Interview Question Reference

Prime Vintage Insurance

Supplemental Application — Interview Question Reference

285 questions · 14 steps

Step AApplicant Information10q Step BGeneral Information65q Step CRevenue Breakdown25q Step DWine Stock Inventory1q Step EProperty34q Step FLiability Coverage13q Step GAdditional Coverage23q Step HAuto Supplemental8q Step IRestaurant / Food Service30q Step JB&B / Guest House24q Step KRV / Camping16q Step LProfessional Liability E&O14q Step MEmployment Practices Liability16q Step NSign & Submit6q

Step AApplicant Information10 questions

Field ID

Question

namedInsured

A1 — What is the legal name of the business being insured?

Enter the full legal business name as it appears on your license.

mailingAddress

A2 — What is the mailing address?

Street, City, State, ZIP

phone

A3 — What is the best phone number to reach the business?

A4 — What is the business email address?

website

A5 — Do you have a website? If so, what is the URL?

Optional

effectiveDate

A6 — What is the requested policy effective date?

brokerName

A7 — What is the name of the submitting broker or agent?

brokerAgency

A8 — What agency are they with?

brokerPhone

A9 — What is the broker's phone number?

brokerEmail

A10 — What is the broker's email address?

Step BGeneral Information65 questions

Field ID

Question

c1HasInsurance

B1 — Does the business currently carry winery insurance?

c1CurrentCarrier

B2 — Who are you currently insured with?

If: B1 = Yes

c1EffectiveDate

B3 — What is your current policy effective date?

If: B1 = Yes

c1HasLossRuns

B4 — Do you have loss runs available?

If: B1 = Yes

c1LossRunsUpload

B5 — Please upload your loss runs document.

If: B4 = Yes

c1NewVenture

B6 — Is this a new venture?

If: B1 = No

c1NewVentureYears

B7 — How many years of experience in the winery business does ownership have?

If: B6 = Yes

c1LapsedReason

B8 — Why did coverage lapse?

If: B6 = No

c1PriorLosses

B9 — Have there been any losses or claims in the past 5 years?

c1LossDate

B10 — What was the date of loss?

If: B9 = Yes

c1LossAmount

B11 — What was the dollar amount paid?

If: B9 = Yes

c1LossDescription

B12 — Please describe the loss or claim.

If: B9 = Yes

c2YearsInBusiness

B13 — How many years has the winery been in operation?

c3FullTime

B14 — How many full-time employees do you have?

c3PartTime

B15 — How many part-time or seasonal employees?

c5WinemakerName

B16 — What is the name of your head winemaker?

c5WinemakerYears

B17 — How many years of winemaking experience do they have?

c6WholesalerPercent

B18 — What percentage of sales go through wholesalers/distributors?

c6RetailDirectPercent

B19 — What percentage is sold retail/direct-to-consumer?

Tasting room, wine club, online, etc.

c7OffSiteVenues

B20 — Do you sell or pour wine at off-site venues or events?

c7OffSiteVenueDetails

B21 — Please describe the off-site venues or events.

If: B20 = Yes

c7OffSiteEventsCount

B22 — How many off-site events do you participate in annually?

If: B20 = Yes

c8Contractors

B23 — Do you use independent contractors for any winery operations?

c8ContractorsDetails

B24 — Please describe the contractor work performed.

If: B23 = Yes

c9BottleOwn

B25 — Do you bottle your own wine on-site?

c9BottlingLineDetails

B26 — Do you own the bottling line or use a mobile bottler?

If: B25 = Yes

c10BottleForOthers

B27 — Do you bottle wine for other producers?

c10BottleForOthersCases

B28 — How many cases do you bottle for others annually?

If: B27 = Yes

c11OwnsVineyard

B29 — Do you own or operate a vineyard?

c11TotalAcres

B30 — How many total acres does the property encompass?

If: B29 = Yes

c11PlantedAcres

B31 — How many of those acres are planted with vines?

If: B29 = Yes

c12HostsEvents

B32 — Do you host special events on the property?

Weddings, concerts, festivals, private dinners, etc.

c12EventsUnder50

B33 — How many events per year have fewer than 50 guests?

