDITIONAL DETAILS & INFORMATION must be Provided

1.

Does your entity own or operate any Airports and/or Airline Companies (including flight schools)?

If yes, please complete a supplemental application.

 Yes

 No

2.       Is your entity's formal written disaster plan with record back-up reviewed annually?

 Yes

 No

3

Are disaster drills conducted annually?

 Yes

 No

4

Does your entity own or lease space in any Federal and/or State Government Buildings, and/or National Landmarks?

If yes, please provide details.  

 Yes

 No

5

Does your entity own or operate any Hospitals?

If yes, please provide details.  

 Yes

 No

6

Does your entity own or lease space in any Office Buildings greater than 25 stories in height?

If yes, please provide details.  

 Yes

 No

7

Does your entity own, lease, or operate/manage any Residential Buildings greater than 25 stories in height?

If yes, please provide details.  

 Yes

 No

8

Does your entity own, lease or operate any Stadiums with seating capacities greater than

        15,000?    If yes, provide details in stadium section.

 Yes

 No

9

Does your entity have any Bridges greater than 300 feet I length?

If yes, please complete supplemental.

 Yes

 No

10

Does your entity own, lease or operate any Convention Center / Exhibition Centers with fire code capacities greater than 3,000. persons?

If yes, please complete supplemental application.

 Yes

 No

11

Does your entity own, lease or operate any Dams greater than 300 feet in length or 25 feet in height with down stream exposures which include cities where the population is 10,000 or greater?

If yes, please provide details.

 Yes

 No

2 of 3410/23/2007

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