Commercial Specialists Insurance Services Insurance for Contractors
HOME
CONTACT US
CUSTOMER LOG-IN		 You have insurance needs? We can cover you.
APPLICATIONS
NEWSLETTERS

Food, Glorious Food…Usually

View CSIS Newsletter Archive
MAILING LIST
TELL A FRIEND
Tell a FriendClick here to tell a friend about www.csisonline.com.
 - spacer

Commercial Property

Please fill out the form below. You may also fill out our short form by clicking here.

General Information
How did you hear about us? *
BIA Chamber of Commerce
Current Client Email
Google Yahoo
Mailer Yellow Pages
Referral: Website:
Other:  
Named Insured:
Contractor's License #:
Owner's Name:
Contact's Name:
Phone: *
 Fax:
Cell:
Email Address: *
 Preferred method of contact: *
Phone Fax Email Mail
Address Information
Mailing Address
Street: *
City: *
State: *
Zip: *
 
Premise Address
Street:
City:
State:
Zip:
Business Entity: *
Sole Proprietorship Partnership Corporation LLC Other:
If Other:
Provide a complete description of the operations at this location:
How long has applicant been in this type of business?
Describe all adjoining/adjacent occupancies and/or vacancies:
Total annual commercial occupancy rental receipts:
Total annual apartment rental receipts:
# of commercial units: # of commercial unit vacancies:
# of apartment units: # of apartment vacancies:
Total area occupied by the following:
Auto body/repair/car washes:
Machine Shops/Manuf./Warehouse:
Food & Beverage Services:
Nurseries:
Vacancies:
Dry cleaners/laundries:
Mercantile/Retail Stores:
Offices:
Apartments:
Other:
Does applicant own or run any of these commercial occupancies? If yes, explain:
Does applicant live in any of the apartment units?    Yes No
Parking area or number of spaces:
Any remodeling or building construction work to be performed during the policy period?
Yes No
If Yes, please explain:
Electrical system protected by: Fuses - amperage Circuit Breakers
Fire station within 5 miles? Yes No
Fire hydrant within 1,000 feet? Yes No
Fire extinguishers? Yes No
Sprinklers? Yes No
Smoke Detectors? Yes No
% of building has sprinklers: %
Fire alarm? Local   Central Station   None
Burglar Alarm? Local   Central Station   None
Name of Security Company:
Security Company Phone Number:
Automatic fire suppression equipment over commercial cooking surfaces/exhaust flue?
Yes   No   N/A
How often are commercial flues cleaned by a professional service?
High temperature limit cut-off switches on all commercial deep fat fryers/ovens:
Yes   No   N/A
4 Year History
Policy Period Carrier Name Policy #
To
To
To
To
MM/DD/YYYY   MM/DD/YYYY    
Loss history for the past 4 years: Include claims reported, unreported, and known occurrences which may result in a claim):
Has applicant ever had a fire loss at this or other property or business within 20 years:
Yes No
If Yes Explain:
Does applicant own any other income property or business? Yes No
If Yes Explain:
Is this the predominant location/building? Yes No
If building is to be covered, enter value:
Year Building was built:
Year electrical last updated:
Year plumbing was last updated:
Year heating last updated:
Year roofing last updated:
Enter business personal property value: (minimum $10,000)
Select Deductible: $250 $500 $1,000
Select Liability Limit: $300k $500k $1,000,000 $2,000,000
Other
If owner is an occupant, enter % occupied:
Select construction type: Frame/Stucco   Masonry
Other other:
Elect Off-Premise Power Failure Coverage: Yes   No
Employee Benefit Liability Coverage (EBL): Yes   No
Loss of Earnings Coverage: Monthly:   Aggregate:
Theft coverage: Yes   No
Hired auto/non-owned auto coverage? Yes   No
Other coverage requested:
Additional Comments
Additional Comments:
Legal Terms
You MUST agree to our terms and conditions to submit this request by doing both of the following:
Applicant's Name (to Agree with Terms: *
Applicant's Initials (to Agree with Terms): *
NO COVERAGE IS IN FORCE UNTIL CONFIRMATION HAS BEEN RECEIVED IN WRITING
Verification Process
    Image Verification
Can't see it? Reload for a another code
 
Type Above Code: *

LIVE OPERATOR
ONLINE QUOTE FORM
To request a quote please fill out an online form using the link below
Get Quote Now
 
Instant Quote
 
SEARCH
Keyword:  
JOB BOARD
Looking for a job, or would you like to post a job to our job board using the links below?
POST JOB  VIEW JOBS
OUR CLIENT LINKS
Use the links below to either browse our client websites or request to have your website linked from our site.
  
© 2007 CSIS COMMERCIAL SPECIALISTS
INSURANCE SERVICES		 HOME | ABOUT US | NEWSLETTERS | GET QUOTE NOW | CLIENT LINKS | JOB BOARD
TERMS | PRIVACY POLICY | SITE MAP
Visit CSIS Insurance on Facebook