If: B32 = Yes

c12Events50to100

B34 — How many events per year have 50–100 guests?

If: B32 = Yes

c12Events100to250

B35 — How many events per year have 100–250 guests?

If: B32 = Yes

c12EventsOver250

B36 — How many events per year have more than 250 guests?

If: B32 = Yes

c13RentsFacility

B37 — Do you rent out your facility to third parties for their events?

c13ThirdPartyCoi

B38 — Do you receive a certificate of insurance from the third party?

If: B37 = Yes

c13RentalEventsUnder50

B39 — How many third-party rental events per year have fewer than 50 guests?

If: B37 = Yes

c13RentalEvents50to100

B40 — How many rental events per year have 50–100 guests?

If: B37 = Yes

c13RentalEvents100to250

B41 — How many rental events per year have 100–250 guests?

If: B37 = Yes

c13RentalEventsOver250

B42 — How many rental events per year have more than 250 guests?

If: B37 = Yes

c14LiveMusic

B43 — Do you host live music on the property?

c14LiveMusicRevenue

B44 — What is the annual revenue attributed to live music events?

If: B43 = Yes

c14MusicTastingRoomOnly

B45 — Is live music limited to the tasting room only?

If: B43 = Yes

c14MusicOtherVenues

B46 — Where else is live music performed on the property?

If: B45 = No

c14MusicVendorCerts

B47 — Do music vendors provide their own certificates of insurance?

If: B43 = Yes

c15PrimaryResidence

B48 — Is there a primary residence on the property?

c15ResidenceInsuredElsewhere

B49 — Is the residence insured under a separate homeowners policy?

If: B48 = Yes

c15ResidenceCarrier

B50 — Who is the carrier for the homeowners policy?

If: B49 = Yes

c16OtherDwellings

B51 — Are there any other dwellings on the property (employee housing, guest cottages, etc.)?

c16DwellingCount

B52 — How many additional dwellings are on the property?

If: B51 = Yes

c16DwellingsOccupiedFullTime

B53 — Are any of these dwellings occupied full-time?

If: B51 = Yes

c17Pool

B54 — Is there a swimming pool on the property?

c17PoolDivingBoard

B55 — Does the pool have a diving board or slide?

If: B54 = Yes

c17PoolFenced

B56 — Is the pool fully fenced?

If: B54 = Yes

c17PoolSelfLatchingGate

B57 — Does the fence have a self-latching gate?

If: B56 = Yes

c17PoolSignsPosted

B58 — Are pool rules and no-diving signs posted?

If: B54 = Yes

c18OtherCrops

B59 — Do you grow any crops other than grapes or apples on the property?

c18OtherCropsDetails

B60 — What other crops do you grow?

If: B59 = Yes

c19Livestock

B61 — Do you keep any livestock on the property?

c19LivestockFenced

B62 — Is the livestock area fully fenced and separated from visitor areas?

If: B61 = Yes

c19LivestockVisitorInteraction

B63 — Do visitors interact with the livestock?

If: B61 = Yes

c20Watercraft

B64 — Is there any watercraft on the property?

c20WatercraftDetails

B65 — Please describe the watercraft and how they are used.

If: B64 = Yes

Step CRevenue Breakdown25 questions

Field ID

Question

bGrossRevenue

C1 — What is your total gross revenue for the most recent completed fiscal year?

Include all revenue sources: wine sales, tasting room, events, lodging, food, merchandise, etc.

b1ProduceWine

C2 — Do you produce bottled wine?

b1CasedWineCases

C3 — How many cases of bottled wine do you sell annually?

If: C2 = Yes

b1CasedWineRevenue

C4 — What is the annual revenue from bottled wine sales?

If: C2 = Yes

b2SellBulkWine

C5 — Do you sell bulk wine?

b2BulkWineGallons

C6 — How many gallons of bulk wine do you sell annually?

If: C5 = Yes

b2BulkWineRevenue

C7 — What is the annual revenue from bulk wine sales?

If: C5 = Yes

b3SellBulkFruit

C8 — Do you sell bulk grapes or apples?

b3BulkFruitTons

C9 — How many tons of bulk grapes/apples do you sell annually?

