Business Owners Policy Data Collection Form
Primary Point of Contact
Years in Business
Current Insurance Carrier / Company
Current Insurance Policy Renewal or Expiration Date
Current Insurance Company or Agency Level of Satisfaction
General Liability Rating / Data
Any Commercial Property or General Liability Claims in the Last 3 Years
Brief Description of Operations
Total Annual Gross Sales (Estimate)
If yes, how many?
Total Annual Payroll (Estimate)
Total Annual Subcontractor or Independent Contractor Cost / Expense (Estimate)
Type of Work Subcontracted (If Any)
Total Office Area Occupied
Your Building / Office Data
Is Your Building
Total Square Feet of the entire of building that you occupy (Estimate)
Total Square Feet that You Occupy
Year that the Building was Originally Built
Do you have any Burgler Alarm / Fire Alarm / Sprinkler / Or an other type of Security or Protection Systems
Business Property and Building Data
Total Business Personal Property Amount? (Office Equipment / Desk / Computers / Furniture). Value for all personal property.
Total Business Inventory (Products / Equipment / Inventory that you own). Value for all business inventory.
Tenant Improvements to the Building (things that you have done to your office or building to improve it - paint / carpet / flooring / appliances). Value of all improvements.
If yes, percentage?
Specialty Tools or Equipment. Any High Value Items owned by the company for business