Commercial Property Quote Form

APPLICANT INFORMATION

NAMED INSURED *

First

Last

BUSINESS NAME

PREMISES ADDRESS

NATURE OF BUSINESS

YRS IN BUSINESS

PRIOR COVERAGE

• Yes
• No

YRS OF EXPERIENCE

LOSSES WITHIN LAST 5 YEARS

• Yes
• No

COVERAGE INFORMATION

BUILDING LIMIT: $

BUSINESS INCOME LIMIT: $

SIGNAGE LIMIT: $

PUMPS LIMIT: $

COVERAGE FORM

• Basic
• Broad
• Special
• Special w/ Theft (Must have alarm)

WIND/HAIL DEDUCTIBLE

BUSINESS PERSONAL PROPERTY (CONTENTS) LIMIT: $

GAS LIMIT: $

CANOPY LIMI: $

OTHER LIMIT: $

VALUATION

• ACV (ACTUAL CASH VALUE)
• RCV (REPLACEMENT COST VALUE)

ALL OTHER PERILS DEDUCTABLE

BUILDING INFORMATION

YEAR BUILT

# OF STORIES

PLUMBING YEAR

CONSTRUCTION TYPE

ROOF YEAR

HEATING YEAR

SQFT

WIRING YEAR

Submit