If: C8 = Yes

b3BulkFruitRevenue

C10 — What is the annual revenue from bulk grape/apple sales?

If: C8 = Yes

b4ProduceCider

C11 — Do you produce cider?

b4CasedCiderCases

C12 — How many cases of cider do you sell annually?

If: C11 = Yes

b4CasedCiderRevenue

C13 — What is the annual revenue from cased cider sales?

If: C11 = Yes

b5SellBulkCider

C14 — Do you sell bulk cider?

b5BulkCiderGallons

C15 — How many gallons of bulk cider do you sell annually?

If: C14 = Yes

b5BulkCiderRevenue

C16 — What is the annual revenue from bulk cider sales?

If: C14 = Yes

b6TastingRoom

C17 — Do you operate a tasting room?

b6TastingFeeRevenue

C18 — What is the annual revenue from tasting room fees?

If: C17 = Yes

b6OfferTours

C19 — Do you offer winery or vineyard tours?

If: C17 = Yes

b6AnnualVisitors

C20 — Approximately how many visitors do you receive annually?

If: C17 = Yes

b6StaffCertified

C21 — Is your tasting room staff alcohol-service certified?

If: C17 = Yes

b6ProvidesTransportation

C22 — Do you provide any guest transportation?

If: C17 = Yes

b6TransportationDetails

C23 — Please describe the transportation you provide.

If: C22 = Yes

b7SellsMerchandise

C24 — Do you sell merchandise?

Apparel, glassware, gifts, etc.

b7MerchandiseRevenue

C25 — What is the annual revenue from merchandise sales?

If: C24 = Yes

Step DWine Stock Inventory1 question

Field ID

Question

sov

D — Statement of Values (Wine Stock Inventory)

Upload or manually enter your wine stock inventory by location.

Step EProperty34 questions

Field ID

Question

f1Spoilage

E1 — Do you want Wine/Cider Spoilage coverage?

f2Cooperage

E2 — Do you want Cooperage coverage?

f3MobileEquipment

E3 — Do you want Mobile Equipment coverage?

Covers tractors, forklifts, ATVs, and other mobile farm/winery equipment.

f4FineArts

E4 — Do you have Fine Arts on the premises?

f4FineArtsValue

E4 — What is the total appraised value of the fine arts?

If: E4 = Yes

f5SignsNeon

E5 — Do you have neon or illuminated signs?

f5SignsNeonValue

E5 — What is the total value of the neon/illuminated signs?

If: E5 = Yes

f6Earthquake

E6 — Do you want Earthquake coverage?

f6EarthquakeDeductible

E6 — What deductible do you want for Earthquake coverage?

If: E6 = Yes

f7Flood

E7 — Do you want Flood coverage?

f7FloodDeductible

E7 — What deductible do you want for Flood coverage?

If: E7 = Yes

f8BoilerMachinery

E8 — Do you want Boiler & Machinery / Equipment Breakdown coverage?

f9ElectronicData

E9 — Do you want Electronic Data Processing coverage?

f9ElectronicDataValue

E9 — What is the total value of your electronic data processing equipment?

If: E9 = Yes

f10OutdoorProperty

E10 — Do you have outdoor property to insure?

Fences, retaining walls, outdoor furniture, signage, etc.

f10OutdoorPropertyValue

E10 — What is the total value of the outdoor property?

If: E10 = Yes

f11Cyber

E11 — Do you want Cyber Liability coverage?

f12DroneUAV

E12 — Do you operate any drones or UAVs on the property?

f12DroneUAVDetails

E12 — Please describe the drone/UAV use.

If: E12 = Yes

f13SolarPanels

E13 — Do you have solar panels on the property?

f13SolarPanelsValue

E13 — What is the total value of the solar panels?

If: E13 = Yes

f14StrikeTeam

E14 — Do you have a private wildfire strike team under contract?

If yes, please provide a copy of the contract.

f15FireHydrant

E15 — Do any locations have a fire hydrant on site?

f15WaterSource

E15 — What is the water supply source for the hydrant?

If: E15 = Yes

f15GPM

E15 — How many gallons per minute (GPM) does each hydrant hold?

If: E15 = Yes

f15AnnualInspection

E15 — Are the hydrants thoroughly inspected annually?

