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GREAT AMERICAN INSURANCE COMPANY ARMORED CAR APPLICATION

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GREAT AMERICAN INSURANCE COMPANY ARMORED CAR APPLICATION

    GREAT AMERICAN INSURANCE COMPANY

    ARMORED CAR CARGO INSURANCE PROGRAM APPLICATION

STATUS OF SUBMISSION:

Proposed Effective Date: Proposed Expiration Date:

APPLICANT INFORMATION:

    First Named Insured & other Named Insureds:

Telephone: ( ) Fax: ( )

    Mailing address of First Named Insured:

     ( ) INDIVIDUAL ( ) CORPORATION ( ) SUBCHAPTER “S” CORPORATION

     ( ) PARTNERSHIP ( ) JOINT VENTURE ( ) NOT FOR PROFIT ORGANIZATION

     YEARS IN BUSINESS __________

    PREMISES INFORMATION:

     LOC # BLDG # STREET, CITY, COUNTY, STATE, ZIP CODE

DESCRIPTION OF OPERATION(S):

GENERAL INFORMATION:

    Estimated gross receipts:

     Armored: ______________ Courier: _______________ Money Room: _____________

     Coin Room: ________________ Other: _________________

    What is the total amount of the values transported for the past 12 months? ___________________

    Of that amount what percent is: Cash ___________________________ Negotiable securities ____________

     Non-negotiable securities ___________ Other

    ________________________

Ed. 11/99 Page 1 of 10

Has your insurance ever been cancelled? ( ) Yes ( ) No If yes, why?

LOSS HISTORY:

Enter all claims or occurrences that may give rise to claims for the prior 5 years. Check here if none ( )

    DATE OF DESCRIPTION OF OCCURRENCE OR DATE OF AMOUNT DED. FOR AMOUNT CLAIM OCCURRENCE CLAIM CLAIM PAID EACH CLAIM RESERVED STATUS

    OPEN ( ) CLOSED ( )

    OPEN ( ) CLOSED ( )

    OPEN ( ) CLOSED ( )

    OPEN ( ) CLOSED ( )

    OPEN ( ) CLOSED ( )

Please provide descriptions of all losses in excess of $5,000, including corrective action.

PREMIUM INFORMATION:

    YEAR INSURANCE COMPANY PREMIUM

PERSONNEL:

1. Schedule of all officers

    NAME POSITION YEARS WITH COMPANY PREVIOUS EXPERIENCE

2. Schedule of employees by job classification other than listed above.

     Supervisors __________ Drivers ___________ Vault personnel ____________ Sales

    ___________

     Clerical _____________ Mechanics ________ Guards ___________________

     All other employees (full & part time) __________

Ed. 11/99 Page 2 of 10

PERSONNEL CONTINUED:

3. Is it mandatory for all new employees to submit to the following tests?

     (please explain any no answers)

     MEDICAL ( ) YES ( ) NO

     POLYGRAPH ( ) YES ( ) NO

     PSYCHOLOGICAL ( ) YES ( ) NO

     DRUG ( ) YES ( ) NO

4. In screening new employees, do you conduct and document the following checks?

     REFERENCES ( ) YES ( ) NO CREDIT ( ) YES ( ) NO

     NEIGHBORHOOD ( ) YES ( ) NO CRIMINAL ( ) YES ( ) NO

     DRIVER RECORD ( ) YES ( ) NO

    5. Do you maintain photographs and/or fingerprint records of all employees? ( ) yes ( ) no

    6. Do you conduct and document periodic, random drug tests? ( ) yes ( ) no

    7. Are employees required to wear or carry the following on duty? uniform ( ) yes ( ) no

     sidearms ( ) yes ( ) no

8. List any other protective items issued or provided to employees:

    9. Do you immediately collect I.D. cards, name tags, uniforms and other company identification from employees

     when they leave your service? ( ) yes ( ) no

10. TRAINING:

     A. Do you have a formal training program? ( ) yes ( ) no

     B. Do you have a written procedures manual? ( ) yes ( ) no

     (if “yes”, please provide a copy.)

     C. Do you use this manual as a basis for training? ( ) yes ( ) no

     D. What is the minimum period of training time you require new employees to complete before you use them

    in your operation?

    11. Does management regularly monitor operational crew performance and retain such records on file?

     ( ) yes ( ) no

    12. Do you conduct and document random credit checks on existing employees? ( ) yes ( ) no

    Ed. 11/99 Page 3 of 10

VAULT & PREMISES: (Complete one of the attached Vault Exposure sheets for each additional premises.)

