Commercial Property Insurance Questionnaire
General Liability
Applicant name
*
First Name
Last Name
Applicant's birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Legal entity name
*
Legal entity
*
Please Select
Sole Proprietorship
Partnership
LLC
Corporation
Nonprofit
Other
Company website
Business established eate
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Number of employees
*
Detailed description of business location(s) and operations
*
Detailed description of products sold or services offered
Gross annual sales
*
Estimate is ok
Annual payroll
*
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Building Information
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Construction type
Please Select
fire-resistive
non-combustible
ordinary
heavy timber
wood-framed
other
Year built
Square footage
Occupancy
Please Select
Owner Occupied
Tenant Occupied
Vacant
Mixed occupancy
Vacancy percentage
Number of total units
Lease lengths, any expiring soon?
Tenant screening procedures
Detailed occupancy breakdown per unit
*commercial vs habitational, types of commercial operations
Year renovated
Rows
Year of Renovation
Roof
Electrical
Plumbing
Heating
Building security
Rows
Local
Central
None
Fire Alarm
Burglar Alarm
Patrol security
Rows
Yes
No
Patrolled
24-hours
Armed
Estimated building value
Business personal property value
Submit
Should be Empty: