Fine Art Dealer Application

Fine Art Dealer Application

Insured Name: ______

Effective Dates: ______to ______

Primary Insured Address: ______

Has applicant ever been declined for insurance or canceled for any reason in the past? Y____ N____

Has applicant had any losses, recoverable or otherwise in the past 3 years? Y____ N____

If yes, what was the nature of the loss(s) and amounts paid? ______

______

Does Applicant record collection inventory electronically? Y____ N____

Is an up to date electronic copy of inventory stored off site? Y___ N___

What percentage of current Collection is: Owned:_____% Consigned _____%

Percent of Owned Collection: Fragile ____% Non-Fragile _____%

Percent of Collection on Consignment: Fragile ___% Non-Fragile_____%

Maximum Total Value of Owned Collection(based off of Fair Market Value):$______USD

Maximum Total Value Property on Consignment(values as stated on consignment agreement) $______USD

Any Precious Metals / Gems part of Collection? Y_____ N______

Is a consignment agreement used for all non-owned Works? Y____ N____(please provide copy with application)

When Was Last Physical Inventory Taken of owned property?____/______/______

Totaled: $______USD (based off of Fair Market Value)

List of Art Fairs Attended/Plan Attend: ______

Average Value Brought to Fairs? $______USD

Central Station Alarm? Y___ N_____ If YES Provide name of Monitoring Company ______

Does Central Station Alarm have line Security? Y____N___

Are there Deadbolts on all points of entry / exit? Y___ N___

Is applicant on the ground floor? Y___N___ Has applicant had any flooding at any time? Y___ N___

If Below Grade Exposure, are items stored at least 12” above the ground? Y____ N___

Does applicant currently have insurance coverage for the inventory? Y___N___

Estimated Total Values shipped annually? Domestic $______USD International $______USD

Typical Method of shipping: Art Packers/ Shippers ______% Express Carriers:_____% Other_____%

Construction of Main Location: Frame ___ Masonry ___ Fire Resistive ___ Other ____

Address of All Permanent Locations (Aside from main location, Including short term and long term storage):

1) ______Approx Value $______USD

Frame ___ Masonry ___ Fire Resistive ___ Other ____ CS Monitoring System? (Fire and Burglar) Y___ N___

2) ______Approx Value $______USD

Frame ___ Masonry ___ Fire Resistive ___ Other ____CS Monitoring System?(Fire and Burglar) Y___ N___

3) ______Approx Value $ ______USD

Frame ___ Masonry ___ Fire Resistive ___ Other ____CS Monitoring System? (Fire and Burglar) Y___ N___

4) ______Approx Value $ ______USD

Frame ___ Masonry ___ Fire Resistive ___ Other ____ CS Monitoring System (Fire and Burglar)? Y___ N___

I understand that the information provided herein is accurate and no false or misleading information has been provided herein.

Applicant Signature:______Title:______Date: ____/_____/______

Producer Signature:______Date: ____/_____/______