Embedded Property Coverages



ACE AGRIBUSINESS SUPPLEMENTAL UNDERWRITING APPLICATIONPRODUCER: APPLICANT: I. PROPERTY, CRIME & INLAND MARINE FORMCHECKBOX Change Limits and/or Deductibles for Property Coverages Found in Form AG 0100Standard Deductible is $1,000. Other options include: $0, $100, $250, $500, $2,500, $5,000, $10,000, $25,000 & $50,000.For deductibles greater than $50,000, contact your Underwriter.CoverageStandard LimitChangeLimit ToChange Deductible ToAdditional Debris Removal$10,000$NAEmergency Removal Expense$10,000$NAFire Department Service Charges$10,000$NAInventory and Appraisals Expense$5,000$NAPollutant Clean Up and Removal$10,000$$Recharge of Fire Protection Equipment$10,000$NAFraud or Deceit Coverage$50,000$$Newly Acquired Computers$50,000$$Newly Acquired or Constructed Buildings$250,000$$Newly Acquired Mobile Equipment$100,000$$Personal Effects$10,000$$Personal Property – Acquired Locations$250,000$$Property Away From a Covered Location$100,000$$Stock – Acquired Locations$250,000$$Trees, Shrubs, Plants and Lawns$2,500$$Accounts Receivable$5,000$$Brands or Labels Expense $5,000$$Carrier Liability$5,000$$Fine Arts, Furs, Guns, Jewelry and Metals$5,000$$Loss of Use of Dwelling$5,000$$Ordinance or Law – Increased Costs $10,000$$Overseas Transit and Location. $5,000$$Property in Transit $10,000$$Property on Exhibition $10,000$$Property Sold Under Installment Sales Plan $5,000$$Sales Representative Samples$10,000$$Sewer Back Up and Water Below the Surface $1,000$$Spoilage $5,000$$Surface Water Run-Off $5,000$$Tank Leakage$5,000$$Utility Services Interruption $5,000$$Valuable Paper and Records – Cost of Research $5,000$$Watercraft – Physical Damage $5,000$$Wrongful Delivery of Liquid Property$5,000$$ FORMCHECKBOX Keytrol Fraud FORMCHECKBOX Waiver of Deductible - Commodities Limit of Insurance: $Number of Locations: I. PROPERTY, CRIME & INLAND MARINE (continued) FORMCHECKBOX Inflation Protection%Add’l. Options: FORMCHECKBOX 0% FORMCHECKBOX 2% FORMCHECKBOX 4% FORMCHECKBOX 6% FORMCHECKBOX 8%Applicable Location(s):1. 2. 3. FORMCHECKBOX Equipment Breakdown Coverage - Select Deductible FORMCHECKBOX $500 FORMCHECKBOX $1,000 FORMCHECKBOX $10,000 FORMCHECKBOX $2,500 FORMCHECKBOX $5,000 FORMCHECKBOX $10,000 FORMCHECKBOX $15,000 FORMCHECKBOX $20,000 FORMCHECKBOX $25,000 FORMCHECKBOX $5,000 FORMCHECKBOX $75,000 FORMCHECKBOX $150,000 FORMCHECKBOX $175,,000 FORMCHECKBOX $150,000 FORMCHECKBOX $200,000 FORMCHECKBOX $200,000 FORMCHECKBOX Wind & Hail Deductible$ Applicable Location(s):1. 2. 3. FORMCHECKBOX EarthquakeCovered LocationCovered PropertyDeductibleLimitMasonry Veneer Covered?1$ FORMCHECKBOX Yes FORMCHECKBOX No2$ FORMCHECKBOX Yes FORMCHECKBOX No3$ FORMCHECKBOX Yes FORMCHECKBOX No4$ FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Business IncomeCovered LocationLimitCoinsuranceMaximum Period of IndemnityMonthly Limit1$%2$%3$%4$% FORMCHECKBOX Optional Exclusions – Identify Location and Indicate Applicable Cause(s) of Loss ExclusionLocationSprinkler LeakageVandalismWater DamageWind or HailTheftCollapseConsequential Water Loss1 FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 2 FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 3 FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 4 FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Hay, Straw and Fodder CoverageLocationLocation LimitLimit That