Questions on the Application? Call Jason Miller at 800-866-2682, Ext. 101
4. Contact Person:
PART II. SCHEDULE OF SERVICES (please note the numer of employees in each classification and the name of each employee in each classification)
Beautician/Barber (Hair)
Number to be Insured:
6. Do you have operations not listed on the schedule below?
What Limit of Insurance Would You Like Quoted?
(Common limits are $1,000,000/$2,000,000, $500,000/$1,000,000, $300,000/$600,000 or $100,000/$300,000, where the first number is the per occurrence limit and the second number is the aggregate limit)
If yes, do you have insurance for these operations? Name of Insurance company:
7. Do you need products liability?
If yes, what are your total annual sales of products (excluding private label)? $
8. Do you sell private label products?
If yes, what are your total annual sales of private label products? $
9. Have you ever experienced a liability claim arising from any professional activity whether or not insured?
If yes, please provide details here:
Names of Individuals:
Waxing
Number to be Insured:
Names of Individuals:
Nails
Number to be Insured:
Names of Individuals:
Body Wraps
Number to be Insured:
Names of Individuals:
Massage
Number to be Insured:
Names of Individuals:
Eyelash & Brow Enhancements
Number to be Insured:
Names of Individuals:
Topical Makeup Application
Number to be Insured:
Names of Individuals:
Other, please describe:
Number to be Insured:
Names of Individuals:
Have massage technicians been trained in massage?
Do massage technicians have individual insurance in force?
If you are performing Botox, Microdermabrasion, Chemical Peels or other higher acuity services please complete our med spa application HERE
PART III. History
The following services require a separate application if coverage is needed; we can ballpark the premium with this information:
Category
Number to Insure
Category
Number to Insure
Tanning Units UV and Airbrush
Permanent Makeup
Needling/MCA
Pigment Removal/Lightening
Laser/IPL/LED Unite
Facials, Peels, Microderm
Body Tatoo/Piercing
Electrology
Do you currently have insurance coverage? If yes, please indicate the following:
Insurer:
Liability Limits:
Policy Number:
Premium:
Expiration Date:
If current coverage is a claims-made policy, please indicate retro-date here:
Please list any liability insurance claims, whether or not insured. If none, click here:
Do you have knowledge of any event, circumstance or occurrence (other than listed above) that might result in a claim?
If yes, please describe here:
I understand and agree that this application and any supplements provided will be relied upon for issuance of any policy. I further understand and agree that failure to provide a true and accurate response to the foregoing questions may, at the option of the company, result in the voiding of the insurance issued in reliance on this application and/or denial of claims under any policy issued.
i authorize and consent to investigations of information bearing upon moral character, professional reputation and fitness to engage in the activities of my business including authorization to every person or entity, public or private, to release to all Lloyd's of London participating syndicates, any documents, records or other information bearing upon the foregoing. I understand and agree that these investigations shall not be confined to information submitted in this application, but shall include any other sources of information deemed relevant by the Company as may be authorized by law.
I understand this insurance is being provided through a surplus lines company and the insurer may not be subject to all the insurance laws and rules in my state and the risk is not protected by the State Insurance Insolvency Rund.
Name:
Date:
City:
State:
Zip:
Web Site:
(If this strikes you as perhaps the stupidest question ever asked on a liability application, you are not alone! The sad truth is that we have run in to many, many day spas that who answer this with 'no')
