Subway Sandwiches and Salads Ltd.

Application

Legal Name of Store (Corp., Ltd., or Inc. #)
Store Number / AIR MILES® Rewards Number
Owner’s Name
Business Telephone Number / Mobile Telephone Number
Email Address
Effective Date Coverage Required
Mailing address
City / Province / Postal code

Location Information

Please copy pages 1 & 2 and complete for all locations to be insured
New Location / Owned / Existing Location / Leased
Location address
City / Province / Postal code
Location Type / Food Court
Strip Mall / Power Centre / Stand-Alone Building
Gas Station Drive Thru? Yes No
Approximate Total Seating Capacity
Year built / Total area / sq. ft.
Occupancy of immediately adjacent premises / Right / Distance / sq. ft.
Left / Distance / sq. ft.
Mortgagee / Loss Payee’s Name
Mortgagee / Loss Payee’s Address
Additional Named Insured
Nature of Interest
Additional Named Insured
Nature of Interest
Development Agent’s Name
Landlord’s Name
Landlord’s Address


Construction

If the answer is no, skip this section and move on to “Property Values”

Do you require building insurance? / Yes No
If yes, please complete the following section:
Walls / Floors / Roof
Have there been any renovations/upgrades at this location? / Yes No
If yes, describe (and provide dates)

Protection

Hydrants / Yes No / Full-time fire department within
5 miles / Volunteer fire department within
5 miles
Sprinklers / Yes No / Central station / Local alarm / % bldg sprinklered
Extinguishers / Yes No
Smoke Detectors / Yes No
Burglar Alarm / Yes No / Central station / Local alarm
Watchman Service / Yes No / 24 hours / When business is closed

Property Values

This schedule of values and declaration does not form part of the policy but is the basis of limits and property insured, so omissions and misstatements could affect coverage.

Note: Any column total showing zero or left blank indicates that there is no coverage required

Buildings (only if you own) / Computer Equipment
Contents/ Equipment/
Tenants’ Improvements/ Stock / Data and Media
Subway Signs
Total Insurable Value / $

Exposure Details

What is the maximum amount at any one location?
Money inside premises / $
Money inside premises overnight / $
Please provide details on the store safe in the space provided


General Liability

Estimated gross annual sales/revenue / CAD $
Gross annual payroll / $
Employee count / Salaried / Part-time / Other
Are any employees not covered by Canadian Workers’ Compensation?
(including contract employees and volunteers) / Yes No
If yes, how many? / Position
Do you subcontract work to independent contractors? (including Snow Removal) / Yes No
If yes, annual cost / $
Do you provide a delivery service? / Yes No
If yes, describe
Do your partners, officers and employees use automobiles not owned by you on company business? (Including banking duties, delivery services, etc.) / Yes No
If yes, provide number of employee owned automobiles used
Do you refuel any vehicles on your premises? / Yes No
If yes, list locations
Please attach your five year claims experience or complete the following:
Date of Loss (dd-mmm-yy) / Description of Loss / Paid
$
$
$
$

Declaration and Signature

The undersigned declares that to the best of his or her knowledge and belief the statements set forth herein are true. The Insurance Company is hereby authorized to make any investigation or inquiry in connection with this application that it deems necessary.

This application must be signed by the Franchisee or other person responsible for purchasing insurance.

Print Name / Date
Signature
IMPORTANT: This report contains proprietary and original material which, if released, could be harmful to the competitive position of
Aon Reed Stenhouse Inc. Accordingly, this document may not be copied or released to third parties without Aon’s consent. / 2
Aon Risk Solutions is a trademark of Aon Reed Stenhouse Inc., Aon Canada Inc. and Aon Parizeau Inc.