Renewal Energy Insurance: Solar Energy Contractors

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

Please answer all questions

Provide a short description of the applicant’s operations:
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
Breakdown of Work Performed: / Residential Revenue / Commercial Revenue / Industrial Revenue
Solar Retail Sales
Solar Installations
Other (please specify):
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 Business Sales Related to the Solar Industry: /
<25% / 25 – 50% / 51 – 75% / >75% / N/A
Questionnaire / Yes / No
1. / Do you have a showroom?
2. / Do you inform customers of the limitations of the solar energy systems in terms of the amount of hot water and fuel savings they provide?
3. / Have you signed any contracts containing a “hold harmless” clause that favours others?
4. / Do you sell or install primarily pre-packaged systems or do you custom design systems to meet customer’s needs?
5. / Who does the building structural analysis when installations are done on rooftops?
6. / Provide a description of some recent installations:
7. / If any projects or installations are performed outside Canada, state where and give a brief description of the work performed:
8. / Describe the Hot Works safety procedures you use:
9. / Describe what measures are taken to protect customers’ property from damage:
10. / List all component manufacturers and describe the warranties provided:

Trade Association Memberships:

CanSIA Yes No Other:

Loss experience (Past 5 years):

Contractor Details:

Specify all Contractors & Sub-Contracts (including crane operations) on this project – specifying which part of the project they are involved

Contractor / Sub-Contractor / Type of Work / % of Work / Certificates of Insurance Received
Yes No
Yes No
Yes No

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
1 / Solar Energy - Risk Application / Printed in Canada
on recycled paper /

RSA is a registered trade name of Royal & Sun Alliance Insurance Company of Canada. "RSA" and the RSA logo are trademarks used under licence from RSA Insurance Group plc.

31607 (Rev. 07/2010)