Commercial Package Quote

Underwriting Guidelines and Classes
.
 Hover or Click for Help Quote Urgency:  

Mandatory for All Quotes Fire / Property General Liability All Liquor Liability and/or Any risks selling liquor
For ORANGE Sections - this is common info for ALL QUOTES.
For GREEN Sections - this is info required for Fire / Property coverage.
For BLUE Sections - this is info required for General Liability coverage.
For PINK Sections - this is info required for all risks applying for Liquor Liability and/or any risks selling liquor.

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:
Mailing City, State, Zip (if same as Location, enter "SAME")
Premises County

Type of Risk
Please describe the type of risk as it applies to the applicant:
If building has apartments, what is the total number of units:
Is the applicant the:
Owner of the building NOT occupying any of the premises
Owner of the building occupying all or part of the premises
Tenant in the building
Total sq ft occupied by owner:     

Is there a parking lot the applicant is responsible for?
Yes     No
  If yes, approx square feet: 

Describe Other Occupancies not mentioned above Sq Ft

Applicant occupies this space
A tenant occupies space
 

Applicant occupies this space
A tenant occupies space
 

Applicant occupies this space 
A tenant occupies space
 

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
 
 
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)Fire walls or fire divisions are concrete separations which are built into the building to prevent fires from spreading throughout the building.

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
RC  ACV
Check if bldg. limit is Betterments & Improvements    
Inflation Guard (if replacement cost building will be automatically increased 4%)  
     None     2 %     4 %
     
Business Personal Property Coverage
     Basic    Broad    Special
RC  ACV
Loss of Income Coverage   HELP
     Business Income      Rental Income
 
Central alarm system? Yes     No      
       
Building 2 - Describe structure below      
Description: RC  ACV
Construction:       
Building Coverage
     Basic     Broad     Special
     
Inflation Guard (if replacement cost building will be automatically increased 4%)  
     None     2 %     4 %
     
Business Personal Property Coverage
    
Basic    Broad    Special
RC  ACV
Loss of Income Coverage
     Business Income Rental Income
 
Central alarm system? Yes     No      
 
Additional Coverages
Coverage Extension Endorsement   Yes      No     ($150 annual premium)
     For coverages, see web site under "Available Optional Endorsements."
     Coverages can be increased for additional premium.  If desired, please note below.
       
Limited Glass Coverage
Yes     No     ($35 annual premium)
     For coverages, see web site under "Available Optional Endorsements."
     Coverages can be increased for additional premium.  If desired, please note below.
Additional coverages and/or comments, if any:

Liability Coverages
Coverages Coverage Amount
General Liability Coverage
Products Liability Coverage
Damages to Premises Coverage
Medical Payment

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


Liability Underwriting Section
Complete questions below for ALL LIABILITY applicants.
Gross Annual Sales/Receipts:   How many years in industry?  
How many years at current location?  
Is there any outdoor seating?    Yes   No   N/A
  If yes, approx square feet: 

 
Does applicant have any delivery services or valet service?  
Yes   No
 
Is the operation open 24 hours?   Yes  No
 
   
Complete below if any of the following describes the applicant.
Select Operation Type - Click to highlight selection
(To select multiple hold CTRL & Click)
 


If the applicant serves liquor

(regardless if liquor liability is requested on this quote)

please complete the following section below:
Additional Liability Underwriting Section / Liquor Liability
If retail store, describe the products sold below:
Liability Comments:

Complete this section for the following risks:
 ● Restaurant with Liquor (regardless if liquor liability is requested on this quote)
 ● Taverns (regardless if liquor liability is requested on this quote)
 ● ALL Risks applying for Liquor Liability

Additional Liability Underwriting Section / Liquor Liability
Liquor Liability Limit
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?
     - had any previous arson occurrences on this or any building owned by applicant?
     - had any bankruptcies?
If yes, indicate when below in "YES" answers section.
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."


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