If: E15 = Yes

f16BackupPower

E16 — Do you have backup power with 24–48 hour continuous capacity?

f16BackupPowerDetails

E16 — Please describe your backup power setup.

If: E16 = Yes

f17BrushMaintenance

E17 — Do you have a brush maintenance program in place?

If yes, please provide a copy.

f18BrushMaintenance

E18 — Do you have a wildfire emergency response plan in place?

If yes, please provide a copy.

f19DefensibleSpace

E19 — Do you have at least 200 feet of defensible space on all sides of all buildings?

f19DefensibleSpaceDetails

E19 — Please explain the defensible space situation.

If: E19 = No

f20PowerLines

E20 — Are there any power lines located on the property?

f20PowerLinesDetails

E20 — Please describe the power lines on the property.

If: E20 = Yes

Step FLiability Coverage13 questions

Field ID

Question

e1ProductWithdrawal

F1 — Do you want Product Withdrawal Expense coverage?

Covers costs to recall a product from the market.

e1ProductWithdrawalLimit

F2 — What limit would you like for Product Withdrawal Expense?

If: F1 = Yes

e2WindDrift

F3 — Do you want Wind Drift or Overspray Liability? ($1,000,000 limit)

Covers liability from pesticide/herbicide drift onto neighboring properties.

e3HiredNonOwned

F4 — Do you want Hired & Non-Owned Auto Liability? ($1,000,000 limit)

Covers vehicles rented or used by employees on behalf of the winery.

e4EmployeeBenefits

F5 — Do you want Employee Benefits Liability – Claims Made? ($1,000,000 limit)

e4EmployeeBenefitsRetroDate

F6 — What is the retroactive date for Employee Benefits Liability?

If: F5 = Yes

e5PersonalLiability

F7 — Do you want Personal Liability coverage? ($1,000,000 limit)

e6ProfessionalLiability

F8 — Do you want Professional Liability – Claims Made? ($1,000,000 limit)

Covers winemaking/consulting errors. You will complete Section L.

e6ProfessionalLiabilityRetroDate

F9 — What is the retroactive date for Professional Liability?

If: F8 = Yes

e7EPL

F10 — Do you want Employment Practices Liability – Claims Made?

Covers wrongful termination, discrimination, harassment. You will complete Section M.

e7EPLRetroDate

F11 — What is the retroactive date for Employment Practices Liability?

If: F10 = Yes

e8ExcessLiability

F12 — Do you want Excess Liability (Umbrella) coverage?

e8ExcessLiabilityAmount

F13 — What Excess Liability limit do you want?

Max $1,000,000 with Auto; max $5,000,000 without Auto.

If: F12 = Yes

Step GAdditional Coverage23 questions

Field ID

Question

gStockUnnamedLimit

G1 — Stock at Unnamed Locations: optional sublimit increase? (Auto: $250,000)

gEmployeeDishonesty

G2 — Employee Dishonesty: optional sublimit increase? (Auto: $50,000)

gMoneyOnPremises

G3 — Money & Securities (On Premises): optional sublimit increase? (Auto: $25,000)

gMoneyOffPremises

G4 — Money & Securities (Off Premises): optional sublimit increase? (Auto: $10,000)

gAccidentalBlending

G5 — Accidental Blending of Wine (Human Errors): optional sublimit? (Auto: $0)

gPollutantsCleanup

G6 — Pollutants Clean Up and Removal: optional sublimit increase? (Auto: $50,000)

gAccountsReceivable

G7 — Accounts Receivable: optional sublimit increase? (Auto: $250,000)

gValuablePapers

G8 — Valuable Papers: optional sublimit increase? (Auto: $250,000)

gBusinessIncome

G9 — Business Income timeline: optional increase? (Auto: 12 months)

gPersonalEffects

G10 — Personal Effects and Property of Others: optional sublimit increase? (Auto: $25,000)

gEQSL

G11 — Do you want Earthquake Sprinkler Leakage (EQSL) coverage?