    1. Limits of insurance required: Deductible: ____________________ Current

     ______________________ Requested

2. EXPOSURES

    DAY MAXIMUM FREQUENCY THE MAXIMUM AVERAGE AT RISK

    IS AT RISK MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

3. Are maximums because of federal reserve runs or some other special contract? ( ) yes ( ) no

     If yes, please explain?

4. Please show exposures by percentage:

     CASH ______________% COIN _____________% PRECIOUS METALS

    ____________%

     FOOD STAMPS ______________% JEWELRY _____________% OTHER

    ___________%

5. Please describe all vaults and safes:

    LOCATION MANUFACTURER U.L. RATING DUAL COMBINATION USED?

6. Do the vaults and safes have time locks? ( ) yes ( ) no

     If „yes”, are they set every evening and over the weekend? ( ) yes ( ) no

     If “no”, please explain.

Ed. 11/99 Page 4 of 10

VAULT & PREMISES CONTINUED:

    7. Describe the alarm systems that protect the premises, vaults and safes:

PREMISES:

    LOCATION ALARM COMPANY CENTRAL STATION? U.L. EXTENT 2? U.L. GRADE AA?

VAULT:

    LOCATION ALARM COMPANY CENTRAL STATION? U.L.VAULT U.L. GRADE AA?

    COMPLETE?

SAFE:

    LOCATION ALARM COMPANY CENTRAL STATION? U.L. SAFE U.L. GRADE AA?

    COMPLETE?

8. Are all alarms U.L. certified? ( ) yes ( ) no (Please attach a copy of U.L. alarm certificates for each

    location.)

9. Are they maintained under service contract? ( ) yes ( ) no

10. Does any one person in your company have the complete combinations and alarm codes? ( ) yes ( )

    no If yes, please explain who and why.

11. Are all terminal openings done with at least 2 armed employees present? ( ) yes ( )

    no

12. Are portable duress alarms used during terminal openings? ( ) yes ( )

    no

13. In case of an attack at the time of opening, do the alarm systems have a duress code, which is known by the

     opening employees, that would send an alarm if the code was entered? ( ) yes ( ) no

14. Are the employees always required to use it? ( ) yes ( )

    no

15. What is the response time to an alarm by the police? __________________

16. In case of an attack on a terminal, do you have a duress code or alarm which would instruct all vehicles to

     disregard further orders from that terminal and proceed directly to the nearest police station (or similar

     emergency procedure)?

    Ed. 11/99 Page 5 of 10 VAULT & PREMISES CONTINUED:

    17. Do you practice “joint custody” in the opening and closing of all safes and vaults? ( ) yes ( ) no

     If no, please explain why not.

“Joint custody” means the handling of the above in the presence of and under the observation of at least one other

    person being equally accountable for the physical protection and safeguarding of the various records or items

    involved. Locks and combination on vaults and safes are arranged so that no one person can open them alone.

18. How often are alarm codes and combinations changed? _______________________

    19. Are your premises normally manned 24 hours per day? ( ) yes ( ) no

CLOSE CURCUIT TV

    1. Do all of your terminals use CCTV Cameras” ( ) yes ( ) no 24 hours per day? ( ) yes

     ( ) no

    2. How many CCTV cameras are used at each terminal? ______________________

    3. Are cameras hooked up to VCR‟s and recorded? ( ) yes ( ) no

    4. How long are the tapes retained? ____________

    5. Are tapes randomly reviewed by management? ( ) yes ( ) no

    6. If so, are all improper procedures noted by management reviewed with the employee to correct future mistakes?

     ( ) yes ( ) no

TRANSIT

    1. Limits of insurance required: Deductible: _______________ Current

     __________________ Requested

    2. What is the total number of armored vehicles in regular service? ________ How many spares? ___________

    3. Are all armored vehicles equipped with bulkheads? ( ) yes ( ) no

    4. What is the minimum number of crew assigned to each armored vehicle including the driver? _____________

    5. Are vehicles ever left unattended with liability on board? ( ) yes ( ) no

     Unattended means all crew members are outside of the vehicle at the same time.

