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Marijuana Club Startup Guide

Medical Marijuana Dispensary Supplemental Insurance Application

This information has been provided by:
Rich Pitto,  Broker/Manager
TELEPHONE: 510.222.8643 FAX: 510.222.6162



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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