Not included automatically — must be requested.

gSewerBackup

G12 — Sewer/Drain/Sump Backup: optional sublimit increase? (Auto: $25,000)

gUtilityDirectDamage

G13 — Utility Services Direct Damage: optional sublimit increase? (Auto: $25,000)

gUtilityBI

G14 — Utility Services Business Income & Extra Expense: optional sublimit increase? (Auto: $25,000)

gTrellisVines

G15 — Trellis and Vines: optional sublimit increase? (Auto: $100,000)

gEmployeeCount

G16 — How many total employees do you have?

Include full-time, part-time, and seasonal employees.

f3MobileEquipmentLimit

G17 — Mobile Equipment Blanket Limit desired? (Auto: $25,000, max $250,000 per piece)

gStockOthers

G18 — Stock of Others: desired sublimit for stock belonging to third parties stored at the winery?

f1SpoilageSublimit

G19 — Wine/Cider Spoilage desired sublimit?

gDwellingLossOfUse

G20 — Dwelling Loss of Use: desired sublimit?

gAvgRevenuePerCase

G21 — What is the average revenue per case of wine/cider produced?

Required for Spoilage rating.

c4OtherExposures

G22 — Are there any other business operations or exposures on the premises not yet mentioned?

e.g. Solar farm, farm stand, equestrian facility, agritourism, etc.

c4OtherExposuresDetails

G23 — Please describe the other operations or exposures.

If: G22 = Yes

Step HAuto Supplemental8 questions

Field ID

Question

hVehiclesRegisteredToPolicyholder

H1 — Are all vehicles registered to the policyholder?

Only appears if Hired & Non-Owned Auto was requested (F4 = Yes).

hVehiclesRegisteredDetails

H2 — Please provide details about vehicles not registered to the policyholder.

If: H1 = No

hPersonalUseOnly

H3 — Are any vehicles used for personal use only?

hPersonalUseDetails

H4 — Please describe the personal-use vehicles.

If: H3 = Yes

hEmployeeOwnedVehicles

H5 — Do employees use their own vehicles on behalf of the winery?

hEmployeeOwnedDetails

H6 — Please describe how employee-owned vehicles are used.

If: H5 = Yes

hHiredAutoValueNew

H7 — Value (cost new) of the hired automobile?

hHiredAutoCostOfHire

H8 — What is the anticipated cost of hire?

Includes rental fees, driver remuneration, fuel, maintenance, etc.

Step IRestaurant / Food Service30 questions

Field ID

Question

i2YearsInOperation

I2 — How many years has the restaurant/catering operation been in operation?

Only appears if restaurant or catering operations are present.

i3DaysPerWeek

I3 — How many days per week is the operation open?

i5SeatingCapacity

I5 — What is the seating capacity?

i6OtherAlcohol

I6 — Do you serve other alcohol besides wine or cider?

i6OtherAlcoholDetails

I6 — Please describe the other alcohol served.

If: I6 = Yes

i7TablesideCooking

I7 — Do you have tableside or fondue cooking?

i8CateringOffered

I8 — Is catering offered?

i8CateringPct

I8 — What percentage of gross receipts comes from catering?

If: I8 = Yes

i8CateringEvents

I8 — How many events do you cater each year?

If: I8 = Yes

i9ElectricalUpdated

I9 — Has the electrical system been updated to current code standards in the last 25 years?

i10ExtensionCords

I10 — Are any permanent fixtures powered by extension cords?

i10ExtensionCordsDetails

I10 — Please describe the safety precautions taken.

If: I10 = Yes

i11RefrigUnder41

I11 — Is refrigeration maintained at under 41°F?

i12FreezerUnder20

I12 — Are freezers maintained at under 20°F?

i13FreshShellfish

I13 — Is fresh shellfish served?

i13RawMeat

I13 — Is raw meat or seafood served?

i14UL300

I14 — Is there a UL 300 compliant automatic extinguishing system?

i15ClassK

I15 — Is there a Class K fire extinguisher in all cooking areas?

i16FireSuppressionServiced

I16 — Is the fire suppression system serviced twice a year by a licensed contractor?

i17HoodCleaning

I17 — Is there a contracted cleaning program for the hood and ventilation system?

i17HoodCleaningTimes

I17 — How many times per year are the hoods cleaned?

