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CRIME PROTECTION PLUS TEMPORARY STAFFING AGENCY SUPPLEMENT (Philadelphia Insurance Companies)

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CRIME PROTECTION PLUS
TEMPORARY STAFFING AGENCY SUPPLEMENT
This is a supplement to the Philadelphia Insurance Companies Crime Protection Plus Application
Name of Applicant:
1.
Total number of temporary employees placed:
Last Year:
Prior Year:
2.
Provide a breakdown of the types of staffing services offered to your clients:
Executive:
%
Janitorial Services:
%
Medical:
%
Security Services:
%
Computer / IT Services:
%
Other: (describe)
%
Financial / Accounting:
%
%
Managerial:
%
%
Clerical:
%
Warehousing / Transportation:
%
TOTAL:
100%
3.
Do any of your temporary personnel transport money, securities, or other valuable property outside
of your client’s premises?
Yes
No
If yes, please describe the type of property and value:
4.
Describe the background check(s) you perform on all prospective temporary employees:
5.
Have you had any losses within the past 3 years, whether reported or not, that have occurred as a
result of the acts of your temporary placed employee?
Yes
No
If yes, provide a full description of any occurrence(s) and whether there were any paid losses:
To enter more information, please use the separate page attached to the application.
I understand information submitted herein becomes a part of my Philadelphia Insurance Companies Crime Protection
Plus Application and is subject to the same conditions as stated on the application.
Name (Please Print)
Title
_______________________________________________
Signature
Date
Crime Protection Plus
Temporary Staffing Agency Supplement
Page 1 of 2
© 2017 Philadelphia Consolidated Holding Corp.
08/2017
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Print Application
ADDITIONAL INFORMATION
This page may be used to provide additional information to any question on this Application. Please identify the question
number to which you are referring.
_______________________________________________
Signature
Date
Crime Protection Plus
Temporary Staffing Agency Supplement
Page 2 of 2
© 2017 Philadelphia Consolidated Holding Corp.
08/2017
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CRIME PROTECTION PLUS TEMPORARY STAFFING AGENCY SUPPLEMENT (Philadelphia Insurance Companies)

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Completed 29 July 2020

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