"Commercial"
Name of Insured:
Address:
City:
State:
Zip:
Phone:
Fax:
E-mail Address:
Location Address:
City:
State:
Zip:
PROPERTY
QUESTIONS
Year Building was Built?
Type of Building Construction:
Frame
Stucco
Masonry/Brick
Fire Resistive
Other
Number of Stories:
Other Occupancies:
Square Feet You Occupy:
IF THE BUILDING IS OVER 25 YEARS OLD, PLEASE ANSWER THE FOLLOWING:
Year Electricity was Updated:
Is it on Circuit Breakers:
Yes
No
Year Plumbing was Updated:
Type of Plumbing:
Copper
Galvanized
Other
Fill Out if Answer
Other:
Year of Last Re-roofing:
Type of Roofing Material:
Type of Heating System:
PROTECTIVE DEVICES
Burglar Alarm:
Yes
No
Type of Alarm:
None
Central Station
Local Alarm
Alarm Company:
Sprinkler System in Building:
Yes
No
Smoke Detectors:
Yes
No
Liability Questions
Previous Carrier:
Policy Number:
Prior Premium:
Policy Renewal Date:
BUSINESS INFORMATION
Years in Business:
Projected Gross Annual Receipts:
Projected Annual Payment:
Describe your business, Products, or Services:
(309) 663-6950
