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MEDICAL MARIJUANA DISPENSARY SUPPLEMENTAL
Name of applicant:
_________________________________________________
Is the parking lot maintained by the insured? Yes ____ No
____
If yes, what is the sq footage of the parking lot?
_____________________
Does the applicant make deliveries off premises? Yes____
No____ Applicant understands that there is no coverage for off
premises operations. Understood and agreed
Does the applicant advertise the nature of the business on the
outside of the building? Yes____ No____
The building you occupy is: Frame____ Tilt-up / Concrete
block / Joisted-Masonry____ Other ____
Do you occupy the entire building? Yes____ No____
If no, are there connecting doors to adjacent units, hallways or
interior stairwells? Yes____ No____
What type of Security systems are utilized:
Central Station Alarm____
Interior Motion detectors ____
Gated Doors ____
Gated windows ___
Metal door ___
Exterior camera and door intercom ___
Interior video Cameras ___
Hold-up button / Panic button ___
Security Vestibule/Man-trap ___
Do you utilize door Identification Checkers? Yes____
No____
Do you utilize greeters? Yes____ No____
Do you utilize security guards and/or bouncers? Yes____
No____
If yes, are they employees? Yes____ No____
If no, do they carry insurance and name applicant as additionally
insured? Yes____ No ____
Are they armed? Yes____ No____
Is the applicant or any of the applicant’s employees armed with any
type of weapon? Yes____ No ____
How much inventory is displayed to customers? 0 to 5 % ____ 6
to 10% ____ 11% to 25%____ Greater than 25% ____
After business hours, is all inventory stored in a locked one ton
(2000 lbs) safe? Yes____ No____
After business hours, is all inventory stored in a locked safe with
a burglary rating at or above U.S. U.L. TL-30? Yes ____ No____
Do you have a written plan or manual that describe your business's
security procedures, including what to do in the event of a robbery or other
crime? Yes____ No____
Are employees instructed to cooperate and obey the robber’s
instructions and not to resist? Yes____ No____
Signature of applicant: __________________________ Dated:
____________
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