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Commercial Building
Commercial Property and General Liability
Name
Location Address
Main Contact Phone Number
Email
Entity Name
Type of Entity
Current Carrier
Current Expiration Date
Current Yearly/Monthly Premium
Location #1 Street, City, County, State Zip Code
Annual Revenue
# of Square feet
Year Built
Construction Type
What year was the Roof, Wiring, Plumbing, and HVAC updated?
Burglar Alarm Type
Fire Alarm Type
Location #2 Street, City, County, State Zip Code
Annual Revenue
# of Square feet
Year Built
Construction Type
What year was the Roof, Wiring, Plumbing, and HVAC updated?
Burglar Alarm Type
Fire Alarm Type
Describe the operations completed in the building.
Nature of Business
Apartments
Condominiums
Contractor
Institutional
Manufacturing
Office-Non Governmental
Office-Governmental
Restaurant
Retail
Service
Wholesale
Property Managment
Loss History
Check If No Claims
Do you require an Additional Insured?
Yes
No
If Yes, Name, Entity Name, and Address
Would you like Business Personal Property Coverage
No
$25,000
$50,000
$75,000
$100,000
Greater than $100,00
Would you like Business Income Coverage
No
$25,000
$50,000
$75,000
$100,000
Greater than $100,000
Do you need any additional Coverage?
Additional Remarks
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