     If yes, please explain:

6. Are armored vehicles equipped with kill switches? ( ) yes ( ) no

    7. Are armored vehicles equipped with tracking devices? ( ) yes ( ) no

    8. EXPOSURES: (Complete one of the attached Transit Exposures sheets for each additional premises.)

    DAY NUMBER OF NUMBER OF NUMBER MAXIMUM FOR AVERAGE FOR MAXIMUM AVERAGE ROUTES VEHICLES OF STOPS VEHICLE VEHICLE PAVEMENT PAVEMENT CARRYING THE EXPOSURE EXPOSURE MAXIMUM MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY Ed. 11/99 Page 6 of 10

TRANSIT CONTINUED:

    9. Are maximums because of federal reserve runs or some other special contract? ( ) yes ( ) no

     Please explain how many trucks are involved.

10. Exposures by percentage:

     CASH: ___________________% COIN _________________%

     FOOD STAMPS: ___________________% OTHER _________________%

11. Do you use any of the following equipment on your vehicle?

     Locked cargo drop ( ) yes ( ) no Locked cage ( ) yes ( ) no Other ( ) yes ( ) no

12. Will your vehicles be kept in a secure locked and enclosed premises when not in service?

     ( ) yes ( ) no If not, where will they be kept?

    13. Are vehicle keys signed out by the crew in the morning and signed back in by crew upon their return?

     ( ) yes ( ) no

14. Does management regularly conduct street inspections on the performance of its‟ crew and retain such records

     on file? ( ) yes ( ) no

15. Please describe your radio communications system:

16. Do you ever carry currency or other valuables in unarmored vehicles? ( ) yes ( ) no

     If yes, please explain:

Please attach a copy of your customer service contract.

AUTOMATIC TELLER MACHINES: If you conduct ATM operations please complete this section

1. Limits of insurance required: Deductible: _________________ Current

     _________________ Requested

2. What services do you provide?

     ( ) MACHINE MALFUNCTION ( ) CASH REPLENISHMENT

     ( ) DEPOSIT PICKUP ( ) FULL SERVICE

3. How many ATM‟s do you service?_______________

4. What percentage of the ATMs you service use the Mas-Hamilton locks? _________________

5. Do you use armored vehicles for all of your ATM cash replenishment? ( ) yes ( ) no

     If not, please explain the type of vehicle used and the security afforded.

6. Are your ATM vehicles ever left unattended? ( ) yes ( ) no

     If yes, explain why?

Ed. 11/99 Page 7 of 10

AUTOMATIC TELLER MACHINES CONTINUED:

7. Do you use a minimum of a two (2) person crew? ( ) yes ( ) no

     If no, please explain:

8. Are all machines serviced equipped with cassettes? ( ) yes ( ) no

9. When crews are replenishing funds within an ATM, are they performing

    “cash adds” or “cassette swaps”? (please circle) ____________________

10. If they are performing “cash adds” do they reconcile/verify that the amount

    of money in the ATM is accurate each time? ( ) yes

     ( ) no

I/WE HEREBY DECLARE THAT THE ABOVE INFORMATION IS TRUE AND I/WE HAVE NOT SUPPRESSED

    OR MISSTATED ANY MATERIAL FACTS TO THE BEST OF MY/OUR KNOWLEDGE.

THE SIGNING OF THIS APPLICATION DOES NOT BIND THE APPLICANT OR THE INSURER(S) TO

    COMPLETE THE INSURANCE. ANY COVERAGE IN PLACE WILL BE VOID IF YOU INTENTIONALLY

    CONCEAL OR MISREPRESENT ANY MATERIAL FACT OR MAKE FALSE STATEMENTS.

ALL WRITTEN STATEMENTS AND MATERIALS FURNISHED TO THE INSURER(S) IN CONJUNCTION

    WITH THIS APPLICATION ARE HEREBY INCORPORATED BY REFERENCE INTO THIS APPLICATION

    AND MADE A PART THEREOF.

SIGNATURE: ______________________________________ TITLE: ___________________________ DATE:

    ______________

Ed. 11/99 Page 8 of 10

     VAULT/PREMISES EXPOSURE

    LOCATION: __________________________________

     DAY MAXIMUM VALUES FREQUENCY MAX. IS AT AVERAGE VALUES STORED IN

    STORED IN VAULT RISK (i.e. #times per month) VAULT

     MONDAY

     TUESDAY

     WEDNESDAY

     THURSDAY

     FRIDAY

     SATURDAY

     SUNDAY

**Please provide copy of U.L. certificate for Vault & Premises alarm systems.

Ed. 11/99 Page 9 of 10

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