146 Equipment Floater Section

Proposed effective date*
Proposed expiration date*
Applicant name*
Coverage/Deductible
Equipment Storage:
Equipment Storage 1
Location number
Months in storage
Maximum value in building
Maximum value outside
Type of security
Equipment Storage 2
Location number
Months in storage
Maximum value in building
Maximum value outside
Type of security
Equipment Storage 3
Location number
Months in storage
Maximum value in building
Maximum value outside
Type of security
Unscheduled Equipment (If Applicable):
Description
Maximum item
Amount of insurance
Percent coinsurance
Additional Interest/Certificate Recipients:
Recipient 1
Recipient name
Address
City
State
Zip
Interest
Certification required
Recipient 2
Recipient name
Address
City
State
Zip
Interest
Certification required
Recipient 3
Recipient name
Address
City
State
Zip
Interest
Certification required
Recipient 4
Recipient name
Address
City
State
Zip
Interest
Certification required
Recipient 5
Recipient name
Address
City
State
Zip
Interest
Certification required
General Information (Explain all yes remarks):
Equipment rented, loaned to/from others with/without operators?*
Explain
Is applicant operating equipment not listed here?*
Explain
Property used underground?*
Explain
Any work done afloat?*
Explain
Scheduled Equipment:
Scheduled Equipment 1
Model year*
Type*
Manufacturer*
Model*
Capacity
Other
Identification number/serial number*
Date Purchase*
New/Used
Amount of insurance*
Scheduled Equipment 2
Model year
Type
Manufacturer
Model
Capacity
Other
Identificaiton number/serial number
Date purchase
New/Used
Amount of insurance
Scheduled Equipment 3
Model year
Type
Manufacturer
Model
Capacity
Other
Identification number/serial number
Date purchase
New/Used
Amount of insurance
Scheduled Equipment 4
Model year
Type
Manufacturer
Model
Capacity
Other
Identification number/serial number
Date purchase
New/Used
Amount of insurance
Scheduled Equipment 5
Model year
Type
Manufacturer
Model
Capacity
Other
Identification number/serial number
Date purchase
New/Used
Amount of insurance
Scheduled Equipment 6
Model year
Type
Manufacturer
Model
Capacity
Other
Identification number/serial number
Date purchase
New/Used
Amount of insurance
Scheduled Equipment 7
Model year
Type
Manufacturer
Model
Capacity
Other
Identification number/serial number
Date purchase
New/Used
Amount of insurance
Scheduled Equipment 8
Model year
Type
Manufacturer
Model
Capacity
Other
Identification number/serial number
Date purchase
New/Used
Amount of insurance
Scheduled Equipment 9
Model year
Type
Manufacturer
Model
Capacity
Other
Identification number/serial number
Date purchase
New/Used
Amount of insurance
Scheduled Equipment 10
Model year
Type
Manufacturer
Model
Capacity
Other
Identification number/serial number
Date purchase
New/Used
Amount of insurance
Scheduled Equipment 11
Model year
Type
Manufacturer
Model
Capacity
Other
Identification number/serial number
Date purchase
New/Used
Amount of insurance
Scheduled Equipment 12
Model year
Type
Manufacturer
Model
Capacity
Other
Identification number/serial number
Date purchase
New/Used
Amount of insurance
Scheduled Equipment 13
Model year
Type
Manufacturer
Model
Capacity
Other
Identification number/serial number
Date purchase
New/Used
Amount of insurance
Scheduled Equipment 14
Model year
Type
Manufacturer
Model
Capacity
Other
Identification number/serial number
Date purchase
New/Used
Amount of insurance
Scheduled Equipment 15
Model year
Type
Manufacturer
Model
Capacity
Other
Identification number/serial number
Date purchase
New/Used
Amount of insurance