Additional Location Information
This form is needed for each additional location
Location #
of #
.
Firm Name
Insurance Contact
Email
example@example.com
Phone Number
Physical Location Information
If you have more than one location complete an additional location questionnaire for each location.
Address
Street Address
County
City
State / Province
Postal / Zip Code
Construction Type
Type of Occupancy
Tenant
Owner Occupied
Year Built
If year built is more than 30 years ago, supply the year of the most recent updates:
Year
Electrical
Plumbing
Roof
Heating
Does the building have a functioning sprinkler system?
Yes
No
Building Information
#
Total Square Footage of Building?
Number of Stories?
Square Footage you Occupy?
What Floor(s) are you located on?
Distance to Fire Station
Feet from the Fire Hydrant
Are there smoke detectors?
Yes
No
Dead bolt locks in use?
Yes
No
Theft Alarm
Local
Monitored
Fire Alarm
Local
Monitored
Do any of the following business types reside in the building? Please check all that apply.
Yes
Manufacturing
Restaurant
General Warehouse
Offices
Retail
Bar or Tavern
Limits requested if insuring the building
$
Building Insurance coverage Limit
Business Contents Limit
Deductible
Computer Hardware Equipment Limit
Computer Software Equipment Limit
Submit
Should be Empty: