Address:

City, State:

Phone:

Named Insured is a(n):    _____Individual     _____Partnership     _____Corporation ____Limited Liability Corporation  _____Joint Venture     _____Other

General business operations:

States/territories in which insured has operations:

States/territories in which insured might begin operations within next twelve months:

Loss control contact name/phone:

Insurance Company Information

Carrier name ___________________________________________________

Financial (A.M. Best) rating ____________________________________

Premium ____________________________________

Minimum number of days for notice of cancellation and nonrenewal (most stringent state on policy) _____________   State: ________

Standard or nonadmitted market? _________________________________

Coverage territory ____________________________________________

Limits

Business income, including extra expense:_________________________________

Business income, excluding extra expense: __________________________

Extra expense limit: _____________________________

Other consequential loss limit: _______________________________

Exposure Survey

____1. Review flow chart to determine critical path of operations?

____2. Use critical path analysis?

____3. Review asset schedule to determine time to replace each item that would seriously affect operations?

____4. Identify possible bottlenecks in production or operating processes?

____5. Would the shutdown of any key locations affect operations? For how long?

____6. Would the loss of key equipment affect operations? For how long?

____7. Should parent and all subsidiaries/affiliates be commonly or separately insured?

____8. Are there inter-dependent operations that would be compromised if one portion were not able to operate?

____9. Are spare parts for critical equipment readily available? On premises? Off premises?

____10. How long would it take to repair the most time-consuming production processes or the most involved operational facilities?

____11. Are there any pieces of obsolete equipment or obsolete facilities?

____12. Are plans in place to replace obsolete equipment or re-build obsolete facilities?

____13. What operations could and would be suspended until repair or replacement?

____14. What operations could and would be shifted to another location or quickly restored regardless of the expense involved?

____15. Do seasonal fluctuations in business patterns affect income?

____16. Any loss of rents?

____17. Any favorable leases that would not be able to be mimicked?

____18. Would widespread damage geographically, such as that caused by tornadoes or floods, affect the length of time required to recover from a direct loss because of the scarcity of building materials?

____19. How long will it take to regain customers after an extended shutdown?

____20. Will extra expenses be incurred to regain customers after an extended shutdown?

____21. Are there any attributes that need special evaluation or coverage consideration, such as:

     - Aerial structures

     - Buildings under construction or renovation

     - Selling agents that rely on commission income

     - Electronic data processing operations

     - Contingent liability for an additional period of restoration due to operation of building laws

     - Extending coverage to underground property in a mining operation

     - Molten metals exposure

     - Continuing expense exposure for not-for-profit or educational organizations

     - Radioactive contamination exposures

     - Other pollution contamination exposures

     - Special research and development issues, such as reliance on current research for future profits

     - Possibility of newly acquired locations

Contingent Business Income/Extra Expense/Consequential Loss Issues

____1. Consider potential effect of off-premises utility interruptions, including water, communications, and power supplies?

____2. Consider potential effect of excessive application of utilities, such as heat, light, steam, air conditioning, coolant, etc.?

____3. Are there any on-premises utility generators that should be considered?

____4. Are alternative sources of key supplies readily available?

____5. Has extra expense needed to use alternative suppliers been calculated?

____6. Is the insured dependent on any contributing properties (suppliers, etc.)?

____7. Is the insured dependent on any recipient properties (consumers, etc.)?

____8. Is the insured dependent on any leader locations to draw customers?

Coverage Considerations

____1. Business income excluding extra expense?

____2. Business income including extra expense?

____3. Extra expense only?

____4. Perils insured?

____5. Should perils such as earthquake and flood be included in coverage?

____6. Blanket or scheduled coverage?

____7. Is extended period of recovery provision in place?

____8. Should length of extended period of recovery be extended?

____9. Consider premium adjustment endorsement?

____10. Consider maximum period of indemnity endorsement if restoration period is less than a year?

____11. Consider monthly limitation of recovery?

____12. Delete coinsurance and add agreed value endorsement?

____13. Would valued form of coverage be appropriate?

____14. Consider adding coverage for off premises utility failure, including overhead transmission lines?

____15. Extend coverage for action of civil authority beyond the time provided in form?

____16. Consider using valued business income/extra expense or special R&D coverage for research and development facilities that may depend on current research for future profits?

____17. Consider coverage for other specialized or contingent exposures, such as:

     - Food spoilage,

     - Other perishable items, such as pharmaceuticals, blood products, etc.

     - Equipment breakdown (boiler and machinery) exposures

     - EDP exposures

     - Builders risk exposures

     - Tuition fees

     - Rental reimbursements

     - Transportation equipment

     - Planned alterations to existing physical plant and new building exposures

____18. Consider coverage provisions of the following endorsements See Business Income and Extra Expense Endorsements for a description of each endorsement:

       - Business income from dependent properties – broad coverage

       - Business income from dependent properties – limited coverage

       - Expanded limits on loss payment

- Ordinary payroll limitation or exclusion

     - Power, heat, and refrigeration deduction

     - Seasonal leases – monthly limits on loss payments

     - Business income report/work sheet

     - Business income premium adjustment

     - Mining properties – business income

     - Business income changes – educational institutions

     - Electronic media and records

     - Ordinance or law – increased period of restoration

     - Extra expense from dependent properties

     - Utility services – time element

     - Radio or television antennas – business income or extra expense

     - Business income changes – beginning of the period of restoration     

Establishing Limit(s) of Coverage

____1. Has business income worksheet been completed?

____2. Should ordinary payroll be insured?

____3. How much coverage should be included for extra expenses to recover from the loss and to regain customers?

____4. Consider buy-back of off-premises transmission lines coverage?

____5. Consider impact of peak season fluctuations in business?

____6. Consider the following expenses to determine what amount should be included in the business income limit for continuing expenses:

     - Payroll (ordinary and extraordinary)

     - Utilities

     - Services performed by others

     - Lease or rental expense (check written leases to determine whether rental payments must be continued if building is damaged)

     - Interest expense

     - Taxes

     - Advertising

     - Franchise and license fees/royalties

     - Postage and telephone

     - Collection expense

     - Professional fees

     - Travel/entertainment expense

     - Insurance

     - Maintenance

     - Delivery

     - Shipping and packing expenses

     - Cost of on-going contracts

     - Contractual penalties that may be imposed if a contract cannot be completed as required

Disaster Planning

____1. Has a company-wide disaster recovery plan been developed?

____2. Are key records (including paper and electronic) duplicated?

____3. Are duplicate records kept off premises?

____4. Are critical spare parts available but kept off premises but in an easily accessible location?

____5. Is there any reserve inventory kept off premises?

____6. Are reciprocal operations arrangements in place with friendly competitors or disaster recovery centers in place?

____7. For service operations, are plans in place to continue operations in temporary facilities with temporary equipment?

____8. How quickly can temporary facilities be established?

____9. Is a separate cyber policy in place?

____10. Does risk management have a plan in place for potential cyber attacks, including being able to continue operations with restoration of backups?

Includes copyrighte material of Insurance Services Office, Inc., with its permission.

Reviewed: September 24, 2019

Reviewed: July 1, 2022