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General Information
Named Insured
Entity classification
Mailing Address
Contact First Name *	This field is required.
Contact Last Name *	This field is required.
E-mail *	This field is required.
Phone Number

General Information
Number of Years in Business
Federal Employee Identification Number
Present Carrier(s)
Present Broker(s)
Business Description (please include a broad narrative of your operations)
Web Address

Property Underwriting (please complete per location)
Building Construction Type (Frame, Concrete, Steel, etc.)
Building Age
If the building is more than 25 years old, please describe any improvements to the building (electrical, roof, etc.)
Number of Stories
Square Footage (total building)

Property Underwriting (please complete per location)
Square Footage (occupied by insured)
If the building is not fully occupied by insured, describe other tenant occupancies (office, mfg, warehouse, etc.)
Is the building protected by a fire sprinkler system?	Yes No
Does the unit have a central station alarm?	Yes No
If so, what company services the c/s alarm?
Does the building have a basement?	Yes No
What is the total replacement cost of business personal property (BPP is defined as furniture, fixtures, tenant improvements, stock, and inventory?

Property Underwriting (please complete per location)
What percentage of the BPP is permanently attached to the building?
Do you have any property of "others" (customers, etc.) in your care, custody and control?	Yes No
If so, what is the replacement cost value of this property?
Is any of your BPP perishable?	Yes No
If so, what is the replacement cost of this property?
What is the replacement cost value of your computer hardware and software?
What is the maximum amount of money and securities on the premises?
Maximum amount of property off premises (this includes in transit)

Commercial General Liability
Estimated annual receipts
What percentage of the annual receipts is from foreign jurisdictions (away from US, US territories and Canada)?
Number of employees
Do you use a standard contract with your clients / vendors?	Yes No
If so, please attach. You can upload only .pdf, .doc, .docx, .txt, .zip files.
Gross annual payroll
What percentage of your work is subcontracted?

Commercial General Liability
What type of work is subcontracted?
Do you utilize a subcontract agreement that requires them to name you as additional insured?	Yes No
What percentage of the payroll is clerical / administration only?
Do you currently carry professional liability coverage? (PL covers economic loss by a third party based on your failure to meet a professional standard of care)	Yes No
If so, name carrier, expiration date and limit

Commercial Autos
Any corporately registered autos?	Yes No
If so, provide make, model, VIN, cost new, garaging address and driver info (name and license number)
How many rental cars a year are rented by named insured?

Workers' Compensation
Current Carrier
Expiration Date	--
Experience Modification
Provide estimated annual payroll by class code
List all officers of corporation, titles, and percentages owned

Workers' Compensation
What percentage of the employees participate in the group medical plan?
Do you provide group medical coverage for your employees?	Yes No
Who is the provider?
Do any employees travel overseas?	Yes No
If so, how many trips per year.

Attachments
You can upload only .pdf, .doc, .docx, .txt, .zip files.
Narrative of Operations
Product Brochures (if applicable)
Copy of Lease(s)
Five year hard copy loss runs on all policies (valuation date within 90 days of policy expiration)
Sample contracts

Argo Insurance Group