Application Form Page 3
ADVERTISEMENT
1
2
3
4EMPLOYMENT PRACTICES COVERAGE DETAILS
20. Total number of Employees of the Applicants Firm:
Full time?_______________
Part time?_______________
Total number of superintendents and maintenance staff who are employed by the owner of the property being managed. Do not include
independent contractors.
Full time?_______________
Part time? _____________
21. Has there been any reduction of employees in the past 12 months or is a reduction anticipated in the next 12 months?
q Yes
q No
If Yes, attach details including percentage.
q Yes
q No
22. Does the Organization currently carry Employment Practices Liability Insurance?
If Yes, please advise Insurance Co., Limit of Liability, expiring premium and date from which this coverage has been
continuously carried:_____________________________________________________________________________________________
23. Within the past 5 years has the Organization or any individual proposed for Insurance received any employment related inquiry,
complaint or notice of hearing from any Municipal, State or Federal Regulatory Authority or Congressional or Legislative Committee
(Including, but not limited to, Equal Employment Opportunity Commission (E.E.O.C.) and State Human Rights cases)? q Yes q No
24. Within the past 5 years, has any employment related claim been made, or is any employment related claim of Sexual Harassment,
Discrimination or Wrongful Termination now pending, against the Organization, or any person proposed for Insurance in the capacity of
q Yes
q No
either Director, Officer, or Employee of the Organization?
25. Is any person proposed for this Insurance aware of any fact, circumstance or situation which may result if an employment claim includ-
ing, but not limited to, Sexual Harassment, Discrimination, or Wrongful Termination against the Organization or any of its Directors,
q Yes
q No
Officers, or Employees?
If "Yes", to any of 23-25 please complete the Supplemental Claims Form.
26. Please complete only if applying for Tenant Discrimination Coverage.
Mandatory Written Policies - please identify if Applicant has in place:
q Yes
q No
Third Party Discrimination Policy:
Please forward a copy of the policy identified above along with this signed and dated Application. If you do not have these written policies
in place, the Company will provide you with sample policies at the time of binding this insurance.
27. Please complete only if applying for Employment Practices Coverage.
Mandatory Written Policies - please identify if Applicant has in place:
Sexual Harassment Policy (applies to employees and third parties): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . q Yes
q No
Anti-Discrimination Policy (applies to employees and third parties): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . q Yes
q No
Please forward copies of the policies identified above along with this signed and dated Application. If you do not have these written poli-
cies in place, the Company will provide you with sample policies at the time of binding this insurance.
Recommended Written Policies - please identify policies Applicant has in place:
Employment Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . q Yes
q No
Employee Handbook. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . q Yes
q No
Company Email/Internet Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . q Yes
q No
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business