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COMMERCIAL PROPERTY
CP 15 15 06 95
POLICY NUMBER:
BUSINESS INCOME REPORTIWORK SHEET
Your Name
Date
This work sheet must be completed on an accrual basis.
The beginning and ending inventories in all calculations should be based on the same valuation method.
APPLICABLE WHEN THE AGREED VALUE COVERAGE OPTION APPLIES:
I certify that this is a true and correct report o f values as required under this policy f o r the periods
, based on a Coindicated and that the Agreed Value f o r the period o f coverage is $ insurance percentage o f
-%.
Signature
Official Title
APPLICABLE WHEN THE PREMIUkI ADJUSTMENT FORM APPLIES:
I certify that this is a true and correct report o f values as required under this policy
f o r the 12 months ended
Signature
Official Title
Agent or Broker
Mailing Address
CP 15 15 06 95
copyright, IS0
- Commercial Risk Services, Inc., 1994
Page 1 of 5
BUSINESS INCOME REPORTIWORK SHEET
FINANCIAL ANALYSIS
12 Month Period
Ending
Income and Expenses
Manufacturing
Estimated f o r 12 Month Period
Beginning
NonManufacturing
Rllanufacturing
NonManufacturing
Gross Sales....................................................
DEDUCT:
Finished Stock Inventory (at
sales value) at Beginning.................... -
XXXXXXXX-
-
XXXXXXXK
XXXXXXXX
xxxxxxxx
ADD:
Finished Stock Inventory (at
sales value) at End ..................................
+
XXXXXXXX+
-
XXXXXXXX
Gross Sales Value o f
Production .......................................................
$
XXXXXXXX$
-
XXXXXXXX
DEDUCT:
Prepaid Freight - Outgoing ....
Returns & Allowances ..................
Discounts ..................................................
Bad Debts ................................................
Collection Expenses .......................
Net Sales ..........................................................
Net Sales Value o f Production...
ADD: Other Earnings f r o m
your business operations (not
investment income o r rents
f r o m other properties):
Commissions or Rents
Cash Discounts
Received..............................................
Other .............................................................
Total Revenues............................................
Page 2 of 5
Copyrighl:, I S0 Commercial Risk Services, Inc., 1994
12 Month Period
Ending
lncome and Expenses
Manufacturing
Estimated for 12 Month Period
Beginning
NonManufacturing
hlanufacturing
NonManufacturing
Total Revenues (Line H. from
previous page).............................................
I.
DEDUCT:
Cost of goods sold (see nex:t
page for instructions)...........................
Cost of services purchased
from outsiders (not your
employees) to resell, that do
not continue under contract ..........
Power, heat and refrigeration
expenses that do not continue
under contract (if CP 15 11 is
attached)............................................................
All ordinary payroll expenses
or the amount o f payroll
expense excluded (if CP 15 110
is attached).....................................................
Special deductions for mining
properties (see next page
for instructions).........................................
J.1. Business lncome exposure for
12 months ......................................................
XXXXXXXX
XXXXXXXX-
$
J.2. Combined (firms engaged in
manufacturing & nonmanufacturing operations).................
$
$
The figures in J.1. or J.2.
represent 100% o f your actual
and estimated Business lnconie
exposure for 12 months.
K.
Additional Expenses:
1. Extra Expenses - form
CP 00 30 only (expenses
incurred to avoid or minirnize
suspension of business & to
continue operations).......................
Extended Business Income
and Extended Period o f
Indemnity - form CP 00 '30 or
CP 00 32 (loss of Business
lncome following resumption
o f operations, up to 30 days
or the no. o f days selectcad
under Extended Period of
Indemnity option)...............................
3. Combined (all amounts in K.1.
and K.2.) ....................................................
CP 15 15 06 95
Copyright, IS0
- Commercial Risk Services, Inc., 1994
$
Page 3 of 5
"Estimated" column
L.
Total of J. and K......................................................................................................................................................
$
The figure in L. represents loo%, o f your estimated Business Income exposure for 12 months, and
additional expenses. Using this figure as information, determine the appl-oximate amount o f insurance
needed based on your evaluatio~io f the number o f months needed (may exceed 12 months) to
replace your property, resume operations and restore the business to the condition that would have
existed ~f no property damage hiad occurred.
Refer to the agent or Compan for information on available Coinsurance levels and indemnity options.
The Limit of Insurance you serect will be shown in the Declarations of the policy.
Supplementary Information
12 Month Period
Ending
Manufacturing
CALCULATION OF COST OF
GOODS SOLD
Non-
NonManufacturing
-Rllanufacturing Manufacturing
$
$
-
lnventory at beginning o f year
(Including raw material and stock
in process, but not finished
stock, for manufacturing risks)............. $
Add: The followin
urchase costs:
cost of raw stocf Rcluding
transportation charges).................................. +
Cost of factory supplies
consumed....................................................................
Cost of merchandise sold
including transportation charges
(for manufacturin risks, means
cost of merchan8se sold but
not manufactured by you) ..........................
Cost of other supplies consumed
(including transportation charges).........
Cost of goods available for sale ........
Deduct: Inventory at end o f year
(Including raw material and stock
in process, but not finished
stock, for manufacturing risks).............
Cost of Goods Sold (Enter this
figure in Item I. on previous page)...
Page 4 of 5
Estimated for 12 Month Period
Beginning
XXXXXXXX
+
XXXXXXXX
Copyrighi:, IS0
- Commercial Risk Services, Inc., 1994
S
XXXXXXXX
XXXXXXXX
CP 15 15 06 95
-
CALCULATION OF SPECIAL
DEDUCTIONS - MINING PROPERTIES
r
Ro alties, unless specifically
inc uded in coverage ........................................
Actual depletion, commonly knowrn
as unit o r cost depletion (not
percentage depletion) ......................................
Welfare and retirement fund
charges based on tonnage .........................
Hired trucks .........................................................
Enter this figure in Item I. on
prevlous page.........................................................
Copyrigh,t, IS0
- Commercial Risk Services, Inc., 1994
Page 5 of 5