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Property Address: |
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Property City: |
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Property State: |
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Property Zip Code: |
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Property County: |
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Please describe the nature of your business: |
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Number Of Owners: |
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Number Of Employees: |
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Payroll Of Employees: |
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Total annual gross receipts: |
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Total square footage of the building your business is in: |
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Square footage of your business only: |
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Current insurance company: |
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Business License Number: |
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License Type: |
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Years of Experience: |
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Years in business:
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How many stories: |
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If two stories, ground floor square footage: |
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Total square footage of your dwelling: |
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Construction type: |
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Roof Type: |
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Roof updated: |
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If yes, year roof was updated: |
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Protection Distance: |
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Is the business in a brush area? |
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Is this business open 24 hours a day? |
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Any deep frying (food)? |
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Is there any manufacturing, mixing, re-labeling or re-packaging of products? |
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Is there filling of propane tanks? |
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Is there storage more than 1500 Sq Ft? |
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If any office risk, is E&O with 1 million admitted coverage carried? |
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Are there smoke detectors at this location? |
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Smoke alarm? |
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Fire Extinguisher? |
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Deadbolts on exterior doors? |
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Circuit Breakers: |
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Electrical Updated: |
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Heating, air conditioning, thermostatically controlled? |
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Heating, air conditioning, central? |
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Plumbing updated: |
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If yes, year plumbing was updated: |
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Interior automatic fire sprinklers: |
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Theft alarm: |
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Fire alarm: |
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Losses-Claims in the last 5 years: |
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If yes, date, amount paid and description of each loss-claim: |
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