155 Boiler and Machinery Section
Applicant (first named insured)
*
Effective date
*
Expiration date
*
Small Business Policy (limit rated):
Coverage type
Select
Basic
Include air conditioners and compressor units
Exclude air conditioners and compressor units
Broad
Other
Explain OTHER
Spoilage (not available on basic)
Select
None
5,000
10,000
25,000
Deductible
Select
250
500
Are there any boilers?
Select
Yes
No
Are there any process boilers?
Select
Yes
No
Standard Policy:
Covered equipment
Comprehensive: Include production machines
Select
PD
BII
Comprehensive: Exclude production machines
Select
PD
BII
All boilers-pressure vessels
Select
PD
BII
All air conditioning and refrigeration equipment
Select
PD
BII
All electrical equipment
Select
Property damage
Bodily injury
All mechanical equipment
Select
Property damage
Bodily injury
Other object groups 1
Select
Property damage
Bodily injury
Other object groups 2
Select
Property damage
Bodily injury
Other object groups 3
Select
Property damage
Bodily injury
Coverages:
Property damage ($)
Extra expense ($)
Limit of insurance ($)
Deductible ($)
Limit of loss ($)
Period of restoration (months)
Deductible ($)
Business interruption:
Actual loss sustained
Limit of loss (% of annual value)
Deductible ($)
Ordinary payroll (number of days)
Annual value: location 1
Annual value: location 2
Annual value: location 3
Valued form
Daily limit
Number of days
Select
90
180
270
360
Deductible
Consequential damage
Limit of loss
Percent coinsurance
Deductible ($)
Specified property
Property location
Select
In storage
In process
Premises Information:
Premises 1
Premises number
Machinery and equipment
Building values (100%)
Inspection contact
Phone number
Premises 2
Premises number
Machinery and equipment
Building values (100%)
Inspection contact
Phone number
Premises 3
Premises number
Machinery and equipment
Building values (100%)
Inspection contact
Phone number
Premises 4
Premises number
Machinery and equipment
Building values (100%)
Inspection contact
Phone number
Additional Interests:
Premises 1
Premises number
Certification required?
Select
Yes
No
Name
Address
City
State
Zip
Interest
Premises 2
Premises number
Certification required?
Select
Yes
No
Name
Address
City
State
Zip
Interest
Premises 3
Premises number
Certification required?
Select
Yes
No
Name
Address
City
State
Zip
Interest
Premises 4
Premises number
Certification required?
Select
Yes
No
Name
Address
City
State
Zip
Interest
53 Loveton Circle, Suite 120 • Sparks, MD 21152
Phone • 1.800.926.8085 • 410.472.1620 • Fax • 410.472.1897
Copyright © Coffey & Company, Inc.
website design by
NewBlood
