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Commercial Auto
Workes Comp
Umbrella
Commercial New Business Questionnaire
Entity
CORP
LLC
INDIVIDUAL
PARTNERSHIP
Loss Runs
Attached
Ordered
Property
Prospect's Buildin Interest:
Owns
Tenant
Updates to Bldg:
Electrical
Roof
Plumbing
Heating
Construction Type:
Masonry/
Non-Combustible/
Frame/
Fire Resistive/
Other/
RC or ACV
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Co-Ins:
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RC/ACV
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Ci-ins:
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Deductible
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Deductible
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RC/ACV
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Ci-Ins:
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Equipt Breakdown
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Deductible
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General Liability
Liability Limits
$500,00/$1M
$1M/$2M
$2M/$4M
Fire/Legal Liab:
$50,000
$100,000
$300,000
Other
Products MFR:
Yes
No
Subcontractor Labor:
Yes
No
Data
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Inland Marine/ Floater
Crime
Bond Needs:
Yes
No
Commercial Auto
Liability Limits:
$500,000
$1,000,000
Hired/ Non-owned
Yes
No
DOC Need:
Yes
No
Use of Vehicle
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Broadened PIP:
Yes
No
Physical Damage Deductible:
$500
$1,000
$2,500
Garage Keepers or Dealers Open Lot
Deductible
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Outside Veh Storage:
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Deductible
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Workers Compensation
Safety Program
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Health Plan Provided
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Return to Work in Place:
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Umbrella
Limit
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Owners
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