INTERNAL - Business Discovery Form Is this request for an existing Insured or a Prospect?*Existing InsuredProspectLine of business for quote Full Package General Liability Commercial Property Inland Marine Commercial Auto Professional Liability Workers Compensation Management Liability Other What kind of property coverage do they need?BPP OnlyBuilding OnlyBoth BPP and BuildingAddress For Property Coverage Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Requested Effective Date Date Format: MM slash DD slash YYYY What is their main reason for reaching out to us now?Primary Contact Name First Last Primary Contact DOB Date Format: MM slash DD slash YYYY Business nameIs their DBA name different from your legal entity name?DBA name is the same as legal entityDBA name is different from legal entityTheir DBA (Doing Business As) name?Federal EINPrimary Business PhonePrimary Business Email Location Address Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Is your mailing address different than you physical address?NoYesMailing Address Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Website Description of business operationsAre you contemplating any big changes or additions to your business in the next 12 months?Square feet occupiedOccupancy statusOwnerTenantRenovation details (roof, HVAC, plumbing, electrical)Amount of building coverageAmount of Contents / BPP coverageAny fire/security alarms?No alarmsLocal onlyCentral alarmDetail all lienholders and Additional InsuredsPrevious/Current Insurance CarrierProjected Gross Revenue next 12 monthsProjected Contractor Costs next 12 monthsProjected Total Payroll next 12 monthsHow many employees / permanent 1099 contractors?Any policy declined, cancelled or non-renewed in last 3 years?NoYesDetail loss history for all LOB quoted for prior 3 yearsDoes the business own business autos or mobile equipment?NoYesAre vehicles leased or made available to others?NoYesDetail info for tools/equipment valued at more than $2,000Notes on Auto or Inland marineDetail categories of workersInclude owner(s) on work comp?NoYesWhat limit for Umbrella?Notes for Work comp and UmbrellaGeneral Notes