Applies In Any One Stack, Rick, Pile or Pit or in Any One BuildingDeductibleCoinsurance1$$$%2$$$%3$$$%4$$$%I. PROPERTY, CRIME & INLAND MARINE (continued) FORMCHECKBOX Change Limits for Income Coverages Found in Form AG 0100Income CoverageStandard LimitChanged Limit(IC) Newly Acquired Locations - [If Earnings & Extra Expense coverage selected]$100,000(IC) Newly Acquired Locations - [If Extra Expense Only coverage selected]$50,000(IC) Contract Penalty$10,000NA(IC) Public Health ShutdownNone(IC) Property in Transit &/or Exhibition None(IC) Utility Service Interruption None FORMCHECKBOX Mortgaged or Stolen GrainCommodityTransaction LimitAggregate LimitAnnual Purchase LimitGrain$$$All Other$$$II. LIABILITYDescription ClassExposure FORMCHECKBOX Agri Building or Premises – Lessors' Risk Only – NOCSq Ft Area = FORMCHECKBOX Agri Operations - NOC - Sales Premium Basis 29902Sales = $ FORMCHECKBOX Anhydrous Ammonia Dealers & Distributors – Including Application of Anhydrous Ammonia 10036Sales = $ FORMCHECKBOX Antique Stores 10026Sales = $ FORMCHECKBOX Auto Parts and Supplies Stores10071Sales = $ FORMCHECKBOX Auto Repair or Service Shops 10073Sales = $ FORMCHECKBOX Bird Seed Merchant 25013Sales = $ FORMCHECKBOX Boats - Canoes or Rowboats - Not For Rent Not Equipped With Motors 40111Units = FORMCHECKBOX Boats - Motor or Sail - Not For Rent 40115Units = FORMCHECKBOX Brokered Feed Sales - Not Physically Handled or Stored By Insured 29003Sales = $ FORMCHECKBOX Brokered Fertilizer Sales – Not Physically Handled or Stored By Insured 29002Sales = $ FORMCHECKBOX Brokered Grain Sales - Not Physically Handled or Stored By Insured 29004Payroll = $ FORMCHECKBOX Brokered Pesticides Sales - Not Physically Handled or Stored By Insured29005Sales = $ FORMCHECKBOX Building Material Dealers 10255Sales = $ FORMCHECKBOX Building Material Distributors 10257Sales = $ FORMCHECKBOX Building or Premises – Lessors Risk Only 61212Sq Ft Area = FORMCHECKBOX Building or Premises - Office – NOC 61226Sq Ft Area = FORMCHECKBOX Building or Premises - Office - Premises Occupied By Employees of the Insured61224Sq Ft Area = FORMCHECKBOX Cattle or Hog Raising or Production Operations - No Feed Lots - Including 1 Residence and Not More Than 160 Acres20007Units = FORMCHECKBOX Chemical Distributors – Pesticides 21001Sales = $ FORMCHECKBOX Chemicals - Pesticides - Retail In Metal Containers or Unopened Packages - Manufactured or Blended By Others21002Sales = $ FORMCHECKBOX Chicken Catching, Cooping, Loading and Transporting - Including Supervisor 25001Sales = $ FORMCHECKBOX Contractors-Subcontracted Work - In Connection With Building Construction – 1 or 2 Family Dwellings 91583Total Cost = $ FORMCHECKBOX Cotton Batting, Wadding or Waste Manufacturing 51982Sales = $ FORMCHECKBOX Cotton Compressing 51985Sales = $ FORMCHECKBOX Cotton Gin Operations 51986Sales = $ FORMCHECKBOX Cotton Gin Operations – Other Than Those Performed for a Fee Per Bale 41679 Bales = FORMCHECKBOX Cotton or Wool Merchants 11248Sales = $ FORMCHECKBOX Dairy Products Manufacturing 52002Sales = $ FORMCHECKBOX Distributors - Food or Drink – NOC 12361Sales = $ FORMCHECKBOX Distributors - No Food or Drink – NOC 12362Sales = $ FORMCHECKBOX Drug, Medicine or Pharmaceutical Preparations Manufacturing - For Animal Use52343Sales = $ FORMCHECKBOX Dry or Liquid Fertilizer - Sale Storage Or Distribution 25002Sales = $ FORMCHECKBOX Dwellings - Lessors' Risk Only FORMCHECKBOX One Family 63010 FORMCHECKBOX Two Family 63011 FORMCHECKBOX Three Family 63012 FORMCHECKBOX Four Family 63013Units = FORMCHECKBOX Edible Bean Plant Operations 21007Sales = $ FORMCHECKBOX Egg Dealers - Including Grading, Candling and Packing – Wholesale 25003Sales = $ FORMCHECKBOX Farms - No Residence - Acreage FORMCHECKBOX = 160 Acres or Less 20001 FORMCHECKBOX = 161 To 500 Acres 20002 FORMCHECKBOX = Over 500 Acres - Grazing Away From Insured's Premises To Be Separately Rated 20003 Units = FORMCHECKBOX Farms - With One Family Residence FORMCHECKBOX Acreage Not More Than 160 Acres 20004 FORMCHECKBOX Acreage 161 To 500 Acres 20005 FORMCHECKBOX Acreage Over 500 Acres 20006Units = FORMCHECKBOX Feed Grinders - Portable - Not Self-Propelled - Loaned or Rented To Others 21003 Units = FORMCHECKBOX Feed Lots - Cattle – Hogs- Not Operating Farms or Ranches or Engaged In Butchering or Packing House Operations 24004Sales = $ FORMCHECKBOX Feed Manufacturing - Ground Hay or Grain Only 25008Sales = $ FORMCHECKBOX Feed Manufacturing - Pet Food To Be Separately Rated – NOC 25014Sales = $ FORMCHECKBOX Feed Manufacturing - Ruminant Dairy Animal Feed Only 25009Sales = $ FORMCHECKBOX Feed, Grain or Hay Dealers - Grain Elevator or Feed Mill Operations To Be Separately Rated 12583Sales = $ FORMCHECKBOX Fertilizer Applicators, Spreaders or Nurse Tanks - Not Self-Propelled - Loaned or Rented To Others Without Operators 21004 Units = FORMCHECKBOX Fertilizer Dealers and Distributors - Including Application of Fertilizer and Pesticides To Be Separately Rated 12683Sales = $ FORMCHECKBOX Fertilizer Manufacturing - Including Dry Mixing Plants – NOC 53077Sales = $ FORMCHECKBOX Fishing Ponds or Lakes - Commercially Operated 43760Sales = $ FORMCHECKBOX Food Products Manufacturing FORMCHECKBOX Dry 53374 FORMCHECKBOX Frozen 53375Sales = $ FORMCHECKBOX Fruit or Vegetable Distributors 13112Sales = $ FORMCHECKBOX Fuel Dealers or Distributors - Coal or Wood 13201Sales = $ FORMCHECKBOX Fuel Oil or Kerosene Dealers 13204 Gallons = FORMCHECKBOX Furniture Manufacturing or Assembling - Other Than Wood 53732 Gallons = FORMCHECKBOX Gas Dealers – LPG 13410 Gallons = FORMCHECKBOX Gas Dealers or Distributors – NOC 13411 Gallons = FORMCHECKBOX Gas Stations - Full Service13453 Gallons = FORMCHECKBOX Gas Stations - Self-Service 13454 Gallons = FORMCHECKBOX Gasoline Distributors 53907 Gallons = FORMCHECKBOX Gasoline or Oil Supply Stations - Retail - Lessors' Risk Only 44009Sales = $ FORMCHECKBOX Grain Commission Operations 24003Sales = $ FORMCHECKBOX Grain Elevator Operations - Including Payroll of Local Managers 29001Payroll = $ FORMCHECKBOX Grain Milling - Preparation of Animal Feed To Be Separately Rated 21006Sales = $ FORMCHECKBOX Grocery Distributors 13670Sales = $ FORMCHECKBOX Grocery Stores13673Sales = $ FORMCHECKBOX Hardware Stores 13716Sales = $ FORMCHECKBOX Hatcheries - No Farming Operations25004Sales = $ FORMCHECKBOX Hoists - Hydraulic or Mechanical - For Dumping Materials From Trucks 24001 Units = FORMCHECKBOX House Furnishings Installation 96053Payroll = $ FORMCHECKBOX Land - Occupied By Persons Other Than the Insured For Business Purposes - Lessors' Risk Only45539 Acres = FORMCHECKBOX Landscape Gardening 97047Payroll = $ FORMCHECKBOX Livestock Dealers Sales or Commission Merchants 21011Sales = $ FORMCHECKBOX Livestock Sales Companies 24006Sales = $ FORMCHECKBOX Machinery or Equipment - Farm - Installation, Servicing, Repair or Erection 97221Payroll = $ FORMCHECKBOX Machinery or Equipment - Installation, Servicing or Repair – NOC 97223Payroll = $ FORMCHECKBOX Machinery or Equipment Dealers - Farm Type - Leasing, Renting or Loaning of Equipment To Be Separately Rated 15061Sales = $ FORMCHECKBOX Machinery or Equipment Dealers - Yard or Garden Type 15063Sales = $ FORMCHECKBOX Mail Order Houses 45901Sales = $ FORMCHECKBOX Manufacturers – NOC 54444Sales = $ FORMCHECKBOX Manufacturing Representatives45993Sales = $ FORMCHECKBOX Meat, Fish or Seafood Processing56760Sales = $ FORMCHECKBOX Meat, Fish or Seafood – Curing 56758Sales = $ FORMCHECKBOX Meat, Fish, Poultry or Seafood Distributors 15223Sales = $ FORMCHECKBOX Meat, Fish, Poultry or Seafood Stores 15224Sales = $ FORMCHECKBOX Milk Processing 57002Sales = $ FORMCHECKBOX Mobile Home Parks or Courts 46202Sales = $ FORMCHECKBOX Orchards and Vineyards 98257Payroll = $ FORMCHECKBOX Packing Houses 57651Sales = $ FORMCHECKBOX Pet Food Manufacturing - Feed Manufacturing To Be Separately Rated 25015Sales = $ FORMCHECKBOX Plastic or Rubber Supply Goods Distributors 16501Sales = $ FORMCHECKBOX Poultry or Egg Producers - Including Grading, Candling and Packing - No Farming Operations 25005Sales = $ FORMCHECKBOX Poultry Processing - In Airtight Containers 25006Sales = $ FORMCHECKBOX Poultry Processing - Not In Airtight Containers 25007Sales = $ FORMCHECKBOX Produce Handling or Packing 16604Sales = $ FORMCHECKBOX Recreational Vehicle Dealers 16694Sales = $ FORMCHECKBOX Rendering Works 58682Sales = $ FORMCHECKBOX Rental Stores 16722Sales = $ FORMCHECKBOX Restaurants 16814Sales = $ FORMCHECKBOX Saddles, Harnesses or Horses Furnishings Manufacturing 58802Sales = $ FORMCHECKBOX Seed Merchants FORMCHECKBOX Excluding Mis-delivery and Germination Failure 16890 FORMCHECKBOX Including Erroneous Delivery, Error In Mixture and Resulting Germination Failure 16891Sales = $ FORMCHECKBOX Shoe Stores 18110Sales = $ FORMCHECKBOX Stockyards 48636Payroll = $ FORMCHECKBOX Stores - FORMCHECKBOX Food or Drink – NOC 18435 FORMCHECKBOX No Food or Drink – NOC 18437Sales = $ FORMCHECKBOX Streets, Roads, Highways or Bridges - Existence and Maintenance Hazard Only 48727 Per Mile = FORMCHECKBOX Tanks - Grain Storage - Loaned or Rented To Others21005 Units = FORMCHECKBOX Textile Products Manufacturing – Fabricated 59725Sales = $ FORMCHECKBOX Tire Dealers 18616Sales = $ FORMCHECKBOX Tire Manufacturing - Auto, Bus or Truck 59750Sales = $ FORMCHECKBOX Tobacco Re-handling or Warehousing 99760Payroll = $ FORMCHECKBOX Truckers 99793Payroll = $ FORMCHECKBOX Vacant Land – NOC 49451 Acres = FORMCHECKBOX Vegetable Oil Manufacturing 59905Sales = $ FORMCHECKBOX Warehouses – NOC [99938]99938Payroll = $ FORMCHECKBOX Warehouses - Occupied By A Single Interest - Lessors' Risk Only 68703 Sq Ft Area = FORMCHECKBOX Warehouses - Occupied By Multiple Interests - Lessors' Risk Only68702 Sq Ft Area = FORMCHECKBOX Warehouses – Private 68706 Sq Ft Area = FORMCHECKBOX Warehouses - Cold Storage – Public 99917Payroll = $ FORMCHECKBOX Watch, Clock or Jewelry Repair 91155Payroll = $ FORMCHECKBOX Wine Manufacturing 59964Sales = $II. LIABILITY (continued) FORMCHECKBOX Agricultural Livestock Feed Consulting Services Rating Basis is Payroll. Enter Payroll: $Limit Per Occurrence$25,000$50,000$100,000$300,000$500,000$1,000,000No Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX $250 Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX $500 Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Agricultural Chemicals Consulting Services Rating Basis is Payroll. Enter Payroll: $Limit Per Occurrence$25,000$50,000$100,000$300,000$500,000$1,000,000No Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX $250 Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX $500 Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Pesticide Or Fertilizer Applicator Rating Basis is Payroll. Enter Payroll$Limit Per Occurrence$25,000$50,000$100,000$200,000$300,000$500,000$1,000,000No Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX $500 Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX $1,000 Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX $2,500 Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX $5,000 Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX $10,000 Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Seed Producers Or Distributors Rating Basis is Sales. Enter Sales:$Limit Per Occurrence$25,000$50,000$100,000$200,000$300,000$500,000$1,000,000No Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX $500 Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX $1,000 Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX $2,500 Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX $5,000 Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX $10,000 Deductible FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Replacement Seed Only FORMCHECKBOX Replacement Seed and Replanting FORMCHECKBOX Full Damages FORMCHECKBOX Deductible To Be Applied on the Following Basis: FORMCHECKBOX Per Claim FORMCHECKBOX Per Occurrence FORMCHECKBOX Non-Owned Auto And Mobile Equipment–Property Damage By Collision Or OverturnRating Basis is Number of Unloading Facilities. Enter Number of Unloading Facilities:Limit per Occurrence FORMCHECKBOX $2,500 FORMCHECKBOX $5,000 FORMCHECKBOX $10,000 FORMCHECKBOX $20,000 FORMCHECKBOX $30,000 FORMCHECKBOX $50,000 FORMCHECKBOX Legal Liability For Scheduled Property Value of Property: $ Description of Property: Loss of Use / Rental Value:Amount Per Day: $ Total Days: II. LIABILITY (continued) FORMCHECKBOX Co-Employee Liability Coverage Endorsement FORMCHECKBOX Property Damage To Non-Owned Railroad Rolling Stock III. AUTOMOBILE FORMCHECKBOX Drive Other Car CoverageNamed IndividualCoverages FORMCHECKBOX Rental Reimbursement Cost Per Day: $ Total Days: Applicable Vehicles: IV. MISCELLANEOUS FORMCHECKBOX Non-Auditable CGL Policy Requested? FORMCHECKBOX Yes FORMCHECKBOX NoIf Yes, attach latest Financial Statement or financial information within the last six months FORMCHECKBOX LPG Exposure? FORMCHECKBOX Yes FORMCHECKBOX NoIf Yes, attach supplement FORMCHECKBOX Refined Fuels Exposure? FORMCHECKBOX Yes FORMCHECKBOX NoIf Yes, attach supplement FORMCHECKBOX Underground Storage Tanks? FORMCHECKBOX Yes FORMCHECKBOX NoIf Yes, attach supplement FORMCHECKBOX MSC 90 Required? FORMCHECKBOX Yes FORMCHECKBOX NoIf Yes, Limit required $ FORMCHECKBOX Three or more tractor units on auto schedule? FORMCHECKBOX Yes FORMCHECKBOX NoIf Yes, attach driver safety / vehicle maintenance program ................
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