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Company Name
DBA
Entity Type
Individual
Partnership
Corporation
LLC
Other
Contact Name
Phone
Email
Mailing Address
City
State
WA
Zip
Current Ins Company
Policy Number
Effective Date
Losses in the last four Years
Property Coverage
Location 1
Address
City
State
WA
Zip
Construction Type
Frame
Steel
Masonry
Other
Year Built
Square Footage
# of Stories
# of Buildings
# of Units
Sprinklered
Yes
No
Building Limit
Annual Reciepts
Deductible
$500
$1,000
$2,000
$5,000
$10,000
Year Updated
Electrical
Roofing
Plumbing
Heating
Location 2
Address
City
State
WA
Zip
Construction Type
Frame
Steel
Masonry
Other
Year Built
Square Footage
# of Stories
# of Buildings
# of Units
Sprinklered
Yes
No
Building Limit
Annual Reciepts
Deductible
$500
$1,000
$2,000
$5,000
$10,000
Year Updated
Electrical
Roofing
Plumbing
Heating
Liability Coverage
Liability Limit
$1,000,000 / $2,000,000
$2,000,000 / $4,000,000
Liability Umbrella
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
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