If: I17 = Yes

i18FilterCleaning

I18 — How often are filters/screens pulled down and cleaned?

i19BoardOfHealth

I19 — Have you had any Board of Health violations in the last 36 months?

i19BoardOfHealthDetails

I19 — Please provide details about the violations.

If: I19 = Yes

i20FoodTrucksOnPremises

I20 — Do you allow food trucks on premises?

i20CertificatesSecured

I20 — Are certificates of insurance secured from all food truck vendors?

If: I20 = Yes

i21OwnFoodTruck

I21 — Does the winery own the food truck?

i21FoodTruckOtherBusiness

I21 — Does the food truck service any other business besides the winery?

If: I21 = Yes

i21FoodTruckFrequency

I21 — How often does the food truck leave the premises (times per month)?

If: I21 = Yes

i21FoodTruckRadius

I21 — What is the average radius traveled per trip (miles)?

If: I21 = Yes

Step JB&B / Guest House24 questions

Field ID

Question

j2YearsInOperation

J2 — How many years has the B&B / Guest House been in operation?

Only appears if B&B or Guest House operations are present.

j3OwnerOnPremises

J3 — Does the owner reside on the premises?

j3ManagerOnPremises

J3 — Is there a manager residing on the premises?

If: J3 = No

j4GuestContract

J4 — Do you require guests to sign a liability waiver contract?

j5Stories

J5 — How many stories is the B&B / Guest House?

j6Buildings

J6 — How many buildings are used for B&B / Guest House?

j6Rooms

J6 — How many rooms total?

j6NightsRented

J6 — How many nights are rented on an annual basis?

j6RatePerNight

J6 — What is the average rate per night?

j7Pool

J7 — Is there a swimming pool, hot tub, sauna, or steam room on premises?

j7GuestPoolAccess

J7 — Are guests allowed access to these facilities?

If: J7 = Yes

j7DivingBoard

J7 — Is there a diving board?

If: J7 guest access = Yes

j7NoLifeguardSignage

J7 — Is there signage notifying guests there is no lifeguard on premises?

If: J7 guest access = Yes

j8Horses

J8 — Does the B&B / Guest House have horses or stable facilities?

j8GuestHorseAccess

J8 — Are guests allowed to access and/or ride the horses?

If: J8 = Yes

j9TwoEscapeRoutes

J9 — Do guest rooms have at least two means of escape?

j10SmokeDetectors

J10 — Are smoke and carbon monoxide detectors installed on every floor and in each guest room?

j11FireExtinguishers

J11 — Are there fire extinguishers in the B&B / Guest House?

j11FireExtinguisherCount

J11 — How many fire extinguishers are there?

If: J11 = Yes

j12NoSmoking

J12 — Is there a no-smoking policy for the entire premises?

j13Fireplaces

J13 — Are there any wood-burning fireplaces or stoves?

j13FireplaceCount

J13 — How many fireplaces or stoves are there?

If: J13 = Yes

j13FireplacesCleaned

J13 — Are fireplaces or stoves cleaned annually?

If: J13 = Yes

j14FoodService

J14 — Does the B&B / Guest House provide food service?

If yes, also complete Section I.

Step KRV / Camping16 questions

Field ID

Question

k2BookingService

K2 — Do you use a booking service (e.g. Harvest Host)?

Only appears if RV or camping accommodations are offered.

k2BookingServiceName

K2 — Which booking service do you use?

If: K2 = Yes

k2SelfReservations

K2 — Do you take reservations yourself?

If: K2 = No

k3RVsPerDay

K3 — How many RVs do you allow per day?

k3RVDaysPerYear

K3 — How many days per year do you rent RV spaces?

k3RVSpacesMarked

K3 — Are RV parking spaces clearly marked?

k3RVRatePerNight

K3 — How much do you charge per night for RV spaces?

k4CampsitesPerDay

K4 — How many campsites/tents do you allow per day?

k4CampDaysPerYear

K4 — How many days per year do you rent camping spaces?

k4CampSpacesMarked

K4 — Are camping spaces clearly marked?

k4CampRatePerNight

K4 — How much do you charge per night for camping?

k5GuestContract

K5 — Do you require guests to sign a liability waiver contract?

k6RulesList

K6 — Do you provide guests with a list of rules?

k7PermittedAreas

K7 — Do you advise guests which areas they are and are not permitted to enter?

k8ElectricHookups

K8 — Do you provide guests with electric hookups?

k8ElectricFee

K8 — What fee do you charge for electric hookups per night?

If: K8 = Yes

Step LProfessional Liability E&O14 questions

Field ID

Question

lHasCurrentCoverage

L1 — Do you currently have Professional Liability E&O coverage?

Only appears if Professional Liability was requested (F8 = Yes).

lCoverageType

L2 — Is your current coverage Claims-Made or Occurrence?

If: L1 = Yes

lRetroactiveDate

L3 — What is the retroactive date for your Claims-Made coverage?

If: L2 = Claims-Made

lDesignatedServices

L4 — What professional services do you provide?

Coverage limited to Winemaking / Wine Consulting and Cider Making / Cider Consulting.

lRevenueCurrentYear

L5 — Projected gross consulting revenue for the current year?

lRevenueLastYear

L6 — Annual gross consulting revenue last year?

lRevenueTwoYearsAgo

L7 — Annual gross consulting revenue two years ago?

lWrittenContract

L8 — Do you use a written contract with consulting clients?

Options: In all Cases / Sometimes / Never

lSuedPast3Years

L9 — Have you been sued or threatened with suit for any act, error, or omission in the past 3 years?

lSuedDetails

L10 — Please provide full details of the suit or threatened suit.

If: L9 = Yes

lKnowledgeOfClaim

L11 — Do any principals, officers, or employees have knowledge of any act that might give rise to a claim?

lKnowledgeDetails

L12 — Please provide full details.

If: L11 = Yes

lInsuranceDeclined

L13 — Has any similar insurance ever been declined or cancelled?

lInsuranceDeclinedDetails

L14 — Please provide full details of the declination or cancellation.

If: L13 = Yes

Step MEmployment Practices Liability16 questions

Field ID

Question

mLimitDeductible

M1 — Which EPL limit and deductible do you want?

Only appears if EPL was requested (F10 = Yes). Options: $25K–$250K / $5K–$25K deductible.

mHasCurrentCoverage

M2 — Do you currently have Employment Practices Liability coverage?

mCoverageType

M3 — Is your current coverage Claims-Made or Occurrence?

If: M2 = Yes

mRetroactiveDate

M4 — What is the retroactive date for your Claims-Made EPL coverage?

If: M3 = Claims-Made

mFullTimeEmployees

M5 — How many full-time employees do you have?

mPartTimeEmployees

M6 — How many part-time employees?

mSeasonalEmployees

M7 — How many seasonal employees?

mTemporaryEmployees

M8 — How many temporary employees?

mAntiHarassmentPolicy

M9 — Do you have a written anti-harassment policy with procedures to report to management?

mAntiDiscriminationPolicy

M10 — Do you have a written anti-discrimination policy or EEOC statement?

mAtWillApplication

M11 — Do you use an employment application that contains an at-will provision?

mManagementTraining

M12 — Do you schedule management and supervisory workplace training on HR-related issues?

mTerminationReview

M13 — Do you adopt termination review by management, HR, or outside HR professional?

mADACompliant

M14 — Are your facilities designed to accommodate the disabled in accordance with the ADA?

mLossHistory

M15 — Have you had any wrongful termination, discrimination, sexual harassment, or workplace tort claims in the last 5 years?

mLossHistoryDetails

M16 — Please describe any claims, suits, or threatened suits in detail.

If: M15 = Yes

Step NSign & Submit6 questions

Field ID

Question

nSignatureName

N1 — Please enter your full legal name to sign the application.

By entering your name you affirm that all information provided is true, accurate, and complete.

nSignatureTitle

N2 — What is your title?

nSignatureDate

N3 — What is today's date?

nBrokerName

N — What is the broker's full name?

nBrokerTitle

N — What is the broker's title?

nBrokerDate

N — What is the broker's signing date?

Note on conditional questions: Questions marked with an "If:" condition only appear in the interview when the specified prior answer has been given. Steps H through M are gateway steps — they only appear when the relevant coverage or operation was selected.

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