COMMERCIAL LIABILITY FORM Commercial Liability Form Name of insured Email Address Address Address Address City City Province Province Postal code Postal code Description of activities/project (if a builders risk, is there any form of heat used?) Revenues by country ($) Canada United States Others Work subcontracted to others ($) Revenues On Premises ($) Revenues Off Premises ($) CGL Limit ($) *Including non-owned automobile TLL Limit ($) E&O Sub-Limit ($) aggregate - Claims Made Basis / RDI Faulty Workmanship Sub-Limit ($) aggregate - Claims Made Basis / RDI Pollution Sub-Limit ($) aggregate - Sudden and Accidental (120h) Deductible ($) Years in business Years of experience Did the insured had a claim in the last 5 years? Yes No Loss record Date of claim Amount ($) Cause plus1 Add a claim minus1 Remove claim Current insurer Premium (25% minimum & retained) ($) Subject to Water Ingress Exclusion Underground Cables & Pipes Clause Oil & Gas Conditions Inefficacy / Failure to Perform Exclusion Burning & Welding Conditions Use of Heat Exclusion Pollution Exclusion E&O Exclusion USA Work, Sales & Jurisdiction Exclusion Terrorism / Asbestos / Toxic Mould Exclusion Roof Heat Warranty USA Conditions Rip & Tear Exclusion Warranted Subcontractors carry minimum $1,000,000 CGL Comments Send
