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INSURANCE HOME BUSINESS POLICY

Policy Declarations

Insurer Name:

Policy Number:

Applicant / Insured Information

Date of Birth: Month Day Year

Business Phone:    Tax ID / EIN:

Policy Period

Effective Date: Month Day Year

Expiration Date: Month Day Year

Coverage Summary

Coverages (select included coverages)

Property at premises (buildings and structures)

Business personal property (furniture, inventory, supplies)

General liability (bodily injury and property damage)

Business interruption / loss of income

Extra expense (reasonable expenses to continue operations after a covered loss)

Equipment breakdown (mechanical and electrical equipment)

Cyber liability (data breach and privacy liability)

Deductible, Premium and Payment

Payment Plan: Annual Semi-Annual Monthly

Exclusions (Representative, not exhaustive)

This Policy does not cover loss or liability caused directly or indirectly by: (a) flood, surface water, storm surge, tidal wave, or overflow of any body of water; (b) earth movement including earthquake, landslide or subsidence; (c) war, insurrection, nuclear hazard or governmental seizure; (d) wear and tear, gradual deterioration, vermin, rust or mold; (e) dishonest or criminal acts committed by the insured, employees or business partners; (f) professional services, advice or design liability unless specifically endorsed; (g) punitive or exemplary damages except as required by law; and (h) any coverage specifically excluded by written endorsement issued as part of this Policy.

Conditions and Duties After Loss

In the event of a loss, the insured must: (1) give prompt notice to the insurer or its authorized representative; (2) protect property from further damage and make reasonable temporary repairs; (3) prepare an inventory of damaged property and provide records supporting the claim; (4) submit to examination under oath if requested; and (5) cooperate with the insurer in the investigation and settlement of the claim. Failure to comply with these duties may result in denial of coverage to the extent prejudice results to the insurer.

Claims Reporting (optional initial report)

Month Day Year

Documentation Provided: Photos Receipts/Invoices Police Report Other

Subrogation, Assignment and Loss Payment

The insurer shall be subrogated to the insured's rights of recovery against any person or organization for loss paid under this Policy, subject to reimbursement to the insured for recoveries less the insurer's reasonable costs of recovery. No assignment of interest under this Policy shall be binding on the insurer except with its written consent. Loss payments will be made to the insured, mortgagee, or loss payee as their interests may appear, subject to the terms of this Policy.

Cancellation and Nonrenewal

This Policy may be cancelled by the insured at any time by surrender of the Policy to the insurer or by written notice. The insurer may cancel or nonrenew this Policy in accordance with applicable law. Upon cancellation by either party, return premiums will be computed in accordance with the insurer's customary short rate or pro rata rules, subject to minimum retained premiums as permitted by law.

Endorsements and Modifications

Beneficiary / Loss Payee Designation

For the purpose of loss payment for business interruption or other proceeds, designate payee (if any).

Declarations and Certification by Insured

The undersigned hereby declares that the statements contained in this Policy application and any attachments are true and complete to the best of the insured's knowledge and belief. The insured acknowledges that coverage under this Policy is subject to all terms, conditions, exclusions and endorsements contained in the Policy. The insured agrees to promptly pay the premium and to cooperate in all reasonable respects in the handling of claims. False statements, material misrepresentations or omission of facts may void coverage or permit rescission to the extent allowed by law.

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