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Illinois Commercial Quote

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Quote Urgency:   . Customer in Office Waiting ASAP Within 1 Hour Within 24 Hours Administration Use Only

Producer Info
Producing Agency:	Your Name:	Producer # (if applicable):	Producer Phone:
Preferred Response: (Req'd) E-mail     Fax     E-mail/Fax #:		Billing Method: Agent Bill     Direct Bill - Insured      Direct Bill - Mortgagee
Proposed Effective Date:
Check all that apply:
Fire     General Liability     Liquor Liability

Applicant Info
Applicant Name	Inspection Contact Name
**Location Address**	Inspection Contact Phone
**Location City, State, Zip**	Best Contact Time
Mailing Address (if same as Location, enter "SAME")	Type of Ownership: . Individual Partnership Corporation LLC
Mailing City, State, Zip (if same as Location, enter "SAME")	Premises County

Type of Risk
Please describe the type of business:
Owned & Occupied     Owned & Not Occupied     Tenant Occupied
Total sq ft occupied by owner:      If Apartments, number of units:
Is there a parking lot the applicant is responsible for? Yes     No   If yes, approx square feet:
Describe Other Occupancies	Sq Ft	# of Units
Owned & Occupied   Tenant Occupied
Owned & Occupied   Tenant Occupied
Owned & Occupied   Tenant Occupied

General Building Info
Year building was built Number of Stories 1     2     3	Percent Building Occupied Fully Occupied/100% Partially/Under 100%   If partially occupied, describe vacancies:
Construction   . Frame Brick/Joisted Masonry Fire Resistive Non-Combustible Other - Fill in below	Any construction present or expected? Yes   No     If yes, describe:
Has the building been updated? Yes     No	Number of fire walls/fire divisions in building (if any)
Year of Building Updates Electricity:    Heat: Plumbing:     Roof:
Fire Protection Smoke Detectors   Dead Bolt Locks Fire Extinguisher     Carbon Monoxide Detectors	Is there a working automatic fire alarm in service that reports to a public or private fire alarm station? Yes     No
Is there any Commercial Cooking?  Yes     No   If so, is there an Automatic Fire Extinguisher System in place and  serviced regularly? Yes     No
In Agent's/Applicant's opinion, what is the condition of the premises? Excellent     Good     Fair     Poor
Current Fire and Liability: Company: *(required) Policy #:   *(required to bind)	Renewal to your office? Yes     No
Is the applicant being non-renewed from its current carrier? Yes     No     If yes, describe:
Enter target/current premium:	Current Premium     Target Premium
General Building Comments:

Fire Section
Coverages	Coverage Amount	Deductible	Coverage Options
Building 1
Building Coverage      Basic     Broad     Special		. $500 $1,000 $2,500 $5,000	RC  ACV
Check if bldg. limit is Betterments & Improvements
Inflation Guard
None     2 %     4 %
Contents Coverage      Basic    Broad    Special		. $500 $1,000 $2,500 $5,000	RC  ACV
Loss of Income Coverage      Business Income       Rental Income		. 100% - Rental Income Only 1/6th Monthly 1/4th Monthly 1/3rd Monthly
Central alarm system? Yes     No
Building 2 - Describe structure below
Description:		. $500 $1,000 $2,500 $5,000	RC  ACV
Construction:  . Frame Brick/Joisted Masonry Fire Resistive Non-Combustible Other - Fill in below
Building Coverage      Basic     Broad     Special
Inflation Guard
None     2 %     4 %
Contents Coverage      Basic    Broad    Special		. $500 $1,000 $2,500 $5,000	RC  ACV
Loss of Income Coverage      Business Income Rental Income		. 100% - Rental Income Only 1/6th Monthly 1/4th Monthly 1/3rd Monthly
Central alarm system? Yes     No
Coverage Extension Endorsement   Yes      No     ($150 annual premium)      For coverages, see ENDT attached to quote.
Limited Glass Coverage Yes     No     ($35 annual premium)
Additional coverages and/or comments, if any:

Liability Coverages
Coverages	Coverage Amount
General Liability Coverage	. None $100,000 $300,000 $500,000 $1,000,000
Products Liability Coverage	. None $100,000 $300,000 $500,000 $1,000,000
Damages to Premises Coverage	. None $50,000 $100,000
Medical Payment	. None $1,000 $2,000 $5,000
Liquor Liability	. None $100,000 $300,000 $500,000 $1,000,000

If primary occupancy is an Apartment Building and/or LRO skip to the General Underwriting Questions at the bottom.

Liability Underwriting Section
Select Operation Type
Complete below if any of the following describes the risk submitted. If retail store, describe the products sold below. (To select multiple hold CTRL & Click)	Complete questions below for ALL  applicants.
Bakery with Cooking Bakery without Cooking Coffee Shop/Etc. without Cooking Office Restaurant with Liquor Restaurant without Liquor Has Wait Staff Retail Store - Explain Below	Gross Annual Sales/Receipts
	Is there any outdoor seating? Yes     No     N/A   If yes, approx square feet:
	Is the operation open 24 hours? Yes     No
	How many years in industry?
Retail Store/Other - Explain Below:	How many years at current location?
	Does applicant have any delivery services or valet service?   Yes   No
Liability Comments:

Complete this section for the following risks:  ● Restaurant with Liquor  ● Taverns  ● ALL Risks applying for Liquor Liability

Additional Liability Underwriting Section
Licensed Closing Time 2 AM     4 AM	Actual Closing Time	Days open per week (Sun, Mon, etc.)
Annual Gross Liquor Receipts		How many years at current location?
Is there Entertainment? Yes     No     If yes, describe:
Are there more than 3 pool tables? Yes     No		Is there a dance floor on premise?     Yes     No   If yes, approx sq ft area:   If yes, is the dance floor raised? Yes     No
Is there a beer garden? Yes     No   If yes, approx sq ft area:		Does the establishment have a door attendant? Yes     No
Please complete ONLY if Liquor Liability is requested
Building Owner info is required to bind coverage.
Building's Owner Name		Common Law Requested Yes     No
Street Address		Liquor Awareness Training Yes     No
City, State Zip
Current Company	Current Policy Number	Any losses in the last 3 years? Yes     No      If yes, describe:
Current Premium	Policy Expiration Date	Has any company cancelled or refused coverage in last 5 years? Yes     No   If yes, describe:
Have you insured applicant previously?   Yes     No If yes, explain:
General Liquor Liability Comments:

General Underwriting Questions
Have there been any PROPERTY, LIABILITY or LIQUOR LIABILITY claims in the last 3 years? (Req'd)	(Type "YES" or "NO") (If yes, describe below)
Has the applicant ever been convicted of any degree of arson?	Yes   No
Within the last 12 months period has applicant been cited with any building code violations?	Yes   No
Any prior construction defects or mold evidence uncovered?	Yes   No
Does the applicant require commercial tenants to provide insurance for their space?	Yes   No   N/A
Is there any Section 8 / subsidized / student / elderly housing?	Yes   No
Explain any "Yes" answers:
Comments:
All quotations are subject to satisfactory Property Inspection. (Inspection fee is fully earned at inception of policy.)
NO FLAT CANCELS WILL BE ALLOWED AFTER INCEPTION OF POLICIES.
Agent/Applicant warrants that above are true to the best of his/her knowledge.

If you wish to have a copy of this submission for your records, you must print page BEFORE submitting.

Please note - There might be a delay upon submission. Do not exit until you receive the "Confirmation Page."