Property Coverage
COMMERCIAL SPECIALISTS INSURANCE SERVICES
is one of the largest agencies in the Western States that focus exclusively on the needs of the Western States Building Trade Contractor.
Property Section
APPLICANT
*
PROPOSED EFF. DATE
PROPOSED EXP. DATE
BILLING PLAN
PAYMENT PLAN
AUDIT
AGENCY
DIRECT
PREMISES INFORMATION
Subject of Insurance
Amnt
Coins %
Valuation
Causes of Loss
Inflation Guard
Deductible
Forms and Conditions
-Select-
A.C.V.
R.C.
Stated Amount
Other
%
-Select-
$500
$1000
$2500
$5000
Other
-Select-
Basic form Fire
Basic form Vandalism
Basic form Malicious Mischief
Special form
Special form including theft
Other
-Select-
A.C.V.
R.C.
Stated Amount
Other
%
-Select-
$500
$1000
$2500
$5000
Other
-Select-
Basic form Fire
Basic form Vandalism
Basic form Malicious Mischief
Special form
Special form including theft
Other
-Select-
A.C.V.
R.C.
Stated Amount
Other
%
-Select-
$500
$1000
$2500
$5000
Other
-Select-
Basic form Fire
Basic form Vandalism
Basic form Malicious Mischief
Special form
Special form including theft
Other
-Select-
A.C.V.
R.C.
Stated Amount
Other
%
-Select-
$500
$1000
$2500
$5000
Other
-Select-
Basic form Fire
Basic form Vandalism
Basic form Malicious Mischief
Special form
Special form including theft
Other
Additional Coverages, Restrictions, Endorsements and Rating Information
Construction Type
Fire District/Code #
Prot. CL.
# stories
# basm'ts
YR. built
Total Area
-Select-
Frame
Metal
Concrete
Brick
Other
Building Improvements
Other Occupancies
Wiring YR:
Roofing YR:
Plumbing YR:
Heating YR:
Other:
Right Exposure & Distance
Left Exposure & Distance
Rear Exposure & Distance
Burglar Alarm Type
Certificate #
Expiration Date
Extent
Grade
-Select-
None
Central
Local
-Select-
Central Station
Local
Burglar Alarm Installed and Serviced By
# Guards/Watchmen
Clock Hourly
Fire Protection (Sprinklers, Standpipes, CO2/Halon Systems)
Fire Alarm Manufacturer
Applicant Email Address:
*
Enter Text Above:
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©2005 Commercial Specialists Insurance Services. All rights reserved.
License # 0D80851