Commercial Earthquake Insurance

COMMERCIAL EARTHQUAKE
Your Name:
Business Name:
Address:
City:
State:
Zip Code:
PROPERTY INFORMATION
How Many Units In The Building?
How Many Units In The Building Are Vacant?
Year Built:
Date You Purchased The Property:
Construction Type:
How Many Stories:
Total Square Footage of The Building:
Does the Building Have Interior Automatic Fire Sprinklers?	yes no
Fire Alarm:	yes no
Earthquake Retrofitted:	yes no
Describe Tenants:
COVERAGE INFORMATION
Building Amount (Coverage A):
Other Structures (Coverage B):
Business Property (Coverage C):
Loss of Rents (Coverage D):
Deductible Percentage %:
Building Replacement Cost Coverage:	yes no
HOW SHOULD WE CONTACT YOU? PLEASE SELECT
Phone Number:
Fax Number:
E-Mail Address: