Cosmetology & Spa Insurance Quote Step 1 of 3 33% Applicant Name(s)Email Phone NumberOperating NameRisk Location Addresse.g. 10 Water Street, Somecity, ON. A1A 1A1 Year Established:YYYYHow many years of experience does the Applicant have (including all employment and practicum while at school)?Total number of employees (including the Applicant): Risk InfoDoes the applicant carry all licenses and permits where it is required by law? Yes No Does the applicant follow all applicable health authority rules and regulations where required? Yes No Does the applicant ensure all technicians have training in the services provided? Yes No In the last 5 years, has the applicant been subject to any allegations of misconduct or professional negligence? Yes No DetailsOperationsWhat are the anticipated total gross revenues for the next 12 months?Specialty Aesthetic ServicesDoes the applicant provide more than Hair and Nail services? Yes No Total Revenues from Specialty Aesthetic Services (%):Acid peels with solution concentration levels greater than 30%? Yes No Bioresonance diagnostics and therapy? Yes No Cold-process body contouring (excludes laser and liposuction)? Yes No Micro Blading including Powder brows, Ombre Brows? Yes No Micro needling of any kind - including facials with cream tattoos? Yes No Micropigmentation? Yes No Mole, Skin tags, and wart removal by any means? Yes No Vaginal rejuvenation, penis enlargement and incontinence treatments? Yes No TanningDoes the Applicant have tanning beds or booths (excluding spray tan application)? Yes No Revenues from Tanning services (%):Does the applicant obtain signed /dated consent and waiver forms (guardians on behalf of minors)? Yes No Does the applicant maintain all client records for a minimum of 7 years? Yes No Does the applicant ensure eye protection is worn during services (other than spray tanning)? Yes No Does the applicant follow all manufacturers’ guidelines with respect to operation/maintenance? Yes No Laser, IPL, LED or LHEDoes the applicant provide cosmetic treatments involving Laser, IPL, LED or LHE? Yes No Revenues from Laser, IPL, LED or LHE services (%):Does the applicant obtain signed /dated consent and waiver forms? Yes No Does the applicant maintain all client records for a minimum of 7 years? Yes No Does the applicant ensure eye protection is worn during services (other than spray tanning)? Yes No Does the applicant follow all manufacturers’ guidelines with respect to operation/maintenance? Yes No Does the applicant obtain pre-service medical history from customers? Yes No Does the applicant provide aftercare instructions to all customers? Yes No Does the Applicant only use commercially rated machines? Yes No Cosmetic InjectionsDoes the Applicant provide Cosmetic Injections? Yes No Revenues from Cosmetic Injections (%):Does the applicant obtain signed /dated consent and waiver forms? Yes No Does the applicant maintain all client records for a minimum of 7 years? Yes No Does the applicant provide only Health Canada approved injections? Yes No Does the applicant provide aftercare instructions to all customers (where required)? Yes No Does the applicant provide weight loss injections? Yes No Does the applicant obtain written pre-service medical history from the customers? Yes No Does the applicant ensure medical professionals are licensed/registered in Canada? Yes No Vitamin Injections / IV TherapyDoes the Applicant provide Vitamin Injections and/or IV Therapies? Yes No Revenues from Vitamin Injections and/or IV Therapies (%):Does the applicant obtain signed /dated consent and waiver forms? Yes No Does the applicant maintain all client records for a minimum of 7 years? Yes No Does the applicant provide aftercare instructions to all customers (where required)? Yes No Does the applicant provide only Health Canada approved injections? Yes No Does the applicant provide weight loss injections? Yes No Does the applicant obtain written pre-service medical history from the customers? Yes No Does the applicant ensure medical professionals are licensed/registered in Canada? Yes No Training SchoolIs the applicant a formal training School? Yes No Revenues from Cosmetology Training, other than Laser (%):Percentage of above revenues from Laser, IPL, LED or LHE training (%)Does the applicant permit students to perform services to the general public? Yes No Does the applicant ensure students are always supervised during services? Yes No Does the applicant inform patrons that services are being performed by students/apprentices? Yes No Loss HistoryHas the applicant had any claims in the last five years? Yes No Date of claim: MM slash DD slash YYYY Nature of claim:Please selectLiability - Property damage to othersLiability - Bodily injuryLiability - Financial loss to othersLiability - OtherProperty - Vehicle impact/aircraft impactProperty - Fire (not arson)Property - Fire by arsonProperty - BurglaryProperty - Change in TemperatureProperty - Change in temperatureProperty - EarthquakeProperty - Electrical currentProperty - ExplosionProperty - Falling objectProperty - FloodProperty - FreezingProperty - HailProperty - LandslideProperty - LightningProperty - Malicious actsProperty - OtherProperty - Overland waterProperty - RiotProperty - Sewer backupProperty - SmokeProperty - WindstormProperty - VandalismProperty - Vandalism by tenantProperty - TheftProperty - WaterProperty - Snow or iceProperty - Equipment breakdownLoss / Expenses Paid:Is the claim closed? Yes No Have all damages been repaired? Yes No Describe the loss control measures that are now in place to avoid a future similar loss:Has the Applicant had more than one claim or loss in the past five (5) years? Yes No Date of 2nd claim: MM slash DD slash YYYY Nature of 2nd claim:Please selectLiability - Property damage to othersLiability - Bodily injuryLiability - Financial loss to othersLiability - OtherProperty - Vehicle impact/aircraft impactProperty - Fire (not arson)Property - Fire by arsonProperty - BurglaryProperty - Change in TemperatureProperty - Change in temperatureProperty - EarthquakeProperty - Electrical currentProperty - ExplosionProperty - Falling objectProperty - FloodProperty - FreezingProperty - HailProperty - LandslideProperty - LightningProperty - Malicious actsProperty - OtherProperty - Overland waterProperty - RiotProperty - Sewer backupProperty - SmokeProperty - WindstormProperty - VandalismProperty - Vandalism by tenantProperty - TheftProperty - WaterProperty - Snow or iceProperty - Equipment breakdownLoss / Expenses Paid on 2nd claim:Is the 2nd claim closed? Yes No Have all damages been repaired? Yes No Describe the loss control measures that are now in place to avoid a future similar loss:Has the Applicant had more than two claims or loss in the past five (5) years? Yes No Date of 3rd claim: MM slash DD slash YYYY Nature of 3rd claim:Please selectLiability - Property damage to othersLiability - Bodily injuryLiability - Financial loss to othersLiability - OtherProperty - Vehicle impact/aircraft impactProperty - Fire (not arson)Property - Fire by arsonProperty - BurglaryProperty - Change in TemperatureProperty - Change in temperatureProperty - EarthquakeProperty - Electrical currentProperty - ExplosionProperty - Falling objectProperty - FloodProperty - FreezingProperty - HailProperty - LandslideProperty - LightningProperty - Malicious actsProperty - OtherProperty - Overland waterProperty - RiotProperty - Sewer backupProperty - SmokeProperty - WindstormProperty - VandalismProperty - Vandalism by tenantProperty - TheftProperty - WaterProperty - Snow or iceProperty - Equipment breakdownLoss / Expenses Paid on 3rd claim:Is the 3rd claim closed? Yes No Have all damages been repaired? Yes No Describe the loss control measures that are now in place to avoid a future similar loss:Prior InsuranceDoes the Applicant currently carry Commercial General Liability coverage? Yes No Current Insurer Name:Policy Number:Premium:Current Insurance Expiry Date MM slash DD slash YYYY Does the Applicant currently carry Professional/Malpractice coverage? Yes No Current Insurer Name:Policy Number:PremiumRetroactive Date on current in-force policy: MM slash DD slash YYYY Limits on current in-force policy:Please select:$1,000,000$2,000,000$5,000,000Has the Applicant ever had insurance cancelled, declined or refused? Yes No Reason for decline/refusal/cancellationPlease selectDue to claimsDue to condition of buildingDue to non-payment, all outstanding premium has been paidDue to non-payment, all outstanding premium has NOT been paidDue to online salesDue to other underwriting reasonsDue to types of goods soldDue to vacancyInsurer is no longer willing to write this classOtherProvide details: CoveragesCommercial General Liability:Please select$1,000,000$2,000,000$3,000,000$5,000,000Tenants Legal Liability:Please select$250,000$500,000$1,000,000Tenants Legal Liability:Please select$250,000$500,000$1,000,000$2,000,000Tenants Legal Liability:Please select$250,000$500,000$1,000,000$2,000,000$5,000,000Employment Benefits Liability Extension:Please select$0 - Not required$1,000,000Employment Benefits Liability Extension:Please select$0 - Not required$1,000,000$2,000,000Employers Liability:Please select$0 - Not required$1,000,000Employers Liability:Please select$0 - Not required$1,000,000$2,000,000Non-owned Auto Limit:Please select$0 - Not required$1,000,000Non-owned Auto Limit:Please select$0 - Not required$1,000,000$2,000,000Non-owned Auto Limit:$0 - Not required$1,000,000$2,000,000$5,000,000Does the applicant require property coverage? Yes No Contents of Every Description (combined single limit for “Business Personal Property” and “Stock/Inventory”) – includes furnishings, tenants improvements, and machinery and tools usual to the business – EXCLUDES coverage for Laser/IPL Equipment, unless a limit shown belowLaser / IPL EquipmentMiscellaneous Articles FloaterDoes the applicant require Business Interruption - Actual Loss Sustained coverage ? Yes No Business Interruption – Profits (ALS -12 months' indemnity):Flood Coverage Yes No Earthquake Coverage Yes No Sewage Backup Coverage Yes No Water Damage Deductible:Please select$5,000$10,000$25,000Optional Crime CoverageOptional Crime Coverage:Please select$0 - Not required$10,000$25,000Optional Equipment Breakdown CoverageOptional Equipment Breakdown Not required Required Value of equipment:Building InformationProperty Deductible:Please select$1,000$2,500$5,000$10,000$25,000Location / Building DetailsBuilding Construction:Please selectWood FrameMasonry veneerMasonry (including mill)LogNon-combustable - HCBNon-combustable - (All steel structure)Fire resistive (poured concrete)Fire resistive (concrete tilt up)Modular / PrefabSteel frame with fabric coveringClayStrawInsulated concrete formsWhat year was the building built?Square footage:Roofing Material:Please selectAsphalt shinglesCedarClay / slateFlat Deck / Tar + GravelGreenMetalRubberStrawThatchedZincMultiple - more than one of the above roof typesYear of latest roof update:Heating:Please selectBaseboard electricBoiler - in floor radiant heatBoiler - water baseboardCombination - forced air furnace with add on wood burning unitFireplace insertsForced air furnaceHeat pumpPlug-in space heatersRadiant ceiling heat panels - electricStoves (Wood heat, pellet)Wall furnace Wall heaterWood heat applianceBuilding is not heatedRoof top HVAC systemYear of latest heating update:Electrical:Please selectCircuit breakersFusesMixed - more than one of the above typesYear of latest update to electricalPlumbing type:Please selectCopper, PEX, PVC, ABSPolybutyleneGalvanized steelKitecCast ironMixed - more than one of the above types of plumbingBuilding does not have plumbingYear of latest update to plumbingDoes the premises have a monitored alarm (both fire and burglary) system? Yes No Does the premises have security bars or security film installed on all glass windows and doors? Yes No Is the premises sprinklered? Yes No
