Commercial Insurance Quote Sheet

Commercial Insurance Quote Sheet

Business Name:

Contact’s Name:

Email:

Phone:

Cell:

Fax:

Mailing Address:

SS# OR TAX ID#:

Year Business Started:

Business Type:

Trade Contractor

General Contractor/Builder

Service Business

Retail Store

Restaurant

Office

Condo or Apartment Building

Government Agency

Insurance Needs:

General Liability

Property Coverage (Contents or Building)

Business Auto

Business Interruption/Extra Expense

Workers Compensation

Reason for quote:

New In Business

Shopping Price

Cancelled for Non-Payment

Cancelled for Underwriting Reasons

Non-renewed (company reducing exposure)

Current Insurance Company:

Policy #:

Expiration Date:

Payroll, Sales, and Sub-Costs

No. of Employees:

Annual Sales $:

Annual Payroll $:

Annual Subcontracted Costs:

Liability Limit $:

Describe All Operations (What do you do)?

Property Coverage (Contents or Building)

Construction:

Frame

Joisted Masonry

Non-Combustible

Masonry Non-Combustible

Superior

Roof:

Asphalt Shingles

Architectural Shingles

Metal

Concrete Tile

Clay Tile

Flat – Tar & Gravel

Roof Design:

Gable

Hip

Flat

Roof Age in Years:

Year Built:

Square Footage:

Number of Stories:

Property Address:

Updates to Building:

Roof replaced? Year

Water heater replaced? Year

HVAC replaced? Year

Electrical replaced? Year

If a Condo: # of units in bldg:

# of stories in bldg:

Name of Condo:

Pool: If Yes:

In Ground/Above Ground:

Diving Board/Slide:

Fenced:

Property Coverage Amounts:

Building:

Business Contents:

Business Interruption:

Deductible:

Central Station Burglar Alarm?

Central Station Fire Alarm?

Sprinklered?

Fire Extinguishing System?

Security Guard?

Auto Coverage

Liability: Always Include PIP

UM:

MedPay:

Any losses or claims in last 5 years:

If so, give date of claim, description, and amount of loss:

DOCUMENT CHECKLIST:

Flood Zone Determination OR, Elevation Certificate

Citizens “No Market Document”

Prior insurance dec page

Appraisal (Required By Citizens)

Burglar/Fire Alarm Certificates

Loss Runs

Pictures

Construction Definitions

Frame (code 1)

Buildings where the exterior walls are wood or other combustible materials, including construction where combustible materials are combined with other materials such as brick veneer, stone veneer, wood ironclad, and stucco on wood.

Joisted Masonry (code 2)

Buildings where the exterior walls are constructed of masonry materials such as adobe, brick, concrete, gypsum block, hollow concrete block, stone, tile or similar materials, and where the floors and roof are combustible. (Other than construction defined by the description for code 7.)

Noncombustible (code 3)

Buildings where the exterior walls, floors, and the roof are constructed of, and supported by, metal, asbestos, gypsum or other noncombustible materials. (Other than construction defined by the description for code 8.)

Masonry Noncombustible (code 4)

Buildings where the exterior walls are constructed of masonry materials as described in code 2 with the floors and roof of metal or other noncombustible materials. (Other than construction defined by the description for code 9.)

Modified Fire Resistive (code 5)

Buildings where the exterior walls and the floors and roof are constructed of masonry or fire resistive materials with a fire resistance rating of one hour or more but less than two hours.

Fire Resistive (code 6)

Building where the exterior walls and the floors and roof are constructed of masonry or fire resistive materials having a fire resistance rating of not less than two hours.

Superior Masonry/Heavy Timber (code 7)

Joisted masonry buildings where the entire roof is a minimum of 2 inches in thickness and is supported by timbers having a minimum dimension of 6 inches; or, where the entire roof assembly is documented to have a wind uplift classification of 90 or equivalent.

Superior Noncombustible (code 8)

Noncombustible buildings where the entire roof is constructed of 22 gauge metal (or heavier) on steel supports; or, where the entire roof is constructed of 2 inches of masonry on steel supports; or, where the entire roof assembly is documented to have a wind uplift classification of 90 or equivalent.

Superior Masonry Noncombustible (code 9)

Masonry noncombustible buildings where the entire roof is constructed of 2 inches of masonry on steel supports; or, when the entire roof is constructed of 22 gauge metal (or heavier) on steel supports; or, where the entire roof assembly is documented to have a wind uplift classification of 90 or equivalent.

CITIZENS WINDSTORM CONSTRUCTION DEFINITIONS

Common Fire Classification Corresponding Windstorm Classification

Frame (code 1) Frame

Joisted masonry (code 2) Masonry

Noncombustible (code 3) Masonry

Masonry noncombustible (code 4) Semi-wind resistive

Modified fire resistive (code 5) Wind resistive

Fire resistive (code 6) Wind resistive

Superior masonry/heavy timber (code 7) Semi-Wind resistive

Superior noncombustible (code 8) Semi-Wind resistive

Superior masonry noncombustible (code 9) Wind-resistive

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