Online Commercial Property Quote Request Form

Part 1. Your Company

    1. Name of the Company:   

    2. Name of Principal  

    3. Mailing Address:  

        City:  Province: AB BC MB NB NFL NS ON PEI QC    Post Code:

    4. Location (If different from 2.)

        City:  Province: AB BC MB NB NFL NS ON PEI QC    Post Code:

    6. E-mail: Telephone:

   7.  How many years in business is this company? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Part 2. Buildings and Contents 

    1. Fire Protection:    Within 1000 ft of Hydrant     

                                      Within 5 miles of Fire Hall

                                      Other 

    2. Construction: Frame         Masonry          Concrete 

                                Brick          Other

    3. Age of Building: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 30+

    4. Please Indicate the Most Recent Updates for The Following: 

        (a) Heat 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919       (b) Electrical 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919       

        (c) Plumbing 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919     (d)  Roof 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919

    5. Total Area (square footage):

    6. Number of Stories:

    7. What kind of heating is in the building? Oil         Electrical

    8. The building is : Detached Not Detached Semi-Detached

    9. Exposures/Other Tenants:

    10. Basement or Slab? Finished Basement Unfinished Basement Slab         

    11.  Sprinkler YES NO     Extinguishers  YES NO     Air Conditioning YES NO

           Alarm Equipment Yes, local alarm equipment Yes, connected to a monitor station NO     Safe Equipment YES NO

    12. What kind of business is the company in?/Describe business operations: 

    13. Annual Gross Sales    

    14. Annual US Sales

    15.  Please provide either of the following information: 

        *Annual Payroll    

        *Number of Employees

    16. Do you have any claims/losses in the past? YES NO

          Description of Losses, if any:

    17. Prior Insurer       Policy #

Part 3. Coverage Limits & Deductibles

    1.     Buildings          Deductible $1,000 $2,000 $5,000

    2.     Contents          Deductible $1,000 $2,000 $5,000

    3.     Stock                Deductible $1,000 $2,000 $5,000

    4.     Equipment        Deductible $1,000 $2,000 $5,000