BOP Quote
Fields marked (*) are mandatory.
General Information
Name of Insured*
Address*
City
State
Business Phone*
Fax Number
Email Address*
Location Address (type 'same' if same as above)
City
State
Zip
Property Questions
Age of building/Year Built
Type of building construction
Number of stories
Other occupancies
Square feet you occupy (sq. ft.)
If the building is over 25 years old, please answer the following
Year Electricity was updated
Is it on circuit breakers?
Year Plumbing was updated
Copper or Galvanized plumbing?
If Other
Year Building was last re-roofed
Type of roofing material
Type of heating system in the building
Protective Devices
Burglar Alarm
Central Station or local alarm?
Name of alarm company
Is the building sprinklered
Are there smoke detectors
Other devices (describe briefly)
Please provide information on previous insurance carrier
Previous Ins. Carrier
Policy number
Prior premium
Policy renewal date
Please provide information about your business
Years in business
Projected Gross annual receipts
Projected annual payroll
Describe your business, product or service
Coverage Limits
Building
Contents (equipment, inventory, supplies, etc.)
Deductible
Loss of Income
Money and Securities
Glass or signs
General Liability Limit
Non-owned and Hired Automobile Liability
Is liquor liability needed?
If Glass Coverage is needed, please provide dimensions
Please list other coverages you may need
Miscellaneous Information
Name of Additional Insured (Landlord or vendor)
Mailing Address
City
Zip
State
Additional Comments
Additional Comments