URLThis field is for validation purposes and should be left unchanged.Applicant InformationApplicant Entity Type:(Required) Individual Partnership Corporation LLC Joint Venture Applicant Name:(Required)Applicant's Name:(Required) First Last Applicant's Company Name:(Required)(N/A if you don't have one)Applicant Owner's Name:(Required) First Last Business Address:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is business address same as mailing address?(Required) Yes No Mailing Address:(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:(Required)Fax:Email:(Required) Website FEIN (Tax ID #):(Required)Does the applicant have a DBA (Doing Business As) name:In what year did the applicant start operations?(Required) MM slash DD slash YYYY Please describe the applicant's day-to-day business operations:(Required)Main area of practice, type of services provided, products, etc. - Please be detailedHow many years of management experience in this industry does the applicant have?(Required)Are there any locations or business interests that are owned by the applicant but not shown on the application?(Required) Yes No If yes, please describe:(Required)Do you own any business autos?(Required) Yes No Are there any vehicles that have been customized, altered, or that have special equipment?(Required) Yes No Are there any vehicles leased to others?(Required) Yes No Are there high-valued goods, including merchandise at your location?(Required) Yes No If yes, what is the approximate value of your high-value inventory?(Required)What is the value of your business personal property? (BPP are all your furniture, computers, printers, etc. Basically, anything you will take with you if you move.)(Required)Is this entity a franchise?(Required)Applicant pays for the right to operate under the franchisor's brand and system, the franchisor being the one that owns the brand, products, and business model Yes No If yes, please describe:(Required)Number of Locations that the applicant has (in any state):(Required)Policy Level UnderwritingHow many total employees does the applicant have?(Required)Full Time Employees:Part Time Employees:Contractors:What is the total annual payroll amount for all employees?(Required)Please list the number of employees and their positions below:(Required)(For example, Postion: Salesperson, Count: 3) PositionCount Add RemoveTotal square footage occupied by the insured:(Required)What is the value of all inventory on hand at any given time?(Required)This is your contents amount.Is there a monitored burglar/fire alarm in the store?(Required) Yes No Please list the type of roof that the building has:(Required)Does your store/office have a Fire Sprinkler System:(Required) Yes No What percentage of the building is vacant or unoccupied?(Required)Please enter a number from 0 to 100.Has the building undergone a comprehensive renovation since it was originally built?(Required)This can include gutting to the exterior walls with completely new interior walls, plumbing, heating, wiring, and/or roof. Yes No Enter most recent renovation type and date:(Required) MM slash DD slash YYYY Wiring Year:(Required)Roofing Year:(Required)Plumbing Year:(Required)Heating Year:(Required)Does the applicant conduct video surveillance at this location?(Required) Yes No Business OperationsWhat is the applicant's primary activity/operation?(Required)(e.g., retail store, office, restaurant, service provider, light manufacturing, contractor)Are there any other business operations or services provided that are not directly related to the primary activity?(Required) Yes No If so, please describe in detail:(Required)Does the applicant operate from a commercial or home-based location?(Required)Property Coverage DetailsDo you own or lease your business property, or both?(Required) Own Lease If leased, what is the square footage occupied and what are the landlord's insurance requirements (e.g., additional insured status, specific liability limits)?(Required)What is the age of the building?(Required)What is the building construction type?(Required) Frame Masonry Metal Other Year Built:(Required)Number of Stories:(Required)Roof Type:(Required)Total Building Area:(Required)Total Area Occupied by Insurance:(Required)Is the property open 24 hours/day:(Required) Yes No Building Safety Details:(Required) Automatic Sprinkler System (100% of building) Central station fire alarm Private fire department protection service contract Ansul system over all cooking equipment Central station burglar alarm Security guards Security cameras Security service making off-hours hourly records Building square footage occupied by the applicant:(Required)Estimated building replacement cost (if owned):(Required)ProductsDoes the applicant manufacture, distribute, sell, or handle any products?(Required) Yes No If yes, please list and describe them:(Required)Are any products imported or exported?(Required) Imported Exported Both Other What is the quality control process for products?