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    Business Name*:
    Does the insured have a DBA?* Yes/No: If yes:
    Legal Entity* Sole Proprietor/Corporation/LLC/Partnership/Association/Trust:

    SIC and/or NAICS:

    Is the insured a general contractor (class B license), that subs out more than 25% of their work?*: Yes/No
    Are any of the locations in this submission outside of the state of California?*: Yes/No

    Insured Contact Name*:
    Insured Business Phone Number*:
    Insured Cell Number:
    Insured Fax Number:
    Insured Email Address*:
    Business Website*:
    Mailing Address*:
    ZIP Code:

    Desired Effective Date For New Policy*:

    Nature of Business*:
    Brief description about the business operations:

    Have the insured’s operations changed due to COVID-19? Yes/No If YES please describe how so. *:
    Is the insured’s business currently closed due to COVID-19? If YES please explain when they plan to reopen.*:
    Has the insured had any claims that are related to COVID-19? If YES please give details.*:
    Is the insured compliant with all CDC safety controls in relation to COVID-19? If NO please provide details.*:

    Year Business Was Established*:
    Number of Years of Management Experience *:
    Briefly describe the details of the management experience:*:
    Gross Sales (All Locations)*: $
    Gross Sales From Internet (All Locations)*: $
    Number of Employees *:
    Annual Payroll*: $
    Any losses in the past five years?*: Yes/No
    General Liability Per Occurrence/Aggregate*: 1 million / 2 million OR 2 million / 4 million
    How many locations are there?*: 1/2/More than two

    Same As Mailing Address? Yes/No If no:
    Location 1 Street Address *:
    ZIP Code:

    Location 1 Construction Type *:
    For construction descriptions: http://www.amrisc.com/Amrisc%20pdfs/CompleteSOV/ISOTypesDescriptions.pdf
    Location 1 Roof Type*:
    Location 1 Year Built *:
    Location 1 Building Updates: Is the building older than 20 years?*: No/Yes
    **If building older than 20 years and no updates are provided, quoting may be delayed**

    Location 1 Occupancy*: Single Occupancy/Multiple Occupancy
    Location 1 Total Square Feet of Building*:
    Location 1 Total Square Feet Occupied by Insured*:
    Location 1 Square Feet Occupied by Other Building Tenants*:
    Location 1 Square Feet Unoccupied*:
    Location 1 Number of Stories Ocupied *:
    Location 1 – Protective Devices*: Fire/Theft/Central Station
    Check all that apply **Credits may be available for central station, proof may be required.
    Location 1 Type of Smoke Detectors*: Hard Wire/Battery/Lithium Battery
    Location 1 – Sprinkler %*: 100%/80% – 99%/<80%/None
    Location 1 Contractor responsible for sprinkler sytem maintenance and inspection (indicate frequency)*: Yes-Monthly/Yes-Quarterly/Yes-Semi-Annually/Yes-Annually/No/
    Location 1 Interest*: Tenant/Owner – Owner Occupied/Owner – Tenant Occupied (Lessors Risk)/Other:
    Location 1 Building Limit *: $
    Enter “0” if tenant or not needed

    Location 1 Business Personal Property Limit*: $
    Location 1 Deductible *: $250/$500/$1000/$2500/$5000/$10000/Other:
    Location 1 Gross Sales*: $
    Location 1 Gross Sales From Internet*: $
    Enter “0” if none

    Location 1 Is there any Additional Interest?*: None/Landlord/Additional Insured/Mortgagee/Other:/Other Value
    Location 1 Additional Interest Name:
    Location 1 Additional Interest Address:
    ZIP Code:

    Other Coverage Needed
    Hired / Non-owned Coverage*: Yes/No
    Umbrella Coverage Requested*: Yes/No
    Other Additional Coverages Required*: Yes/No
    Describe additional coverages requested: