lkalmanson - Commercial Exotic Owner Liability

Commercial Exotic Animal Owner's Liability Application
Claims - Made Policy Form

LIABILITY COVERAGE WILL BE RESTRICTED TO THE DIRECT BODILY INJURY / PROPERTY DAMAGE CAUSED BY THE SCHEDULED ANIMAL ( S ) ONLY UNLESS OTHERWISE ENDORSED AND AN ADDITIONAL PREMIUM CHARGE IS MADE.

AGENCY: LESTER KALMANSON AGENCY, INC &/OR MITCHEL KALMANSON

PO BOX 940008
MAITLAND, FL 32794-0008
PHONE: 407-645-5000
FAX: 407-645-2810
WWW.LKALMANSON.COM

IMPORTANT: THIS IS NOT A BINDER

INCOMPLETE & UNSIGNED APPLICATIONS ARE NOT ACCEPTABLE

PROPOSED EFFECTIVE DATE

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TERM

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NAME OF INSURED ( OWNER )

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D.B.A

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MAILING ADDRESS

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CITY

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STATE

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ZIP

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select

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PHYSICAL ADDRESS WHERE ANIMAL ( S ) IS/ARE KEPT (IE DESIGNATED PREMISES)

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PHONE NUMBERS

HOME

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CELL

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WORK

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EMAIL ADDRESS

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REQUESTED LIMITS OF LIABILITY (PER OCC / AGG)

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IF OTHER

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PER OCC

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PER AGG

DEDUCTIBLE (PER CLAIM (BI/PD) INCLUDES L.A.E)

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IF OTHER

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SCHEDULE OF COVERED ANIMAL ( S ) TO BE INCLUDED ON THIS POLICY: (INCLUDE ALL REQUESTED INFORMATION )

ID/NAME OF ANIMAL - AGE - SEX - SPECIES - MICROCHIP #/PERM. ID - USE - OWN/NON-OWN - OTHER

A

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B)

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C)

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D)

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ATTACH SEPARATE LIST / SCHEDULE OF ADDITIONAL ANIMALS IF NEEDED

TOTAL NUMBER OF EXOTIC ANIMAL ( S ) TO BE SCHEDULED FOR LIABILITY PURPOSES

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TOTAL NUMBER OF EXOTIC ANIMAL ( S ) OWNED &/OR ON PREMISES IN YOUR CARE OR NOT, CUSTODY, AND/OR CONTROL NOT ( TO BE ) INSURED ( IF ANY )

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ATTACH (MAIL / FAX) COPY OF ANY AND ALL (FEDERAL, STATE, LOCAL) PERMITS, LICENSES, VETERINARY RECORDS (KEPT) ETC

PROVIDE COMPLETE DETAILS OF YOUR FACILITY FOR HOUSING STATED ANIMAL(S). (IE TYPE OF FENCING, TRANSPORT CAGE (S) USED, ETC)

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DESCRIBE EXACT USE OF ALL SCHEDULED EXOTIC ANIMALS (S) TO BE INSURED:

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ATTACH ( FAX / MAIL ) ANY AND ALL COPIES OF ANY RENTAL / LEASE AGREEMENT (S) &/OR ANY OTHER CONTRACT (S) USED IN YOUR COMMERCIAL OPERATION.

NAME OF PRESENT, EXPIRING, &/OR PREVIOUS INSURANCE CARRIER:

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CURRENT POLICY (STATED) LIMITS OF LIABILITY

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CURRENT: DEDUCTIBLE

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PREMIUM

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ANY LOSSES, CLAIM(S), OR INCIDENTS WHICH WILL GIVE RISE TO A CLAIM IN THE PAST THREE (3) YEARS FROM THE SCHEDULED ANIMAL(S) AS STATED ABOVE OR ATTACHED HERETO?

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IF YES, PROVIDE FULL DETAILS AND INCLUDE ANY CHANGES TO PREVENT FUTURE CLAIMS

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PLEASE LIST OF ANY ADDITIONAL INSURED(S) TO BE ADDED TO YOUR INSURANCE POLICY (INCLUDE NAME, ADDRESS, PHONE, RELATIONSHIP, & DATES) - SUBJECT TO ADDITIONAL PREMIUM:

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IS YOUR FACILITY (DESIGNATED PREMISES) OPEN TO THE PUBLIC?

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IF YES, PROVIDE FULL DETAILS

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ARE YOU (NAMED INSURED) INVOLVED IN ANY OTHER (EXOTIC) ANIMAL OPERATION(S)

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IF YES, EXPLAIN:

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ARE YOU AFFILIATED WITH ANY OTHER ORGANIZATION(S)?

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IF YES, EXPLAIN

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WHAT EXPERIENCE DO YOU AND/OR YOUR STAFF HAVE IN PRESENTING / DISPLAYING (EXOTIC) ANIMAL(S) TO THE PUBLIC?

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FORWARD A COPY OF YOUR CURRENT U.S.D.A. LICENSE. ALSO, FORWARD A COPY OF ALL EMPLOYEE LICENSE(S).

HOW ARE THE EXOTIC ANIMAL(S) TRANSPORTED? (IE CAGES, ETC)

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PROVIDE PICTURES AND DESCRIPTION OF YOUR TRANSPORT CAGE(S) AND/OR TRAILER USED.

PROVIDE DIAGRAM(S) OF CROWD CONTROL BARRIER(S) / FENCE(S) USED FOR YOUR (EXOTIC) ANIMAL(S) (PUBLIC) PRESENTATION.

HOW MANY TRAINED PERSONNEL/EMPLOYEE (S) DO YOU HAVE ON EACH JOB? (IE MINIMUM NO. USED FOR EACH DISPLAY / PRESENTATION)

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IS THERE SOMEONE WITH THE (EXOTIC) ANIMAL(S) AT ALL TIMES WHEN THE ANIMAL(S) IS/ARE OUT OF THE PREMANENT ENCLOSURE(S) / CAGE(S)?

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EXPLAIN:

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DOES ANYONE LIVE ON THE PREMISES WHERE THE ANIMAL(S) IS/ARE KEPT?

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DO YOU ALLOW PEOPLE TO PET ANY OF YOUR (EXOTIC) ANIMAL(S) &/OR HAVE THEIR PICTURES TAKEN WITH ANY OF YOUR (EXOTIC) ANIMAL(S)?

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IS THE PUBLIC RESTRICTED FROM ACCESS TO ALL WORK, STORAGE, &/OR (EXOTIC) ANIMAL ENCLOSURE(S) / CAGE(S)?

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DESCRIBE SAFETY MEASURES TO AVOID ATTRACTIVE NUISANCE HAZARDS (FENCING, SIGNS, ETC)

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DESCRIBE FREQUENCY OF PEN CLEANING

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ARE PENS SPECIFICALLY CLEANED TO AVOID SPREAD OF DISEASE(S)

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DO YOU PROVIDE ANY ANIMAL RIDES? (IE PONY, ELEPHANT, CAMEL, CARRIAGE, ETC)

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IF YES, PROVIDE DETAILS

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ARE ALL PARKING &/OR WALK/WORK AREAS MAINTAINED AND KEPT FREE OF ANY DEBRIS / TOYS &/OR AID(S)

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DESCRIBE ALL ANIMAL SHOWS AND EVENTS PERFORMED FOR THE PUBLIC (INCLUDE SCHEDULE OF SHOWS AND EVENTS - OR USDA ROUTING SCHEDULE)

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ARE ALL BARRIERS BETWEEN THE PUBLIC/INVITEES AND THE (EXOTIC) ANIMAL(S) ADEQUATE TO PREVENT CONTACT AND/OR INJURY

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ARE ALL BARRIERS MAINTAINED FREQUENTLY

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HOW OFTEN

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PLEASE PROVIDE A CURRENT LIST / SCHEDULE OF ALL OPERATION(S) AND/OR EXPOSURE(S) TO BE INSURED

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DO YOU CARRY WORKER'S COMPENSATION TO PROTECT YOUR EMPLOYEE(S) AND / OR YOUR VOLUNTEER(S)

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IF NO, EXPLAIN

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DO YOU USE ANY INDEPENDENT CONTRACTOR(S) FOR ANY SERVICE(S)

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IF YES, PROVIDE DETAILS - AND FORWARD COPY OF ALL CONTRACT(S)

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TYPE OF DIET YOUR (EXOTIC) ANIMAL(S) IS/ARE ON - INCLUDE NORMAL FEEDING SCHEDULE

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IS/ARE YOUR (EXOTIC) ANIMAL(S) FASTED

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HOW OFTEN AND WHEN

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INDICATE TYPE OF MATERIAL / CAGING / GAGE FOR PERMANENT ENCLOSURE(S) / CAGE(S) / COMPOUND IS CONSTRUCTED OUT OF (PLEASE MAIL PICTURES/ VIDEOS OF THE FACILITY)

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IS PREMISES LIABILITY COVERAGE TO BE AFFORDED

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PROVIDE ACREAGE USED IN CONJUNCTION WITH YOUR ANIMAL OPERATION(S).

REMARKS (IF ANY)

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NOTE: ALL ANNUAL PREMIUM(S) ARE 35% MINIMUM EARNED AT INCEPTION.

ALL SHORT TERM POLICY(S) ARE 100% FULLY EARNED AT INCEPTION

NO FLAT CANCELLATION(S) ARE PERMITTED

LIABILITY COVERAGE WILL BE LIMITED TO SCHEDULED OPERATION(S) &/OR EXPOSURE(S) &/OR (EXOTIC) ANIMAL(S) ONLY

IN CONSIDERATION OF THE PREMIUM CHARGED AT INCEPTION, IT IS HEREBY AGREED AND UNDERSTOOD THAT THE FOLLOWING WORDING IS HEREBY MADE PART OF THIS POLICY

IT IS WARRANTED BY THE NAMED INSURED, AND AS A CONDITION PRECEDENT TO LIABILITY COVERAGE ( S ) AFFORDED HEREIN OR HEREUNDER THAT ALL ANIMAL ( S ) / SPECIE( S ) OWNED BY, LEASED, AND/OR RENTED TO AND/OR IN THE CARE, CUSTODY, AND/OR CONTROL / SUPERVISION OF THE NAMED INSURED ( S ) SHALL BE ATTACHED TO A LEASH, WITH AN EXPERIENCED ANIMAL TRAINER / HANDLER (UNDER THE DIRECT SUPERVISION OF THE NAMED INSURED(S) AND/OR ITS EXPERIENCED EMPLOYEE(S) AND/OR CONFINED AND/OR RESTRAINED IN SUCH A MANNER THAT THE ANIMAL ( S ) / SPECIE(S) CANNOT BE OF HARM TO THE GENERAL PUBLIC AND/OR INVITEE(S) AND/OR ANY VOLUNTEER(S).

THIS LIABILITY INSURANCE DOES NOT APPLY TO ANY "BODILY INJURY," &/OR "PERSONAL INJURY," &/OR ANY MEDICAL PAYMENTS (IF AFFORDED) &/OR ANY LEGAL DEFENSES ARISING OUT OF ANY CLAIM(S), ACCUSATION(S), &/OR CHARGE(S) BROUGHT BY AND/OR AGAINST ANY INJURED(S) FOR ACTUAL AND/OR ALLEGED DAMAGE(S) AND/OR INJURIES ARSING OUT OF ANY COMMUNICABLE DISEASE(S) &/OR INFECTION(S), INCLUDING E-COLI INFECTION &/OR BACTERIA, NO MATTER HOW TRANSMITTED, BY ANY (NAMED) INSURED'S &/OR IT'S EMPLOYEES &/OR ANY OF THEIR ANIMAL/SPECIES, INCLUDING BUT NOT LIMITED TO ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) AND/OR ANY OTHER COMMUNICABLE DISEASE(S) AND/OR INFECTION(S) AND/OR BACTERIA

IT IS FURTHER AGREED AND UNDERSTOOD THAT THIS SPECIFIC COMMUNICABLE / INFECTIOUS DISEASE EXCLUSION ENDORSEMENT WOULD APPLY TO ANY AND ALL CLAIMANT(S) WHETHER INDIVIDUALLY AND/OR AS A CLASS MEMBER OF ANY CLASS ACTION LITIGATION

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURER FILES A STATEMENT OF CLAIM OR AN APPLICATION CONTAINING ANY FALSE, INCOMPLETE, OR MISLEADING INFORMATION IS GUILTY OF A FELONY OF THE THIRD DEGREE

I UNDERSTAND AND AGREE THAT ANY MISSTATEMENT OF WARRANTY OF FACT ON THIS APPLICATION SHALL BE CONSIDERED A VIOLATION OF COVERAGE AFFORDED UNDER ANY POLICY ISSUED ON THE BASIS OF THIS APPLICATION

( THIS APPLICATION WILL BECOME PART OF ANY POLICY ISSUED AS A RESULT IF ITS SUBMISSION. )

PLEASE INITIAL AND DATE TO ACCEPT TERMS OF APPLICATION (REQUIRED TO PROCESS APPLICATION)

INITIAL

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DATE

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AFTER SUBMITTING YOUR ONLINE APPLICATION

PLEASE DOWNLOAD, PRINT, AND SIGN THE "EXOTIC LIABILITY" AND "TERRORISM" SIGNATURE FORMS

THESE FORMS REQUIRE WET SIGNATURES AND MUST BE RECEIVED VIA MAIL TO PROCESS THE APPLICATION

***CONFIDENTIALITY NOTICE: This message and any attachments are for the sole use of the intended recipient(s) and may contain confidential and privileged information that is exempt from any public disclosure. Any unauthorized use, review, disclosure, or distribution is prohibited. If you have received this message in error, please contact the sender by phone or electronic mail, and destroy all copies of this message.***

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Commercial Exotic Animal Owner's Liability Application Claims - Made Policy Form

LIABILITY COVERAGE WILL BE RESTRICTED TO THE DIRECT BODILY INJURY / PROPERTY DAMAGE CAUSED BY THE SCHEDULED ANIMAL ( S ) ONLY UNLESS OTHERWISE ENDORSED AND AN ADDITIONAL PREMIUM CHARGE IS MADE.

AGENCY: LESTER KALMANSON AGENCY, INC &/OR MITCHEL KALMANSON

IMPORTANT: THIS IS NOT A BINDER

INCOMPLETE & UNSIGNED APPLICATIONS ARE NOT ACCEPTABLE

PLEASE INITIAL AND DATE TO ACCEPT TERMS OF APPLICATION (REQUIRED TO PROCESS APPLICATION)

AFTER SUBMITTING YOUR ONLINE APPLICATION

PLEASE DOWNLOAD, PRINT, AND SIGN THE "EXOTIC LIABILITY" AND "TERRORISM" SIGNATURE FORMS

THESE FORMS REQUIRE WET SIGNATURES AND MUST BE RECEIVED VIA MAIL TO PROCESS THE APPLICATION