<%@ Language=Inherit from Web site %>  FEE Based Insurance Inspections and Account Loss Control File Management

 

 

 

 

 

 

Text Box: FIELD UNDERWRITING INSPECTION AND 
INSURED COMMERCIAL LOSS CONTROL ACCT MGMT SERVICES    Phone: 484 239 4436
 
 

 

 

 

 

PROPERTY & CASUALTY FIELD UNDERWRITING & ACCOUNT LOSS CONTROL SERVICES

 

Global Loss Control offers a specialized and professional services in account loss control, field underwriting, and risk assessment for commercial insurance P & C underwriters, loss control manager's, and commercial businesses, please check required services included within this form. 

GLOBAL LOSS CONTROL CUSTOMER ACCOUNT INFORMATION SECTION

 

INSURANCE COMPANY NAME 

CUSTOMER PURCHASE ORDER/CONTRACT NUMBER   

DATE OF THIS REQUEST                  DATE REQUEST REQUIRED   

INSURED OR PROSPECT PERSONAL AND CONFIDENTIAL DATA SECTION

 

DATE SUBMITTED         POLICY NO.  

POLICY EFFECTIVE DATE      

 

 

IS THIS A REQUIRED QUOTATION? YES           NO    

 

NAME - POLICY HOLDER    

 

OWNER NAME                   

 

 CITY                                                                                                                       STATE     

ZIP    

 

CONTACT PERSON           

BUSINESS PHONE NO.  

 

TYPE OF BUSINESS  

 

PREMIUM SIZE (CHECK BOX BELOW)

$10 k TO $50 k    $50K TO $250K            $250K TO $500K         $500K and $1 million + 

   Other

 

ANNUAL PAYROLL $   

 PROPERTY VALUE $  

CONTENTS VALUE     $  

 

ANNUAL GROSS RECEIPTS

 

INSURED ACCOUNT LOSS CONTROL AND FIELD UNDERWRITING SERVICE REQUEST  SECTION                        

I. PROPERTY

VII. ACCT. LOSS CONTROL MGT SERVICES

Fire and E.C. Safety Program Auditing
DIC Perils, Flood Quake Fire protection analysis
All Risk Plan review
Business Interruption Special hazards identification

II. LIABILITY

Process safety program audit
Comprehensive General Training needs assessment
X C U Safety training
Products./ Completed Operations Job Tasks Analysis & Observation
Mfg. & Contractor Liability Personal Protective Equipment (PPE) review
Garage Liability Accident incident investigation

III. Worker's Comp.

Large loss claim review
Industrial Fleet Loss Control Program Services
Construction
Mercantile  
Service industries Industrial Hygiene plan review and program audit
Environmental spill response workers Contracts job site evaluation and quality of  workmanship
Environmental spill contractors

Restaurant assessment package

      UL 300 system review

      Hood and Duct service plan review

      Purveyors listing and assessment

      Sanitation review           

Environmental remediation contractors

Specialty Contractors assessment package

IV. CRIME

 
Money in and out  
Safe Burglary  
Open Stock  
Storekeepers  
   
Fleet  
Business Owners Policy (BOP)  
Special Quoting Request  
   
   
 
LIST SPECIAL ATTENTION ITEMS IN SPACE PROVIDED BELOW

 


      

All rights reserved. Information in this document (Website) is subject to change without notice  does not represent a commitment on the part of Global Loss Control, Inc. No part of this document or (Website) shall be reproduced or transmitted in any means, electronic or mechanical, including  photocopying and recording, for any purpose without the express written permission of  Copyright© Global Loss Control, Inc, - P. O. Box 3085, Easton, Palmer, PA 18043.

 BY D J B Last  Update January 2012

 

 

COPYRIGHT© GLOBAL LOSS CONTROL® DJB Jr.,  F.A.C.F.E., A.S.A.  LICENSE 85 - ACCREDITED SAFETY AUDITOR

 

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