NameThis 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)Owner's Name(Required) First Last Business Address(Required) Street Address 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 the business address the same as the mailing address?(Required) Yes No Mailing Address(Required) Street Address 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)FaxEmail(Required) Web Address:FEIN (Tax ID #):(Required)Does the applicant have DBA (Doing Business As) name:In what year did the applicant start operations?(Required)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 so, please list locations/interests:(Required)Does applicant own any business autos?(Required) Yes No If there are business autos, please provide details:(Required)Are there any vehicles that have been customized, altered, or that have special equipment?(Required) Yes No If so, please list customizations:(Required)Are there any vehicles leases to other?(Required) Yes No Are there high-valued good, including merchandise at your location?(Required) Yes No If yes, what is the approximate value of your inventory?(Required)What is the value of your business property? (BPP are all your furniture, computers, printers, etc. Basically, anything you will take with you if you move)(Required)Property DetailsBuilding Type:(Required) Office Retail Warehouse Manufacturing Restaurant Other Total square footage occupied by the applicant:(Required)Total number of buildings:(Required)Year built:(Required)Number of floors in the building:(Required)Does property have a parking lot or garage?(Required) Yes No What is the area of the lot/garage? (in square feet)(Required)Type of Construction(Required) Frame Masonry Metal Concrete Other Type of Roof (e.g., TPO, EPDM, built-up, shingles, metal):(Required)What year was the roof last replaced/updated?(Required)What year was the electrical wiring last updated/inspected?(Required)What type of wiring is it?(Required) Copper Aluminum Knob and Tube Other What year was the plumbing last updated/inspected?(Required)Type of pipes (e.g., copper, PVC, galvanized)?(Required)What year was the heating/HVAC last serviced/replaced?(Required)What type of heating system is it (e.g., central furnace, boiler, electric heat)?(Required)Does your property have a Fire Sprinkler System?(Required) Yes No Is there a fire alarm system?(Required) Yes No Is the system monitored by a central station?(Required) Yes No What is the distance to the nearest fire hydrant?(Required)What is the distance to the nearest fire station?(Required)What is the Public Protection Class (PPC) for the location (a 1-10 rating, where 1 is best)?(Required)Please enter a number from 1 to 10.Are fire extinguishers readily available and regularly inspected?(Required)Does the building have a security system?(Required) Yes No Describe the security measures (e.g., camera, guards, keycard access):(Required)Who is responsible for the care and maintenance of the property (building, sidewalks, parking lots)?(Required)What is the estimated replacement cost of the building?(Required)Do you own or lease any additional structures (storage unit, detached buildings, etc.)(Required) Yes No If yes, please describe:(Required)Business property & Contents CoverageWhat is the requested replacement cost value (RCV) of the building(s)? (This should be based on current construction costs, not market value):(Required)Descrribe the overall condition of the building, including the exterior, roof, interior, and foundational elements:(Required)What is the regular maintenance schedule for the building systems (e.g., HVAC, plumbing, electrical)?(Required)Are there any known deferred maintenance issues or structural problems?What is the estimated value of business personal property (equipment, inventory, furniture, etc.)?(Required)Do you have specialized equipment or high-value items that require additional coverage?(Required) Yes No If yes, please describe:(Required)Are contents primarily at the main business address, or are there other locations where property is stored or used? Please specify:(Required)What is the requested replacement cost value (RCV) of your business personal property?(Required)Does this value fluctuate significantly (e.g., seasonal inventory)? If so, what are the peak and off-peak values?(Required)Do you store hazardous materials or flammable substances on-site?(Required) Yes No Please specify:(Required)Does the applicant rely on specialized machinery for daily operations?(Required) Yes No Do you have backup power sources (e.g., generators)?(Required) Yes No Property Use & OperationsDoes the building have multiple tenants?(Required) Yes No If so, what kind of businesses do they have?(Required) Underwriters need to know about your co-occupants due to potential shared exposures.What percentage of the building do you occupy?(Required)Please enter a number from 1 to 100.Are there any vacant units in the building?(Required) Yes No What percentage of the building is vacant?(Required)Please enter a number from 1 to 100.What is the primary use of the building? (check all that apply)(Required) Office Space Retail Sales Manufacturing Third Party Processors/Harvesters Restaurant/Food Service Wholesale/Distributors Laboratories Management Offices Indoor/Greenhouse Storage/Warehouse Other (please specify) Other uses:(Required)Are any structural renovations or repairs planned in the next 12 months?(Required) Yes No Please describe plans:(Required)Are there any existing structural issues or damages to the property?(Required) Yes No Please describe issues:(Required)Do you lease any part of the property to others?(Required) Yes No Please describe leases:(Required)Does the applicant rely on another location for storage, production, or operations?(Required) Yes No Please explain location(s):(Required)Safety and SecurityWhat specific protective safeguards are in place and routinely maintained (e.g., alarm systems, sprinkler systems, automatic extinguishing systems, security guards)?(Required)Are there any monitoring contracts in place for these systems?(Required)What is the procedure for testing and maintenance of these safeguards?(Required)Business Interruption & Extra CoverageWould the applicant suffer a financial loss if the property were damaged and operations had to stop?(Required) Yes No What is your estimated monthly revenue?(Required)What is your estimated time required to resume full operations if a major loss occurs?(Required) Less than 30 days 30-60 days 60-90 days More than 90 days Do you have a contingency plan in place for business disruptions?(Required) Yes No Future Construction ActivityWill there be construction activities during the policy term?(Required) Yes No What is the scope of work and general timeframe?(Required)What are the projected construction costs?(Required)Will a general contractor be hired?(Required) Yes No Is the general contractor required to carry their own Commercial General Liability coverage?(Required) Yes No Additional Coverages & EndorsementsWould you like to include coverage for the following? (Check all that apply)(Required) Equipment Breakdown Coverage Spoilage Coverage (for perishable goods) Utility Services Interruption Coverage Ordinance or Law Coverage (for compliance with updated building codes) Flood or Earthquake Coverage Cyber Liability Coverage Employee Theft Coverage Insurance History & Claims Information?Do you currently have commercial property insurance?(Required) Yes No Current Insurer(Required)Policy Expiration Date(Required) MM slash DD slash YYYY Current Policy Limits(Required)Have you had any property insurance claims in the past five years?(Required) Yes No If yes, please provide details of your claim(s) (date, description, current status, type of claim, amount paid):(Required)Has the applicant ever had insurance coverage canceled or non-renewed?(Required) Yes No Please explain:(Required)Additional Comments or Special Considerations(Please provide any other relevant information that may impact your insurance coverage needs.) Δ
