BUSINESS OWNERS PROGRAM
Michigan Business Property Quote
Request
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No coverage is bound until you are contacted
by one of our representatives.
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1
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Contact
Information |
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Name of Business |
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Contact Name: |
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Address: |
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Address 2: |
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City - St - Zip: |
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Phone Number: |
FAX
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E-Mail Address: |
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2
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Location for this quote.(Address) |
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Please answer these questions
based on your primary location and
building. If you have additional
locations or buildings, please
submit another copy of this section
and answer the questions for your
other property. Home based
businesses should complete the
following questions based on the
business portion of the home.
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3
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What is the desired Property
Deductible? |
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4
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Is the business within 1,000 feet of
a fire hydrant? |
YES
NO
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5
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Is the business within 5 miles of a
Fire Station?
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YES
NO
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6
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What is the 100%
replacement value of the business
personal property (including
business contents, fine arts, value
of all computer hardware and
software and laptops)? $
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7
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What is the construction of the
building where the business is
located? |
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If the construction of the building
is not known, please provide details
on the materials used for the roof,
floors and walls.
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8
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What is the square footage of the
space occupied by the business? |
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9 |
Is the business the sole occupant of
a free standing building? |
YES
NO
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10
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Does the building have an automatic
sprinkler system covering 100% of
the premises? |
YES
NO
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11
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Does the business have a central
station burglar alarm? |
YES
NO
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12
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Is there any use of grills or deep
fat frying in your business
operations or in any other
businesses in your building? (i.e.
restaurant in the same building)
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YES
NO
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13 |
Please indicate whether the
following optional coverages are
desired: |
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a) Earthquake Coverage (not
available in all areas): |
YES
NO
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b) Sprinkler Leakage - Earthquake
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YES
NO
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c) Flood Coverage (not available in
all areas): |
YES
NO
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d) Computer Mechanical Failure and
Computer Virus Coverage ($100,000
limit) |
YES
NO
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e) Systems Breakdown Coverage? (i.e.
boilers, pressure vessels, AC units,
etc. |
YES
NO
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f) Mine Subsidence Coverage (KY, IL,
IN, WV only) |
YES
NO
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g) Business Income from Dependent
Properties ($10,000 limit)
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YES
NO
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h) Personal Property Off Premises
and Property in Transit Limited
International Extension Endorsement |
YES
NO
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i)
Business Income Sub-limit |
YES
NO
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If yes, choose limit option desired:
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j) Business Income Waiting Period
Deductible (24 hours) |
YES
NO
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k) Business Income Off Premises
Power Failure ($10,000 limit) |
YES
NO
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14 |
Please indicate whether any of the
following exclusions are desired:
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a) Business Income Exclusion |
YES
NO
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b) Theft Exclusion |
YES
NO
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c) Windstorm and Hail Exclusion |
YES
NO
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d) Stock Exclusion |
YES
NO
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15 |
What is the total maximum daily
value of money and securities (i.e.
checks) on the premises? |
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The policy includes limits of
$10,000 inside the business and
$2,000 while being delivered to the
bank. If higher limits are desired,
choose one of the following options:
(Please note that in order to
receive higher limits use of a safe
on premises is required.)
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16 |
If loss of refrigeration coverage is
desired, please provide the total
value of property subject to
refrigeration? |
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17 |
Many property coverage forms provide
for coverage similar to the limits
below. If you require higher limits
than listed please list below. |
Separate Limits for Each Coverage
(unless you choose a blanket limit):
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Fire Dept. Service
Charge/
Fire Extinguisher
Recharge
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$2,500
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Money Orders and Counterfeit
Currency |
$2,500
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Forgery and Alteration
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$2,500 |
Increased Construction Cost
(after a loss) |
$5,000 |
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Glass |
$2,500 |
Signs |
$2,500 |
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Customers’ Goods on Premises |
$10,000 |
Back-up of Sewer/Drains
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$2,500 |
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Personal Property Off
Premises |
$5,000 |
Property In Transit
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$5,000 |
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Valuable Papers/Records on
premises |
$10,000 |
Accounts Receivable at the
premises |
$10,000 |
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Employees Dishonesty - ERISA |
$2,500 |
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Indicate coverage area where you
will require limits higher than
shown above: |
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Complete the following questions
only if interested in purchasing
insurance for the building. Home
based businesses do not need to
complete these questions. |
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18 |
What is the 100% replacement value
of the building? |
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19 |
Are you interested in having one
blanket limit for both building and
business personal property? |
YES
NO
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20 |
What is the square footage of the
entire building? |
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21 |
How many stories in the building?
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22 |
What is the original year the
building was built? |
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23 |
If the building(s) is over 30 years
old, indicate the year each of the
following was updated:
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