Commercial Property Additional Building/Location Request

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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 *

YYYY

Additional Location Address - street/city,state,zip *

Buying or Renting location? *

Buying

Renting

If buying is there a Mortgagee?

Yes

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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

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If yes, please indicate date(year) for each

If Renting, does the Landlord want to be named as 'An Additional Insured?'

Yes

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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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