Commercial Buisness Owners

Please Fill Out The Form Below:

Business Owners Policy (BOP) Prospect Questionnaire

Please complete all applicable fields. Attach additional pages if needed.

Business Owners Policy (BOP) Prospect Questionnaire

Business Basics Title

Business Basics

Name:

Email:

Legal business Name:

DBA(s)

Business Address:

Mailing Address (if different)

Business Entity Type:

Description of Operations/Products/Services

Years in Business:

Years Owner Experience in Industry

FEIN or SSN

Locations & Premises Title

Locations & Premises

Number of Locations

Do you own or Lease building(s)?

Square Footage & Occupancy Breakdown

Building Construction Type

Year Built

Year of Roof/Plumbing/Electrical/HVAC Update

Any Cooking/Manufacturing/Hazardous Operations

Property Coverage Title

Property Coverage

Replacement Cost of Building

Replacement Cost of Business Personal Property

Inventory Value at Peak Season

High-Value Equipment or Tools?

Outdoor Property (signs, fences, landscaping)

Property Off-Premises or in Transit?

Liability Coverage

Liability Coverage

Estimated Annual Gross Sales

Estimated Annual Payroll

Number of Full-Time Employees

Number of Part-Time Employees

Number of Seasonal Employees

Subcontractors Used? (Y/N)

Do They Carry Insurance? (Y/N)

Any Prior Liability Claims?

Operations Outside State/Country?

Risk Management & Safety Title

Risk Management & Safety

Fire Protection (Sprinklers, alarms, extinguishers)

Burglar/Security Protection (alarms, camera)

Formal Safety Program (Y/N)

Hazardous Materials Stored? (Y/N)

Public Access to Premises (Y/N)

Additional Coverages Title

Additional Coverages

Need Business Income/Extra Expense Coverage

Need Employee Dishonesty/Theft Coverage?

Need Data Breach/Cyber Liability Coverage?

Hired/Non-Owned Auto Liability Needed? (Y/N)

Professional Liability Exposure? (Y/N)

Prior Insurance & Loss History Title

Prior Insurance & Loss History

Current Insurance Carrier

Policy Expiration Date

Current Limits & Deductibles

Claims in Past 5 Years? (Y/N)

Details of Claims

Any Prior Cancellations or Non-Renewals? (Y/N)

Follow Us

Business Owners Policy (BOP) Prospect Questionnaire

1380 Pantheon Way #200,

San Antonio, TX 78232

Follow Us

Business Owners Policy (BOP) Prospect Questionnaire

1380 Pantheon Way #200,

﻿San Antonio, TX 78232

San Antonio, TX 78232