General Information
Name of Business:
Contact Name:
Mailing Address:
City:	State:   Zip:
Business Phone:	Fax:
Best Time To Call:	AM   PM
Contact Email Address:
Insured Is:	Select One Individual Partnership Corporation Other   How Long in Business:

 

Property Information
Street Address:
City:	State:   Zip:
Year Built:		# of Buildings:
# of Units:		# of Stories:
Total Building Square Footage:		sq. feet
Building Construction:	Select One Frame/Stucco Masonry Other	Type of Parking:	Select One Garages (Attached) Garages (Detached) Carports (Attached) Carports (Detached) Underground Subterranian Street
Type of Roof:	Select One Composition Tile Wood Shake Rock Other	Year Roof Last Updated:
# of Pools:		Are pool(s) Fenced:	Select One Some Are All Are None Are No Pool
Are there diving boards:	Select One On All Pools On Some Pools None No Pool	Is there a pool slide:	Select One On All Pools On Some Pools None No Pool
# of in-room Jacuzzis:		# of Kitchenettes:
Type of Electrical:	Select One Circuit Breakers Fuses Fuse Stats	Year Electrical Last Updated:
Type of Heating:	Select One Gas Electrical Solar Other	Year Heating Last Updated:
Type of Plumbing:	Select One Copper Galvanized PVC Other	Year Plumbing Last Updated:
Automatic Fire Sprinklers:	Select One Yes No	On All Floors:	Select One Yes No N/A
Fire Alarms:	Select One Yes, Monitored Yes, Not Monitored No	Smoke Detectors:	Select One Yes No
Burglar Alarms:	Select One Yes, Monitored Yes, Not Monitored No	On-Site Security:	Select One Yes No
Total Sq. Footage of Restaurant:	sq. ft.	Restaurant Operated By:	Select One Hotel Tenant None
Liquor Receipts:	$	Bar Serves:	Select One Beer/Wine Only Full Bar No Bar
Total Sq. Footage of Retail Stores:	sq. ft.	Total Sq. Footage  of Banquet Halls:	sq. ft.
Total Sq. Footage of Exterior Glass:	sq. ft.	Distance to Lake, River, Ocean:	Select One Not Applicable 100 Yards 500 Yards 1/2 Mile Couple of Miles
Hotel is owned by:	Select One Individual Partnership Corporation Trust LLC Other	Is the hotel part of a franchise:	Select One Yes No Will Soon Be

 

Desired Coverages
Building Amount:	$	Annual Income:	$
Contents Amount:	$	Deductible:	Select One $250 $500 $1,000 $2,500 $5,000
Exterior Glass:	$	Accounts Receivable:	Select One $5,000 $10,000 $25,000 $50,000 $75,000 $100,000 $150,000 $200,000
Employee Dishonesty:	Select One None $10,000 $25,000 $50,000	Employee Benefits Liability:	Select One $500,000 $1,000,000
Money & Securities:	Select One None $5,000 $10,000 $25,000 $50,000 $100,000	Valuable Papers:	Select One $5,000 $10,000 $25,000 $50,000 $75,000 $100,000
Building Ordinance:	Yes   No	Agreed Amount Endorsement:	Yes   No
Inflation Guard:	Select One 2% 4% 6% 8% 10%	Outdoor Sign Value:	Select One $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000
Earthquake Sprinkler Leakage:	Yes   No	# of Additional Insureds:
General Limit Liability:	Select One $1,000,000 $500,000 $300,000	Guest Medical:	Select One $5,000 $1,000
Liquor Liability:	Select One None $1,000,000 $500,000 $300,000	Non-owned/Hired Auto Liability:	Select One None $1,000,000 $500,000 $300,000
Inn-Keepers Legal Liability:	Select One None $5,000 $10,000 $25,000 $50,000	Tenant Fire Legal Liability:	Select One None $50,000 $75,000 $100,000 $125,000 $150,000 $175,000 $200,000
Garage Keepers Collision Value:	Select One None $6,000 $7,500 $9,000 $12,000 $15,000 $18,000 $22,500 $30,000 $37,000 $45,000 $60,000 $75,000 $90,000 $120,000 $150,000 $180,000 $225,000 $300,000	Garage Keepers Collision Deductible:	Select One None $100 $250 $500
Garage Keepers Other Than Collision Value:	Select One None $6,000 $7,500 $9,000 $12,000 $15,000 $18,000 $22,500 $30,000 $37,000 $45,000 $60,000 $75,000 $90,000 $120,000 $150,000 $180,000 $225,000 $300,000	Garage Keepers Other Than Collision Deductible:	Select One None $100 $250 $500

 

Current Insurance Information
Current Insurance Company:		Policy Expiration Date:
# of claims in last 3 years:		Select One None 1 2 3 4 5 More than 5
List all claims below in past 3 years:
Type of Claim:
Date:		Amount Paid:	$
Type of Claim:
Date:		Amount Paid:	$
Type of Claim:
Date:		Amount Paid:	$
Type of Claim:
Date:		Amount Paid:	$
Type of Claim:
Date:		Amount Paid:	$

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