Office & Business Owners Policy (BOP) Online Application

First Name

Contact Name

Street Address

City

State

Zip

Telephone

Fax

E-Mail

Underwriting Information

1. What is the nature of your business?

2. Is the business a

Corporation
Partnership or
Sole Proprietorship?

3. How many owners, partners and/or corporate officers are there?

Owners:
Partners:
Corporate Officers:

4. How many employees are there?

Full-Time:
Part-Time:

5. What is the total annual payroll amount?

Owners, Partners or Corporate Officers:
Full-Time (not including owners, partners or corporate officers):
Part-Time (not including owners, partners or corporate officers):

a) What is the total annual gross revenue or sales?
b) Indicate % earned at this location:

What is the FEIN?

8. Have you filed bankruptcy within the past three (3) years?

Yes
No

Year business established.

10.

How many years of industry experience does the owner of the business have?

11.

On average, how many hours per day does your business operate?

12. Do you have ownership interest in any other business?

Yes
No

13. Do you lease employees to or from other employers?

Yes
No

14. Have any of your business insurance policies been declined, non-renewed or cancelled in the last three (3) years?

Yes
No

Building & Property Information

15. a) What is the total square footage of the building you occupy?

Lease
Own

c) Are there other occupantes?

Yes
No

16. What is the total square footage of your business only?

17. How many stories is the building?

18. If it is two stories, what is the ground floor square footage?

19. What is the construction type?

20. What type of roof covering?

21. a) What is the distance of the nearest fire hydrant?

b) What is the distance of the nearest fire department?

22. How old is the building?

23. If the building is over 20 years old has the plumbing, electrical, roof and/or heating/AC been updated?

Yes
No

If so, when?

24. Does the building have interior automatic fire sprinklers?

Yes
No

25. a) Is there are theft alarm?

Yes
No

b) % of building protected

a) Is there a fire alarm?

Yes
No

b) % of building protected

27. a) Is there a sprinkler system?

Yes
No

b) % of building protected

28. Are there any property or general liability losses or claims in the last 5 years?

Yes
No

29. If yes, what is the date, amount paid and description of each loss or claim?

Coverage Information

30. What is your current insurance company?

31. What is your expiration date?

32. Value of building, if owned?

33. Value of office contents?

34. Value of computer equipment & software?

35. How frequently do you deposit cash to the bank?

36. What is the maximum amount of money kept at your location overnight?

Are there any questions, comments or additional coverage required?

All information provided is confidential and will be used soley to obtain an indication for coverage.
Coverage cannot be bound from this information sheet.