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16. Name of additional insureds, if any Relationship to tenant/user <br />17. Present or previous insurance carrier <br />18. Has any insurance carrier cancelled or refused coverage? <br />If yes, explain <br />19. Previous losses <br />20. a) Security available: <br />tAo <br />.,A0 <br />qla <br />Number <br />b) Does security force have power to affeWdetain? <br />c) Enclose a copy of security directions. U <br />21. Medical facilities��bein, u <br />Y" <br />On premises? _Yes _No Ambulance on Premises —Yes No <br />Ambulance response time Hospital distance <br />22. Emerg�ncy Evacuation Plan (in case Of catastrophic emergency i.e. bomb threat, earthquake, storm) <br />How are you notified? How is crowd warned? How are exits marked and directions posted'? <br />How is crowd dispersed from facility, Parking area, etc? <br />23. Attach a diagram Of facilitv/location indicating emergency exits. <br />I hereby warrant and conf irm that the above information. to the best of my knowledge, is true and corTcct, and further ccrtifv <br />that I have read all of the questions and answers on this application. <br />I UNDERSTAND 1711S APPLICATION IS A REQUIREMENT FOR COVERAGE, A 13ART OFTHE coNTRACT, AND <br />EVIDENCE OF MY ACCEPTANCE OF THIS INSURANCE, AND ANY FALSIFICATION OR MISREPRESENTATION <br />WILL BE DEEMED A BREACH OF CONTRACT, VOIDING ALL INSURANCE COVERAGE. <br />It is understood and agreed that the completion of this <br />Gulf Insurance Company until accePledbn the Comna <br />Tenant/User's <br />shall not be binding either to the proposed insured or to the <br />Number Y c� <br />_ 0,6,3 <br />Quote: Class 1 11 111 (circle one) Premium: <br />-------_Quotation No. <br />— City's I Sig . nature Date <br />7/1/98 <br />F1 <br />Aon Risk Services <br />