Commercial Property Additional Building/Location Request
Complete this form for Commercial Property Insurance for additional building/location request
Name *
Address/City/State/Zip *
Email Address *
Phone/Home/Cell *
Policy Type/Number *
Requested Effective Date for Coverage *
MM
/
DD
/
YYYY
Additional Location Address - street/city,state,zip *
Buying or Renting location? *
If buying is there a Mortgagee?
Clear selection
Mortgagee/Name/Address/City, State, Zip/Loan Number
Use of the Building?
If buying, purchase price?
If buying, have Up-Dates been done on
Roof
Electric
Plumbing
HVAC
Row 1
Clear selection
If yes, please indicate date(year) for each
If Renting, does the Landlord want to be named as 'An Additional Insured?'
Clear selection
If YES, Landlord name/address/city,state,zip
PLEASE NOTE- IF YOU HAVE BEEN AT THIS NEW LOCATION FOR OVER 30 DAYS, WE WILL NEED LEASE AGREEMENT,LOAN DOCUMENTS, ANYTHING THAT SHOWS THE EFFECTIVE DATE OF THIS CHANGE TO CONFIRM YOU HAVE MAINTAINED ACCURATE COVERAGE. FAILURE TO DO SO COULD PREVENT COVERAGE IF A CLAIM HAS OCCURRED.
IF YOU CURRENTLY HAVE THIS LOCATION INSURED THROUGH ANOTHER CARRIER WE WILL NEED 3 YEAR LOSS RUNS AND COPIES OF THE CURRENT DECLARATION PAGES. THEY ARE REQUIREMENTS OF ANY CARRIER THAT WILL COVER THE PROPERTY
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