(Required)Are there any product warranties provided?(Required)Have there been any product recalls in the past?(Required) Yes No If yes, please explain:(Required)What is the estimated annual sales volume of products?(Required)Completed Operations/ServicesDoes the applicant perform any work or services once completed, which could later cause injury or damage?(Required) (e.g., installation, repair, consulting, construction, cleaning services) Yes No Please expain:(Required)What is the typical timeframe from completion of service to potential discovery of a defect/issue?(Required)Are there any warranties or guarantees provided on services?(Required)Advertising ActivitiesWhat methods of advertising does the applicant use (e.g., print, online, social media, radio, TV)?(Required)Does the applicant create its own advertising content or use a third-party agency?(Required)Are there procedures in place to review advertising content for potential copyright infringement, libel, or slander?(Required)Does the applicant provide advice, consulting, design, or other professional services that, if faulty, could lead to financial harm to a client?(Required)Describe any professional services offered:(Required)What are the qualifications and licensing of individuals providing these services?(Required)Liquor LiabilityDoes the applicant sell, serve, or furnish alcoholic beverages?(Required) Yes No What is the percentage of revenue from alcohol sales?(Required)Please enter a number from 1 to 100.What are the training procedures for staff (e.g., responsible beverage service)?(Required)Is the applicant licensed for alcohol sales?(Required) Yes No Safety and SecurityWhat safety measures are in place to prevent slips, trips, and falls (e.g., clear pathways, non-slip flooring, adequate lighting, wet floor signs, routine cleaning)?(Required)Are entrances and exits clearly marked and well-maintained?(Required) Yes No Is there adequate lighting, especially in parking areas or walkways, after dark?(Required) Yes No Does the building have parking? Please explain:(Required)(Subterranean, open parking lot attached to building, carports, etc.)What security measures are in place (e.g., locks, alarms, surveillance cameras, security personnel)?(Required)Are there any known crime issues in the surrounding area? Please detail:(Required)Does the applicant have a swimming pool, playground, trampoline, or other recreational facilities on business premises accessible to the public? Please describe:(Required)Are there any specific hazards on the premises (e.g., forklifts in operation, machinery, chemicals, elevated platforms)? Please elaborate:(Required)Prior Losses / HistoryDuring the last five years, has any applicant been indicted for or convicted of any degree of the crime of fraud, bribery, arson or any other arson-related crime in connection with this or any other property?(Required) Yes No Has the prospect had a foreclosure, repossession, bankruptcy, judgment or tax lien, business failure or any litigation during the past five (5) years?(Required) Yes No Have there been any past losses or claims relating to sexual abuse or molestation allegations, discrimination or negligent hiring?(Required) Yes No Has the prospect had any losses in the past four (4) years (current policy and prior 3 years)?(Required) Yes No Has any policy or coverage been cancelled or non-renewed during the prior three (3) years for other than non-payment of premium?(Required) Yes No If so, please explain in detail:(Required)Workers’ Compensation & Employee PracticesDo you currently have workers’ compensation insurance?(Required) Yes No Do you provide employee benefits?(Required) Yes No Do you conduct background checks on employees?(Required) Yes No Do employees receive safety training?(Required) Yes No Do you have an Employee Handbook or HR policies?(Required) Yes No Cyber Liability & Additional Coverage OptionsDo you store customer data electronically?(Required) Yes No Do you process credit card transactions?(Required) Yes No Have you experienced a data breach in the past five years?(Required) Yes No Are you interested in adding the following coverages?(Required) Cyber Liability Insurance Employment Practices Liability Insurance (EPLI) Flood or Earthquake Insurance Equipment Breakdown Coverage Commercial Auto Insurance Other coverages Select AllOther coverages:(Required)Insurance History & ClaimsDo you currently have a Business Owners Policy (BOP)?(Required) Yes No If yes, who is your current insurer?(Required)Expiration date of current policy:(Required) MM slash DD slash YYYY Have you had any insurance claims in the past five years?(Required) Yes No If yes, please provide details (date, description, type of claim, amount paid, status):(Required)Additional Comments or Special Considerations(Please provide any other relevant information that may impact your insurance coverage needs.) 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