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RETAIL AND WHOLESALE

Company Name DBA Entity Type
Contact Name Phone Email
Mailing Address City State Zip
Current Ins Company Policy Number Effective Date
Losses in the last four Years
Payroll
Number of Employees
Annual Gross Receipts
Type of Product Sold
Property Coverage
Location 1
Address City State Zip
Construction Type Year Built Square Footage Number of Stories
Building Limit Contents Limit Computer Limit

% Sprinklered

Year Updated Electrical Roofing Plumbing Heating

Location 2
Address City State Zip
Construction Type Year Built Square Footage Number of Stories
Building Limit Contents Limit Computer Limit

% Sprinklered

Year Updated Electrical Roofing Plumbing Heating
Crime Coverage
Money & Securities Employee Dishonesty
Motor Truck Cargo
No. of Vehicles Hauling Cargo Average Value of Cargo per Vehicle Maximum Loss Limit
Liability Coverage
Liability Limit Liability Umbrella
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