Kennel Insurance Application

Kennel Insurance Application Applicant Information Date: Company Name: Your Name

Mailing Address: City State Zip

Property Address: City State Zip Phone: ( ) E-mail Address:

Business Entity: Full Time Employees Part Time:

Business Website: YES NO Have there been any claims within the last 5 YES NO Is Building Sprinklered? years? YES NO Less than 1000' from Hydrant? If yes, when? Is distance to responding fire station less YES NO than 5 miles? Property County

Year Business Was Established Burglar Alarm Type: Fire Alarm Type:

Building Construction type: Wood Frame Brick Metal Other

Year Built Total Square Feet Number of Stories

Interest type: Owner Occupant Tennant Replacement Value of Building $

Business Property and Contents Value: $

Desired Deductible: $250 $500 $1000 $2500 $5000

General Liability: $300,000 $500,000 $1,000,000 $2,000,000 Other

Animal Bailee: $25,000 $50,000 $100,000 $160,000 Other

Note: See page 2 for explanation of this coverage.

Animal Theft: $25,000 $50,000 $100,000 $160,000 Other

Pet Services Professional Liability If yes how many employees do you want covered Yes No

Check all that apply Overnight Boarding Pet Grooming Dog Breeding Rescue/Shelter

Current Insurance Co. Renewal Date:

Please fill in all fields of this application and Fax, E-mail or Mail a copy to the Ford Insurance Agency.

E-Mail: [email protected]

Fax: 207.439.6805

Mail: Ford Insurance Agency, Inc 2 Harold L Dow Highway Eliot, Maine 03903

Insurance Definitions that apply to this Application:

Animal Bailee: This coverage applies “all risk” coverage to loss of domestic animals of others, including their accessories in the insured’s care, custody or control. Animals are valued at market value at the time of loss or damage. Coverage does not apply to animals held for sale, animals belonging to the insured, or animals in the care, custody or control of other bailees. Special Exclusions include death from natural causes, veterinary treatment process and unexplained disappearance or misdelivery. Theft is also excluded if the animal is left in a vehicle overnight. This coverage is recommended for Veterinarians and Pet Groomers.

Animal Theft: Coverage applies for theft of domestic animals that are owned by the insured and held for sale, as well as animals owned by others and boarded by the insured. Animals are valued at market value at the time of loss or damage. This coverage is recommended for Pet Stores.

Pet Services Professional Liability: applies to claims made against the named insured for damages caused by a negligent act, error or omission of the insured or of any person for whom the insured is legally liable while performing pet services. Refer to form for a complete list of covered and excluded pet services.