Start Your Commercial General Insurance Application Account Information Legal Name * Operating As (O/A, O/B) Mailing Address * Postal Code * Owner Name * Date of Birth * Phone / Cell # * Email * Home Address Website Business Type —Please choose an option—CorporationSole ProprietorshipPartnershipOther Need Terms by: Prior Insurance & Operations Previous Insurer Previous Premium Expiry Date Target Premium Year Business Started Years of Experience Describe Business Operations, Products and Services * Any history of insurer cancellation, decline, or non-renewal? NoYes - Provide Details Any losses in the past 5 years? NoYes - Provide Details Annual Receipts & Liability Information Annual Gross Receipts * Cost of Sublet Work / Sublet % Operations Breakdown (Total must equal 100%): % Manufacturing: % Wholesale: % Retail: % Internet: % Canada: % United States: % Other Countries: Staff Information: Number of Owners: Part-Time Employees: Full-Time Employees: Cover by WCB? NoYes Hours of Operation: Do you do Repairs? NoYes Installations? NoYes Delivery Operations? NoYes Business Location & Construction Details Location Address * Location Postal Code * Location Building Type * —Please choose an option—Stand AloneStrip MallIndustrial MallOther Construction/Wall Classification * —Please choose an option—Fire ResistiveMasonry, Non-CombustibleNon-CombustibleMasonry (including Mill)Brick VeneerFrame Year Built: * Building Sqft: * Roof Material: * Heating System Type: * Major Renovations & Years (Renos): * Fire & Security Protection Fire Alarm System —Please choose an option—Monitored AlarmLocal AlarmNo Alarm Fire Hydrants Proximity —Please choose an option—150 Meters300 MetersUnprotected Distance to Fire Hall —Please choose an option—5 Kilometers8 Kilometers13 Kilometers + Fire Extinguishing / Suppressions —Please choose an option—Portable ExtinguishersMonitored SprinklersLocal Sprinklers Burglar Alarm System —Please choose an option—Monitored AlarmLocal AlarmNo Alarm Crime / Physical Asset Security —Please choose an option—Deadbolt LocksLocked FenceSurveillance CamerasBars on the windowsSecurity GuardWire Mesh Safe / Vault Class Protection —Please choose an option—No SafeSafe Class 1 (Fire-resistive safe / steel container combo)Safe Class 2 (1 steel body, 1.5 door anchored or TL-15)Safe Class 3 (Burglar-resistant safe TL-30 / TRTL-15) Coverage Limits & Schedules Coverage Target Basis (RC / AC) Deductible (e.g.) Co-Ins % Requested Limit (e.g.) Building —Please choose an option—RCAC Equipment —Please choose an option—RCAC Stock —Please choose an option—RCAC Betterments and Improvements Contractor's Equipment Floater Business interruption required (yes/no) —Please choose an option—YesNo Profits ALS Indem
