Commercial Insurance Application – Jennifer Tumbrello

Your business

Business name Required

Entity type Required

What the business does Required

Year business startedRequired

FEIN (tax ID)Required

Why are you shopping?Required

Contact first name Required

Contact last name Required

Phone Required

Email Required

Mailing address Required

City Required

State Required

ZIP code Required

Location & building

Location address (if different from mailing)Required

Location city (if different)Required

Location state (if different)Required

Location ZIP (if different)Required

How the space is usedRequired

Owned or leased?Required

Year builtRequired

Number of storiesRequired

Building area (sq ft)Required

Square feet you occupyRequired

Roof typeRequired

Roof replaced (year)Required

Plumbing updated (year)Required

Wiring updated (year)Required

HVAC updated (year)Required

Fire sprinklers?Required

Central alarm?Required

Additional location 2 (if any)

Street addressRequired

CityRequired

StateRequired

ZIPRequired

How this location is usedRequired

Owned or leased?Required

Year builtRequired

Building area (sq ft)Required

Square feet occupiedRequired

Annual revenue at this location ($)Required

Full-time employees hereRequired

Part-time employees hereRequired

Additional location 3 (if any)

Street addressRequired

CityRequired

StateRequired

ZIPRequired

How this location is usedRequired

Owned or leased?Required

Year builtRequired

Building area (sq ft)Required

Square feet occupiedRequired

Annual revenue at this location ($)Required

Full-time employees hereRequired

Part-time employees hereRequired

Operations & payroll

Estimated annual gross receipts ($)Required

Estimated annual payroll ($)Required

Full-time employeesRequired

Part-time employeesRequired

Subcontractors used per yearRequired

Insurance history

Is the business currently insured?Required

Current carrierRequired

Current annual premiumRequired

Policy expiration dateRequired

Any losses in the past five years?Required

Most recent claim — dateRequired

Most recent claim — amount paid ($)Required

Most recent claim — causeRequired

Most recent claim — statusRequired

Second claim — dateRequired

Second claim — amount paid ($)Required

Second claim — causeRequired

Second claim — statusRequired

Other claims (dates, causes, amounts)Required

Coverage needed by (date)Required

Policy termRequired

Business details & underwriting

HOA / community (only if applicable)

Is this for an HOA / community association?Required

Address(es) of the communityRequired

Approx. square footage of entire communityRequired

What needs fire insurance?Required

How many units?Required

Approx. square footage of each unitRequired

Pool / spa?Required

Diving board?Required

Public barbeques on the grounds?Required

Clubhouse?Required

Clubhouse square footageRequired

Any vacant units?Required

How many vacant units?Required

How did you hear about us? Required

Anything else Jennifer should know?Required