Insurance Control Requirement

INSURANCE CONTROL REQUIREMENT

Identification

Insurer Name:

Policy Details

The following policy information identifies the insurance contract subject to these control requirements.

Required Controls (Loss Control Requirements)

The insured must implement and maintain the controls listed below in accordance with the schedule and verification obligations. Failure to implement or maintain these controls may be deemed a material breach of the policy terms and may affect coverage.

Smoke detectors and alarm system in operating condition. Last inspection date:

Automatic sprinkler system maintained and tested. Last service date:

Portable fire extinguishers inspected and tagged. Inspection date:

Security alarm and monitoring services active. Provider:

Regular maintenance program and logs maintained. Most recent log date:

Employee training on loss prevention completed. Last training date:

Implementation Schedule & Responsibilities

The insured shall correct any deficiencies and complete required installations by the dates indicated below.

Inspections and Verification

The insurer or its authorized representative is granted the right to inspect the insured premises and records to verify compliance with these control requirements. Inspections may be scheduled or conducted on reasonable notice.

Next scheduled inspection date:

Inspection frequency: Monthly Quarterly Annually

Exclusions

The following items are expressly excluded from the insurer's obligations under this Control Requirement unless otherwise amended in writing by the insurer.

Beneficiary / Additional Interest

Identify any additional interest or beneficiary to be noted on the policy.

Documentation Checklist

The insured shall provide the following documentation to verify compliance. Check all provided.

Photos of premises and controls

Maintenance logs and service records

Employee training records

Third-party inspection / certification

Certification and Agreement

By signing below the Applicant certifies, represents and warrants that the information contained in this Insurance Control Requirement is true, complete and accurate to the best of Applicant's knowledge. Applicant agrees to implement and maintain the required controls and to provide timely access, records and documentation to verify compliance. Applicant acknowledges that material misrepresentation, failure to maintain controls, or refusal to permit inspection may constitute grounds for denial of coverage or rescission to the extent permitted by policy terms and applicable law.

Applicant further agrees to indemnify and hold harmless the insurer for any loss resulting directly from Applicant's failure to implement or maintain the specified controls, except where such loss is caused by the insurer's gross negligence or willful misconduct.

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