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General Liability Questionnaire
General Liability Questionnaire
Named Insured:
DBA
Contact Name:
*
Phone
Email
*
Mailing Address:
Location Address:
Type of Ownership (corporation, individual):
Date Business Started: (If less than 3 years, years of management experience)
MM slash DD slash YYYY
Description of Operations:
Property Management:
Yes
No
If yes, what % of revenue is attributable to Property Management Services
If yes, do you obtain certificates of general liability insurance naming you as additional insured on the contractor/service provider’s policy?
Escrow:
Yes
No
Mortgage:
Yes
No
Coverage Details
How many people in your firm?
How many officers/owners/partners are there in the firm?
Annual Revenue:
Do you sell tract homes?
Yes
No
Value of Business Personal Property (desks, computers, etc):
Location
Off-site Office or Home Office?
Own/Rent:
Within City Limits?
Yes
No
Square Footage Occupied:
Square Footage of Building:
Year Built:
Construction Type (i.e. Frame):
Roof Type:
Number of Stories:
% Sprinklered (indoors):
Year of Building Updates (only needed if building is over 50 years old):
Electric
Plumbing
Roof
Heating
Alarm (central/local or none):
Distance to Fire Hydrant:
Distance to Fire Station:
Do you have a current BOP policy?
Yes
No
Any prior coverage declined, cancelled or non-renewed in the past three years?
Yes
No
Any prior claims?
Yes
No
Do you currently have a Professional Liability policy?
Yes
No
Additional Insured Needed: Name/address/type (landlord, franchise, leasing agent)
Phone
This field is for validation purposes and should be left unchanged.
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