Commercial Property Application
Business Name
CEO / President Name
Street Address
Apt. / Suite Number
City, State Zip ,
Business Description
Company FEIN or President SS#
Year Business Was Established
Email Address
Contact Phone Number

Prior Insurance Info
(Prior 3 years)
Carrier Policy # Effective / Expiration Dates Liability Limits
Any Claims or Losses?   Yes  No
If Yes Please Explain:

Please attach the last 3 years of updated loss run.

Property Info
  • Location 1
  • Location 2
  • Location 3
  • Location 4
  • Location 5
Address  
Address 2  
City, State Zip   ,
Nature of Business /
Description of Operations
on Premise(s).		  
Building Value  
Loss Of Rent / Income  
Deductible  

Building Info:
Construction Type:  Roof Type:
Year Built:  Sq Ft: Sq. Ft. Garage: Num of Floors:
Fire Protection: Sprinklered Non-Sprinklered

Building Improvements:
  Fully Updated Partially Updated Year Improved
Heating
Electrical
Roofing
Plumbing

Does Building have a central Alarm?  Yes No
If yes, who installed it and can you provide a certificate?
Address  
Address 2  
City, State Zip   ,
Nature of Business /
Description of Operations
on Premise(s).		  
Building Value  
Loss Of Rent / Income  
Deductible  

Building Info:
Construction Type:  Roof Type:
Year Built:  Sq Ft: Sq. Ft. Garage: Num of Floors:
Fire Protection: Sprinklered Non-Sprinklered

Building Improvements:
  Fully Updated Partially Updated Year Improved
Heating
Electrical
Roofing
Plumbing

Does Building have a central Alarm?  Yes No
If yes, who installed it and can you provide a certificate?
Address  
Address 2  
City, State Zip   ,
Nature of Business /
Description of Operations
on Premise(s).		  
Building Value  
Loss Of Rent / Income  
Deductible  

Building Info:
Construction Type:  Roof Type:
Year Built:  Sq Ft: Sq. Ft. Garage: Num of Floors:
Fire Protection: Sprinklered Non-Sprinklered

Building Improvements:
  Fully Updated Partially Updated Year Improved
Heating
Electrical
Roofing
Plumbing

Does Building have a central Alarm?  Yes No
If yes, who installed it and can you provide a certificate?
Address  
Address 2  
City, State Zip   ,
Nature of Business /
Description of Operations
on Premise(s).		  
Building Value  
Loss Of Rent / Income  
Deductible  

Building Info:
Construction Type:  Roof Type:
Year Built:  Sq Ft: Sq. Ft. Garage: Num of Floors:
Fire Protection: Sprinklered Non-Sprinklered

Building Improvements:
  Fully Updated Partially Updated Year Improved
Heating
Electrical
Roofing
Plumbing

Does Building have a central Alarm?  Yes No
If yes, who installed it and can you provide a certificate?
Address  
Address 2  
City, State Zip   ,
Nature of Business /
Description of Operations
on Premise(s).		  
Building Value  
Loss Of Rent / Income  
Deductible  

Building Info:
Construction Type:  Roof Type:
Year Built:  Sq Ft: Sq. Ft. Garage: Num of Floors:
Fire Protection: Sprinklered Non-Sprinklered

Building Improvements:
  Fully Updated Partially Updated Year Improved
Heating
Electrical
Roofing
Plumbing

Does Building have a central Alarm?  Yes No
If yes, who installed it and can you provide a certificate?