BOP Fact Finder

BOP Fact Finder
Customer Information
Business Name
DBA / Trade Name
Entity Type
Tax ID
State of Operations
Registration Status
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Business Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Website
Policy Effective Date

MonthDayYear
Date
Estimated Annual Revenue
Estimated Annual Payroll
Describe Business Operations
Employee Counts and Audit Contact Information
Coverages & Business Category
Business Type
General Liability Limit
Umbrella / Excess Liability Limit
Endorsements

Other
Additional Coverages

Other
Additional Insureds
Location/Building Information
Building 1
Building 2
Business Income Worksheet
Annual Gross Profit
Annual Operating Expenses
Continuing Expenses
Business Income Value
Estimated Rebuild Time (Months)
Adjustment Notes
Worksheet Acknowledgment Signature
Tiering/Risk
Catastrophe Potential
Loss Ratio

1

2

3

4

5

6

7

8

9

10

1 is Lower, 10 is Higher
Tenure (Years with Current Carrier)
Association Memberships

Other
Risk Management Measures

Other
Years in Business
Underwriting Questions
Are there any prior or pending claims, lawsuits, or regulatory actions related to the business?
If yes, provide full details (dates, parties involved, amounts, and current status).
Which underwriting topics apply to this business?

Other
Entity Grid
Entity 1 Name
Entity 1 Type
Entity 1 Tax ID
Entity 1 State Registration ID
Entity 1 Ownership Percentage
Entity 1 Parent Company
Entity 1 Business Description
Entity 1 Operations

Other
Entity 1 Policy Types

Other
Entity 1 Notes
Entity 2 Name
Entity 2 Type
Entity 2 Tax ID
Entity 2 State Registration ID
Entity 2 Ownership Percentage
Entity 2 Parent Company
Entity 2 Business Description
Entity 2 Operations

Other
Entity 2 Policy Types

Other
Entity 2 Notes
Notes & Signatures
Notes
Signature
Prior Carrier & Loss History
Prior Carrier Name
Policy Number
Policy Effective Date

MonthDayYear
Date
Policy Expiration Date

MonthDayYear
Date
Policy Status
Number of Losses in Last 5 Years
Loss Details
Loss Types

Other
Business Continuation & Benefit Plans
Does the business have a succession plan?
Describe the succession plan
Are there written business continuation procedures?
Describe the business continuation procedures
Does the business have a buy-sell agreement?
Describe the buy-sell agreement
Does the business offer employee benefit plans?
Which employee benefit plans are offered?

Other
Describe the employee benefit plans
Are there plans to continue benefits after a covered loss?
Should be Empty:

BOP Fact Finder

Customer Information

Coverages & Business Category

Location/Building Information

Business Income Worksheet

Tiering/Risk

Underwriting Questions

Entity Grid

Notes & Signatures

Prior Carrier & Loss History

Business Continuation & Benefit Plans