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Description of Operations
Fed ID#
($) Est. Annual Receipts
($) Est Annual Payroll
# of Ee's
Sq Ft of Bldg
Sq Ft Occ by Ins
Year Built
Basement
Yes
No
# of Stories
Gen Liab Limit Requested
$100K
$300K
$500K
$1MM
Building Coverage
ACV
RC
Market Value
Coins
Ded
Contents Coverage Limit
ACV
RC
Coins
Ded
Cause of Loss
Spec
Brd
Basic
Year Updated:
Elec
Plumb
Roof
HVAC
Workers Comp Class
Officers
Incl
Excl
Payroll by WC Class
Business Interruption
Loss of Rents
1/3
1/4
1/6
ALS
Additional Insureds
Mortgage or L/P
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