Business Owners Policy

Full Name:	*
Business Name:	*
Business Entity
Business Address:	*
Address:	*
City:	*
State:	*
Zip:	*
Contact Number:	*
Email:	*
Website:	*
Effective Start Date:	*
Any losses in the last 5 years:

General Liability Limits: (quotes baed on $1M in revenue)
$1 Million $2 Million
Gross Revenue:	*
Years in business:	*
Years of Experience:	*
Number of Employess Full-Time:	*
Number of Employess Part-Time:	*
Annual Payroll:	*
Hired/Non-Owned Autos: Do employees use their personal autos to run business tasks:
Location Address (if different than mailing address):	*
Number of Stories:	*
Year built:	*
Do you own the building:
Construction:	*
Square footage you rent:	*
Fire Sprinklers:
Year of updates if older than 25 years:	Electrical: Roof: Plumbing: HVAC: *
Central station alarms	Alarms Fire Alarms Intrusion
Dead Bolts on Exterior Doors:
Do you have a safe in the office:
Building Limit:	*
*Business Personal Property (BPP) Limit:**	*
*Note: Buliding Limit is n/a if you do not own the building / BPP = the collateral amount for the SBA Load**
Please separate the value of your electronic equipment -versus- the value of your Non-EDP equipment
Electronic Data Processing Equipment: (EDP) (value of equipment:	(includes Personal Computers, Monitors, Servers, Terminals, Laptops, Data Storage, Hardware, etc.) *
What is the value of your desk, chairs, file cabinets, and other misc. office furniture?:	*