General Information Name of Business:   Contact Name:   Mailing Address:   City:     State:   Zip: Business Phone:     Fax: Best Time To Call:     AM   PM Contact Email Address:   Insured Is:   Select One Individual Partnership Corporation Other   How Long in Business:

 

Property Information Street Address:   City:     State:   Zip: Year Built:   # of Buildings:   # of Units:   # of Stories:   Total Building Square Footage:   sq. feet Building Construction:   Select One Frame/Stucco Masonry Other Type of Parking:   Select One Garages (Attached) Garages (Detached) Carports (Attached) Carports (Detached) Underground Subterranian Street Type of Roof:   Select One Composition Tile Wood Shake Rock Other Year Roof Last Updated:   # of Pools:   Are pool(s) Fenced:   Select One Some Are All Are None Are No Pool Are there diving boards:   Select One On All Pools On Some Pools None No Pool Is there a pool slide:   Select One On All Pools On Some Pools None No Pool # of in-room Jacuzzis:   # of Kitchenettes:   Type of Electrical:   Select One Circuit Breakers Fuses Fuse Stats Year Electrical Last Updated:   Type of Heating:   Select One Gas Electrical Solar Other Year Heating Last Updated:   Type of Plumbing:   Select One Copper Galvanized PVC Other Year Plumbing Last Updated:   Automatic Fire Sprinklers:   Select One Yes No On All Floors:   Select One Yes No N/A Fire Alarms:   Select One Yes, Monitored Yes, Not Monitored No Smoke Detectors:   Select One Yes No Burglar Alarms:   Select One Yes, Monitored Yes, Not Monitored No On-Site Security:   Select One Yes No Total Sq. Footage of Restaurant:   sq. ft. Restaurant Operated By:   Select One Hotel Tenant None Liquor Receipts:   $ Bar Serves:   Select One Beer/Wine Only Full Bar No Bar Total Sq. Footage of Retail Stores:   sq. ft. Total Sq. Footage  of Banquet Halls:    sq. ft. Total Sq. Footage of Exterior Glass:   sq. ft. Distance to Lake, River, Ocean:   Select One Not Applicable 100 Yards 500 Yards 1/2 Mile Couple of Miles Hotel is owned by:   Select One Individual Partnership Corporation Trust LLC Other Is the hotel part of a franchise:   Select One Yes No Will Soon Be

 

Desired Coverages Building Amount:   $ Annual Income:   $ Contents Amount:   $ Deductible:   Select One $250 $500 $1,000 $2,500 $5,000 Exterior Glass:   $ Accounts Receivable:   Select One $5,000 $10,000 $25,000 $50,000 $75,000 $100,000 $150,000 $200,000 Employee Dishonesty:   Select One None $10,000 $25,000 $50,000 Employee Benefits Liability:   Select One $500,000 $1,000,000 Money & Securities:   Select One None $5,000 $10,000 $25,000 $50,000 $100,000 Valuable Papers:   Select One $5,000 $10,000 $25,000 $50,000 $75,000 $100,000 Building Ordinance:   Yes   No Agreed Amount Endorsement:    Yes   No Inflation Guard:   Select One 2% 4% 6% 8% 10% Outdoor Sign Value:   Select One $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 Earthquake Sprinkler Leakage:   Yes   No # of Additional Insureds:    General Limit Liability:   Select One $1,000,000 $500,000 $300,000 Guest Medical:   Select One $5,000 $1,000 Liquor Liability:   Select One None $1,000,000 $500,000 $300,000 Non-owned/Hired Auto Liability:   Select One None $1,000,000 $500,000 $300,000 Inn-Keepers Legal Liability:   Select One None $5,000 $10,000 $25,000 $50,000 Tenant Fire Legal Liability:   Select One None $50,000 $75,000 $100,000 $125,000 $150,000 $175,000 $200,000 Garage Keepers Collision Value:   Select One None $6,000 $7,500 $9,000 $12,000 $15,000 $18,000 $22,500 $30,000 $37,000 $45,000 $60,000 $75,000 $90,000 $120,000 $150,000 $180,000 $225,000 $300,000 Garage Keepers Collision Deductible:   Select One None $100 $250 $500 Garage Keepers Other Than Collision Value:   Select One None $6,000 $7,500 $9,000 $12,000 $15,000 $18,000 $22,500 $30,000 $37,000 $45,000 $60,000 $75,000 $90,000 $120,000 $150,000 $180,000 $225,000 $300,000 Garage Keepers Other Than Collision Deductible:   Select One None $100 $250 $500

 

Current Insurance Information Current Insurance Co.:   Policy Expiration Date:   # of claims in last 3 years:   Select One None 1 2 3 4 5 More than 5 List all claims below in past 3 years: Type of Claim:   Date:   Amount Paid:   $   Type of Claim:   Date:   Amount Paid:   $   Type of Claim:   Date:   Amount Paid:   $   Type of Claim:   Date:   Amount Paid:   $   Type of Claim:   Date:   Amount Paid:   $

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