Commercial Property Form

Business Name *

Contact First Name *

Contact Last Name *

Contact Phone *

Contact Email *

When did the business take possession of the property? *

Address to Be Insured *

Apartment, suite, etc

City *

Province *

ZIP / Postal Code *

Does the business use this property as part of its daily operations? *YesNo

What will its status be? *RentedVacantSeasonalOther

Have you insured this property before? *YesNo

If yes, list insurer and policy number here *

Have you had any claims with this property? *YesNo

List all claims paid and outstanding during the past five years. State whether net of deductibles. What was the deductible in each policy year? *

How many mortgages are on the property? *

If applicable, please list the mortgage company and amount

Year Built *

Number of Stories *

Square Footage *

What is the re-build cost of this property?

What amount of liability would you like? *$1M$2M

Would you like water damage coverage? *YesNo

Would you like earthquake coverage? *YesNo

What deductible would you like? *

Do you have a fire alarm? *Yes, monitoredYes, not monitoredNo

Do you have a burglary alarm? *Yes, monitoredYes, not monitoredNo

Does the business have CGL in place? *YesNo

Do you have smoke alarms? *YesNo

If you have any additional comments, please let us know below.

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