Renewal Energy Insurance:

Solar Energy Manufacturers and Wholesalers

Applicant’s Name: / Applicant’s Web Address:
Broker Name:
Applicant’s Address: / Postal Code:

Please answer all questions

Provide a short description of your manufacturing processes, or if you’re a wholesaler, describe any assembly, packaging, and labeling processes:
List all items manufactured / distributed (a product list may be attached separately):
Years in Business: / < 5 years / 5 – 9 years / 10 – 19 years / > 20 years
Firm Size: / 1 – 2 employees / 3 – 5 employees / 6 – 24 employees / > 25 employees
Technology: (check all that apply)
Photovoltaic / Solar Domestic Hot Water / Solar Commercial / Industrial Water Heating
Solar Pool Heating / Solar Air Heating / Solar Combi Systems (water & air)
Daylighting / Passive Solar Heating / Solar Cooling
Percent of Your Total Annual Revenue Related to the Solar Industry: /
<25% / 25 – 50% / 51 – 75% / >75% / N/A
Total Annual Revenue / Manufacturing Revenue / Installation Revenue / Wholesale Revenue / Retail Sales Revenue / Other (specify)
Canada:
U.S.A:
Other:
Provide descriptions of all products exported to the U.S.
Questionnaire:
1. / a) Are sub-contractors involved in any part of the manufacturing or installation process? Yes No N/A
b) Do you request proof of third party liability insurance? Yes No N/A
c) Do you assume contractual liability for sub-contractors? Yes No N/A
2. / a) Do you provide or oversee any installations? Yes No
b) If “Yes”, please also complete the Solar Energy Contractors Application.
3. / a) Has any product been discontinued, or has a product recall been ordered, during the last five years? Yes No
b) If “Yes”, provide details:
4. / Do you import any components for product manufacturing or finished products for distribution? Yes No
If “Yes”, describe the components/products and indicate the countries of origin:
5. / Do you have any business locations located outside Canada? Yes No
If “Yes”, describe:
6. / Have you signed any contracts containing a “hold harmless” clause that favours others? Yes No

Trade Association Memberships:

CanSIA Yes No Other:

Loss experience (Past 5 years):

The undersigned declares that all statements made in this Application are true. Signing of this document does not bind the Applicant to complete the insurance, but it is agreed that the Application shall be the basis for the contract, should the policy be issued.

Information provided by / Title
Signature / Date
2 / Solar Energy - Risk Application / Printed in Canada
on recycled paper /

31608 (03/2007) Royal & Sun Alliance Insurance Company of Canada