BOP Questionnaire

BOP Insurance Questionnaire

Business Owners Package Insurance
Insurance Agent:*
Please select your RealCare agent
1. Named Insured*
DBA
Contact Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have multiple locations?*

YesNo
Addresses of all additional locations:
2. Type of Ownership (corporation, individual, etc.)*
3. Date Business Started (If less than 3 years, # of years of management experience)*
Business start date, or years of management experience
4. Description of Operations:*
Please describe your business operations
5. Engaged in Property Management*

YesNo
If yes to #5, what percentage of revenue is attributable to Property Management Services?
% of revenue derived from property management
6. Engaged in Escrow Services*

YesNo
7. Engaged in Mortgage Brokering*

YesNo
Coverage Details
8. How many people in your firm?*
9. How many officers/owners/partners are there in the firm?*
10. Annual Revenue:*
Gross Annual Revenue
11. Do you sell tract homes?*

YesNo
12. Value of Business Personal Property:*
Example: desks, computers, chairs, printers, etc.
Location
13. Is your primary location a home office? (office inside a home)*

YesNo
If yes to #13, provide details:
Please describe your home office situation
14. Do you rent or own your office space?*

RentOwn
15. Is your office within city limits?*

YesNo
16. Office Square Footage Occupied:*
What is the square footage of your office space?
17. Square Footage of Building:*
Total square footage of your office building
18. Year Built:*
Year your office building was built
19. Construction Type (relating to fire resistance):*
Example: wood-frame, heavy timber, non-combustible, fire-resistive.
20. Roofing Type:*
Example: metal, asphalt, wood shingle, slate, etc.
21. Number of Stories/Floors:*
# of floors in office building
22. Percent Sprinklered (indoors):*
What percentage of the square footage has indoor fire sprinklers?

23. Year of Last Building Updates (only needed for buildings over 50 years old):

Rows	Electric	Plumbing	Roof	Heating
Year

24. Alarm System type:*

CentralLocalNone
25. Distance to Fire Hydrant:*
Approximate distance to nearest fire hydrant
26. Distance to Fire Station:*
Approximate distant to nearest fire station
27. Do you have a current BOP policy?*

YesNo
28. Any prior coverage declined, cancelled or non-renewed in the past three years?*

YesNo
29. Any prior claims?*

YesNo
30. Do you currently have a Professional Liability policy?*

YesNo
31. Please list any Additional Insured Needed:
Include additional insureds' name, address, and type (landlord, franchise, leasing agent)
Should be Empty:

BOP Insurance Questionnaire

Coverage Details

Location