Business Income Worksheet - New Agency Partners
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1Business Income Worksheet
Business Income Worksheet
Business Income Worksheet
Business Income Worksheet
Policy Name
Policy Name
Policy Name
Policy Name
Policy Number
Policy Number
Policy Number
Policy Number
Policy Period
Policy Period
Policy Period
Policy Period
*Notes -
*Notes -
*Notes -
*Notes -
Calculate on accrual basis (not a cash basis) and provide actual values for 12 months figuring on the fiscal year.
Example
Location 1
Location 2
Location 3
Net Annual Sales : the gross sales - less: discounts,
Net Annual Sales
Net Annual Sales
Net Annual Sales
returns, allowances, bad debt, collection expenses and
prepaid freight - plus: other earnings from your business
operations such as rents, commissions, cash discounts
$
4,450,000
received, interest or service fees.
(For Manufacturing risks: add or subtract the change in
finished goods inventory during the year. If inventory has
increased, add the amount of increase. If inventory had
decreased, subtract the amount of the decrease.)
Cost of Good Sold : deduct the cost of non-continuing
Cost of Good Sold
Cost of Good Sold
Cost of Good Sold
outside services and the cost of (1) raw stock used in
production, (2) materials directly consumed in production, (3)
merchandise sold including packaging materials and (4)
$
(2,800,000)
services purchased from subcontractors.
Power, Heat & Refrigeration : If the Power, Heat and
Power, Heat & Refrigeration
Power, Heat & Refrigeration
Power, Heat & Refrigeration
Refrigeration Deduction Endorsement applies deduct the cost
of this services that don't continue under contract
Ordinary Payroll : If the ordinary payroll exclusion applies
Ordinary Payroll
Ordinary Payroll
Ordinary Payroll
deduct all ordinary payroll expensesor the amount of payroll
expenses to be excluded
$
1,650,000
$
-
$
-
$
-
100% Business Income Exposure
100% Business Income Exposure
100% Business Income Exposure
100% Business Income Exposure
0.80
Coinsurance Percentage
Coinsurance Percentage
Coinsurance Percentage
Coinsurance Percentage
$
1,320,000
$
-
$
-
$
-
Adjusted Business Income Exposure
Adjusted Business Income Exposure
Adjusted Business Income Exposure
Adjusted Business Income Exposure
Extra Expense Exposure
Extra Expense Exposure - Enter the anticipated amount
Extra Expense Exposure
Extra Expense Exposure
needed to pay the increased expenses over normal expenses
to keep an interrupted business in operation. Consider such
items as increased rent, advertising costs, moving expenses,
additional hourly wages, increased utilities, computer
equipment, rental & data reproduction. (complete this section
if requesting Combined Business Income and Extra Expense
$
100,000
coverage)
Extended Business Income Period of Indemnity
Extended Business Income Period of Indemnity
Extended Business Income Period of Indemnity
Extended Business Income Period of Indemnity
Exposure
Exposure - Enter the anticipated amount of reduced earnings
Exposure
Exposure
that might be expected during the 12 months after you are
able to resume normal business operations.
Margin for Error : This figure should reflect the expected
Margin for Error
Margin for Error
Margin for Error
change in earnings for the upcoming year, allowing for both
$
50,000
growth and inflation.
Total Business Income Exposure
Total Business Income Exposure - This is the sum of
Total Business Income Exposure
Total Business Income Exposure
Adjusted Business Income, Extra Expense and Extended
Business Income and Extended Period of Indemnity
$
1,470,000
$
-
$
-
$
-
Exposures
Insured Signature
Date
Agent
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