Insurance Needs Survey - Fabrication/Manufacturers

Fields marked with Required field are required

Name:
Address:
City:
State:
Required field Zip Code:
Email Address:
Required field What Percentage of your operation is...
% Fabrication and Sale of Motorcycles Branded to Your Company Name
% Sale of Branded Parts and Accessories (detail below)
% Tanks
% Sheet Metal Products
% Frames
% Chromed Accessories
% Sale of Branded Merchandise (i.e. hats, shirt, etc.)
Enter zero (0) if not applicable
Required field What is the average gross markup between cost and the sale price of your bikes?
%
Required field What is the average percentage increase at between the raw completed bike and your cost to make unique to your brand?
% (Explanation: We are determining what percentage of your total gross revenue is for building an operational bike without including the cost to make it a customized bike)
Required field Square footage of facility: square feet
% Manufacturing
% Sales
Required field Building Value: $
Required field Business Personal Property: $
Required field Inventory Parts & Supplies:
Required field Inventory of Completed Bikes on your premises:
Required field Inventory Bikes & Process
Value of those bikes at an average state of completion
Example: 5 bikes in various stages of completion
1 @ 10% complete { If this case you could estimate 5 bikes at 50% completion at all times. We are interested in getting an estimate of the exposure you have on site for work in progress on average.
1 @ 50% complete
1 @ 50% complete
1 @ 75% complete
1 @ 90% complete
Historical 2001 2002 2003 2004
Required field Sales: $ $ $ $
Required field Number Employees:
Required field Total Payroll: $ $ $ $
(Excluding Owners' Compensation)
Required field # of bikes completed:
Bikes Completed By Engine Size
Required field Less than 90 CID:
Required field Between 90 CID & 113 CID:
Required field Greater than 113 CID:

Loss Data

You must provide the last three years insurance company loss runs from your insurance agent.

In order to match up your losses to the survey data, enter the first five letters in your company name. When you fax in the loss information, put those same five letters in the upper right-hand corner for identification.

Loss Code:

Corporately-Owned Vehicles

Private Passenger Type: Units
Pickup: Units
Light Duty: (less than 21,000 GVW) Units
Medium Duty: (between 21,000 & 40,000 GVW) Units
Heavy Duty: (greater than 40,000 GVW) Units

General Information

Do you currently have Property Coverage on your building?
Yes No
Do you currently have products/completed operations insurance?
Yes No
Do you believe your insurance cost is in-line with competitors?
Yes No
Do you believe your insurance carrier prices your coverage...
Fairly Unfairly based on their knowledge of your business
Have you ever been restricted or prevented from certain business activities by your insurance carrier?
Yes No
Required field Can you estimate your liability insurance cost per bike sold?
$

Neither the NMDA nor its agents will disclose the information to any third party other than in the pursuit of an association insurance program to benefit you and other NMDA members, and then only in a compiled format without specifics from your individual survey information.