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COMMERCIAL FINE ARTS POLICY - PROPOSAL FOR INSURANCE

 PLEASE ANSWER ALL QUESTIONS

Period of Policy Desired: From: To:



Section 1. - Details of Proposed Assured:

a. Name of Proposed Assured (state in full):
b. Our premises are located at:
c. We share our premises with:
d. Our usual business hours are:

e. We have carried on business since:

f. State all losses (insured or uninsured) during the past 5 years:

g. Has any insurer ever cancelled or refused to issue or continue any insurance for you?
If yes, give Company name and reason below:


Section 2. – Sums Insured required:

US$ On Stock at the proposers premises situated:
US$ On Stock at any other premises to be specified under the policy where items are normally stored or kept, situated:
US$ On Stock at any other location within the USA/Canada but excluding Exhibitions, Art Fairs and the like.
US$ On Stock whilst at Exhibitions, Art Fairs and the like within the USA/Canada.
US$ On stock whilst in transit, including personally conveyed, within the USA/Canada.
US$ On Stock whilst at Exhibitions, Art Fairs and the like outside of the USA/Canada anywhere Worldwide (subject to the territorial limit exclusions of the policy wording).
US$ On stock whilst in transit, including personally conveyed, outside of the USA/ Canada anywhere Worldwide (subject to the territorial limit exclusions of the policy wording).
US$ On Furniture and Fixtures, Improvements and Betterments.
US$ On the Assured’s Reference Library and other Reference Material belonging to the Assured which are not for sale or listed in the Assured’s Inventory.

Section 3. – Deductible(s) required:

US$ each and every loss in respect to Stock.
US$

each and every loss in respect to Furniture and Fixtures, Improvements and Betterments.


Section 4. – Exposures:

1. Inventory Values: On Stock at the proposers premises situated:
Total value of Stock* at the present time: US$
Percentage of consigned items: %
Percentage of stock which is fragile: %

*Stock to include items in trust or on commission or for which you are responsible.

2. Breakdown of Inventory Values:
Paintings, Drawings, Prints etc. %
Sculpture (Bronze, Metal, Wood). %
Sculpture (other media.) %
Furniture and the like. %
Porcelain or Fragile items. %
Other (please specify). %

3. Exposure away from Assured’s premises:
Annual volume of sendings within USA/Canada during last 12 months: US$
Annual volume of sendings outside of USA/Canada during last 12 months: US$
Exhibitions, Art Fairs and the like (list all with limit required at each): US$
Other (please state): US$

4. Carriers utilized for typical/general methods of shipments (please state):

5. Are professional packers employed for all shipments to/from destinations outside of the Town/City where Assured’s premises are located ?

YES/NO

Section 5. – Details of Premises and Protection:

Please competed this section for each location:
1. Premises:
Premises Construction:
Age:
Square Feet Area:
Floor Level:
Residential or Commercial area:

2. Protection:
Burglar Alarm with Central Station: Yes / No
Name of Company:
Burglar Alarm other:  Please specify full details.
Controlled Entry / Exit System: Yes / No
Fire Alarm: Yes / No
Heat / Smoke Detectors: Yes / No
Sprinkler System: Yes / No
Roll down gates: Yes / No
Other, please specify full details.

Section 6. – Additional Information:

1. WEB site address (please state):

2. State how Inventory Records are kept:
Computerized: %
Manual: %
3. Confirm whether a copy of the Inventory Records are kept off premises: YES / NO
4. The Basis of Valuation shall be as stated hereinafter:
a. Property owned by the Insured at the time of loss shall be valued at
b. Property on consignment to and/or entrusted to the Assured shall be valued at

c. Property owned on joint account shall be valued at such value as shown in the Assured’s Inventory.

d. Property actually sold, but not delivered or removed and/or while in transit to consignee’s or owner’s premises shall be valued at the selling price plus expenses, if any, which have accrued from date of sale.

e. Reference Library and Reference Material and Furniture and Fixtures, Improvements and betterments shall be valued at replacement cost.

5. Any other material fact (please state):

(N.B. a material fact is one that is likely to influence acceptance of this risk by Underwriters).


Signing this proposal and declaration does not bind the Proposer to complete the insurance, but it is agreed that this proposal and declaration shall constitute a warranty should it be issued.

Signature of Proposer: ________________________________________________________
Name: ________________________________________________________
Date: ________________________________________________________