Submit Property Insurance Risk

Insured Information

Insured Name

DBA (if applicable)

Contact Name

Contact Email

Contact Phone

Business Website

Years in Business

FEIN/Tax ID

Type of Business

Business Description

Property Information

Primary Location

Property Address

City

State

ZIP Code

Building Type

Construction Type

Year Built

Square Footage

Number of Stories

Occupancy

Building Value ($)

Contents Value ($)

Business Income Value ($)

Property Usage

Protection Information

Sprinklered

Central Station Alarm

Fire Alarm

Burglar Alarm

Fire Protection Class

Distance to Fire Station (miles)

Distance to Fire Hydrant (feet)

Additional Security Features

Coverage Information

Requested Effective Date

Expiration Date

Current Insurance Carrier

Current Annual Premium ($)

Preferred Deductible ($)

Coinsurance

Valuation

Coverage Type

Claims History

Number of Claims in Last 5 Years

Total Incurred Amount ($)

Largest Claim Amount ($)

Brief Description of Largest Claim

Document Upload

Upload Loss Runs (5 years)

Drag and drop your loss runs here or click to browse

Upload Current Property Declarations Page

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Upload Property Photos

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Upload Additional Documents

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