IACOOP.BIZ - Commercial Package Policy Quote

Illinois
Commercial Quote

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Quote Urgency:

Producer Info
Producing Agency:	Your Name:	Producer # (if applicable):	Producer Phone:
Preferred Response: (Req'd) E-mail Fax E-mail/Fax #:		Billing Method: Agent Bill Direct Bill - Insured Direct Bill - Mortgagee

Proposed Effective Date:
Check all that apply:
Fire General Liability Liquor Liability

Applicant Info
Applicant Name	Inspection Contact Name
Location Address	Inspection Contact Phone
Location City, State, Zip	Best Contact Time
Mailing Address (if same as Location, enter "SAME")	Type of Ownership:
Mailing City, State, Zip (if same as Location, enter "SAME")	Premises County

Liability Coverages
Coverages	Coverage Amount
General Liability Coverage
Products Liability Coverage
Damages to Premises Coverage
Medical Payment
Liquor Liability

If primary occupancy is an Apartment Building and/or LRO
skip to the General Underwriting Questions at the bottom.

Liability Underwriting Section
Select Operation Type
Complete below if any of the following describes the risk submitted. If retail store, describe the products sold below. (To select multiple hold CTRL & Click)	Complete questions below for ALL applicants.
	Gross Annual Sales/Receipts
	Is there any outdoor seating? Yes No N/A If yes, approx square feet:
	Is the operation open 24 hours? Yes No
	How many years in industry?
Retail Store/Other - Explain Below:	How many years at current location?
	Does applicant have any delivery services or valet service? Yes No
Liability Comments:

Complete this section for the following risks:
● Restaurant with Liquor
● Taverns
● ALL Risks applying for Liquor Liability

If you wish to have a copy of this submission for your records, you must print page BEFORE submitting.

Please note - There might be a delay upon submission.
Do not exit until you receive the "Confirmation Page."

Type of Risk
Please describe the type of risk as it applies to the applicant:
Is the applicant the: Owner of the building NOT occupying any of the premises Owner of the building occupying all or part of the premises Tenant in the building
Total sq ft occupied by owner: If Apartments, number of units:
Is there a parking lot the applicant is responsible for? Yes No If yes, approx square feet:
Describe Other Occupancies not mentioned above	Sq Ft	# of Units
Applicant occupies this space A tenant occupies space
Applicant occupies this space A tenant occupies space
Applicant occupies this space A tenant occupies space

General Building Info
Year building was built Number of Stories 1 2 3	Percent Building Occupied Fully Occupied/100% Partially/Under 100% If partially occupied, describe vacancies:
Construction	Any construction present or expected? Yes No If yes, describe:
Has the building been updated? Yes No	Number of fire walls/fire divisions in building (if any)
Year of Building Updates Electricity: Heat: Plumbing: Roof:
Fire Protection Smoke Detectors Dead Bolt Locks Fire Extinguisher Carbon Monoxide Detectors	Is there a working automatic fire alarm in service that reports to a public or private fire alarm station? Yes No
Is there any Commercial Cooking? Yes No If so, is there an Automatic Fire Extinguisher System in place and serviced regularly? Yes No
In Agent's/Applicant's opinion, what is the condition of the premises? Excellent Good Fair Poor
Current Fire and Liability: Company: (required) Policy #: (required to bind)	Renewal to your office? Yes No
Is the applicant being non-renewed from its current carrier? Yes No If yes, describe:
Enter target/current premium:	Current Premium Target Premium
General Building Comments:

Fire Section
Coverages	Coverage Amount	Deductible	Coverage Options
Building 1
Building Coverage Basic Broad Special			RC ACV
Check if bldg. limit is Betterments & Improvements
Inflation Guard (if replacement cost building will be automatically increased 4%)
None 2 % 4 %
Business Personal Property Coverage Basic Broad Special			RC ACV
Loss of Income Coverage Business Income $You may select 1/3, 1/4, or 1/6 as the applicable fraction, which in effect provides the option of choosing coverage for 3, 4, or 6 months. For example, if you determine that the maximum monthly income loss could not exceed $40,000 and the maximum possible period of interruption could not exceed 3 months, it would be appropriate to buy $120,000 of coverage with they the 1/3 option and no co-insurance requirement. Coverage is limited to a maximum recovery amount per month, but the <CLICK FOR MORE>$ Rental Income
Central alarm system? Yes No

Building 2 - Describe structure below
Description:			RC ACV
Construction:
Building Coverage Basic Broad Special
Inflation Guard (if replacement cost building will be automatically increased 4%)
None 2 % 4 %
Business Personal Property Coverage Basic Broad Special			RC ACV
Loss of Income Coverage Business Income Rental Income
Central alarm system? Yes No

Additional Coverages
Coverage Extension Endorsement Yes No ($150 annual premium) For coverages, see web site under "Available Optional Endorsements." Coverages can be increased for additional premium. If desired, please note below.

Limited Glass Coverage Yes No ($35 annual premium) For coverages, see web site under "Available Optional Endorsements." Coverages can be increased for additional premium. If desired, please note below.
Additional coverages and/or comments, if any:

Additional Liability Underwriting Section
Licensed Closing Time 2 AM 4 AM	Actual Closing Time	Days open per week (Sun, Mon, etc.)
Annual Gross Liquor Receipts		How many years at current location?
Is there Entertainment? Yes No If yes, describe:
Are there more than 3 pool tables? Yes No		Is there a dance floor on premise? Yes No If yes, approx sq ft area: If yes, is the dance floor raised? Yes No
Is there a beer garden? Yes No If yes, approx sq ft area:		Does the establishment have a door attendant? Yes No
Please complete ONLY if Liquor Liability is requested
Building Owner info is required to bind coverage.
Building's Owner Name		Common Law Requested Yes No
Street Address		Liquor Awareness Training Yes No
City, State Zip
Current Company	Current Policy Number	Any losses in the last 3 years? Yes No If yes, describe:
Current Premium	Policy Expiration Date	Has any company cancelled or refused coverage in last 5 years? Yes No If yes, describe:
Have you insured applicant previously? Yes No If yes, explain:
General Liquor Liability Comments:

General Underwriting Questions
Have there been any PROPERTY, LIABILITY or LIQUOR LIABILITY claims in the last 3 years? (Req'd)	(Type "YES" or "NO") (If yes, describe below)
Has the applicant ever: - been convicted of any degree of arson? - had any previous arson occurrences on this or any building owned by applicant? - had any bankruptcies? If yes, indicate when below in "YES" answers section.	Yes No
Within the last 12 months period has applicant been cited with any building code violations?	Yes No
Any prior construction defects or mold evidence uncovered?	Yes No
Does the applicant require commercial tenants to provide insurance for their space?	Yes No N/A
Is there any Section 8 / subsidized / student / elderly housing?	Yes No

Explain any "Yes" answers:
Comments:

All quotations are subject to satisfactory Property Inspection. (Inspection fee is fully earned at inception of policy.)

NO FLAT CANCELS WILL BE ALLOWED AFTER INCEPTION OF POLICIES.

Agent/Applicant warrants that above are true to the best of his/her knowledge.