Storefront Quote Sheet

How many locations does your business have?

Seperate Form for multiple locations

Year your building was built

Building Value

(If Owned)

Contents Value

(All the equipment, tools, gear, furniture, etc in your business)

Building Deductible

Requested Liability Limit

Tenant Improvement and Betterment Amount

(The amount you've put into a leased building)

Number of Full-time Employees

Number of Part-time Employees

Is there a built in Fire/Sprinkler System

Fully SprinkleredPartially SprinkleredFire Sprinkler System Regularly Maintained

Total Annual Receipts

Total square footage occupied by Insured

What are the regular daily hours of operation at this location?

When did this Business start operations at this location?

Total Square Footage Occupied by Insure

What percentage of the building is vacant or unoccupied?

Is more than 25% of the building occupied by others?.

Has the building undergone a comprehensive renovation since it was originally built?.

(Comprehensive renovation means complete gutting to the exterior walls with completely new interior walls, plumbing, heating,wiring and roof.)

Indicate the type of alarm at this location:

NoneLocalCentralUL With Certificate

Is the applicant responsible for maintaining the parking lot?

YesNo

Is the applicant responsible for Glass on the building?

YesNo

Does the applicant conduct video surveillance at this location?

YesNo

Driver 1

First NameLast Name

Driver 1 - Date of Birth

Date

Driver 1 - Drivers License Number and State

Driver 2

First NameLast Name

Driver 2 - Date of Birth

Date

Driver 2 - Drivers License Number and State

Driver 3

First NameLast Name

Driver 3 - Date of Birth

Date

Driver 3 - Drivers License Number and State

Edmonds Agency / Storefront Business Insurance Quote

Personal Information

BUSINESS INFORMATION

AUTO DETAILS

POLICY LEVEL UNDERWRITING

PRIOR CARRIER INFORMATION

Current Policy Information

ADDITIONAL QUESTIONS

DRIVER INFORMATION

VEHICLE INFORMATION