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Commercial Package Quote Worksheet

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Commercial Package Quote Worksheet

APPLICANT INFORMATION

Name *

Business Name *

Mailing Address

Phone *

Fax *

Email *

EIN# *

Year Started *

Entity Type *

Individual
Partnership
LLC
Corp.
Other

COMMERCIAL PROPERTY

Address *

Yr Built *

# of Stories *

Sq. Ft. *

Fire Dept: *

Distance to FD: *

Building Construction? *

Frame
Log
Metal

Roof? *

Metal
Shingle
Metal
Heating?
Oil
Gas
HWBB

Year Plumbing Updated?

Year Heat Updated?

Year Electric Updated?

Year Roof Updated?

Building Coverage?

Contents Coverage?

Deductible Coverage?

If new purchase, estimated closing date?

If not, purchase date?

Currently Insured? *

Yes
No

What Company?

Exp. Date

For How Long?

Pol. #

GENERAL LIABILITY

Type of business

Any unusual hazards?

Gross annual sales

Number of employees

Gross payroll

Currently Insured? *

Yes
No

Pol. # (copy)

Exp. Date (copy)

List any claims – Last 5 years

Aggregate Limits

300
500
1 Mil
2 Mil
5 Mil

WORKERS’ COMPENSATION

Workers Compensation needed?

Yes
No

Current Insurer

Exp. Date

Limits

Make A Payment Epay

Dunlap Agency, Inc.

794 University Ave. Ste. 101
Fairbanks, AK 99709

(907) 456-5202

info@dunlapagency.com

Dunlap Agency, Inc.

794 University Ave. Ste. 101
Fairbanks, AK 99709

(907) 456-5202

info@dunlapagency.com

Opening Hours

Monday 9:00 am – 5:00 pm

Tuesday 9:00 am – 5:00 pm

Wednesday 9:00 am – 5:00 pm

Thursday 9:00 am – 5:00 pm

Friday 9:00 am – 4:00 pm

Saturday Closed

Sunday Closed

Make A Payment Epay

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