Your Contact Information
First & Last Name
Zip Code
Email
Preferred Phone
Preferred Follow up Method(s)
Email
Phone
Property Information
Building Value
Content Value
Operating Entity
Ownership Entity, if different than above
Address
DBA
Number of Buildings
Number of Stories per building:
Number of rooms
Construction Type
Roof type
Square Footage
Year built
Building Updates: In the last 10 years
Electric
HVAC
Roof
Plumbing
Sprinkler system
Yes
No
Central Station Alarms
Yes
No
Pool
Yes
No
Diving Board
Yes
No
Restaurant
Yes
No
Restaurant Operating/Ownership Entity:
Estimated annual sales
Liquor Liability
Yes
No
Estimated annual sales
Attach all available loss runs
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