COMMERCIAL INFO SHEET
Agent
blank
.
Date
-
Month
-
Day
Year
Date
Language
English
Spanish
Source
Current Client
PL
CL
Walk-In
Post Card
Google
Referral
Other
Type
Pkg
CGL
BOP
WC
Property
Professional Liability
Bonds
Umbrella
Builders Risk
Tools
Life
Name of Business
Entity
First Name
Last Name
DOB
Email
example@example.com
Mailing address
Physical address
cell phone
-
Area Code
Phone Number
business phone
-
Area Code
Phone Number
Description of Business
Website & Social Media FB or Linkedin
Operations Outside California
Yes
No
Years in Business
Years of Experience
Annual Sales
Annual Payroll
Subcontractor Costs
FEIN or SSN#
Contractor License #
Current Insurance Company
How Many Years with Them
When Does it Renew
What Did you Pay
Number of Owners/Officers
Number of Employees
Full Time
Part Time
Claims Last 5 Years
Do You Need Workers Comp?
Yes
No
IF YES PAYROLL OF EMPLOYEES F/T & P/T
PROPERTY INFO
Building Coverage?
Yes
No
Year Built
Square Footage
Number of Stories
Building Construction Type
Years at Location
Indoor Sprinklers
Yes
No
Alarm Typre
Burglar
Fire
Local
Central
Motion
Camera
Sensors
Roof Updated
Electric
Plumbing
Heating/Air
Roof Type
Any Else Occupy your Building
Notes:
Submit
Should be Empty: