Business Owner's Property (BOP) Quote Form

Name*

First Last

Address (Mailing)*

Street Address Address Line 2 City State ZIP Code

Business Address (if different)

Street Address Address Line 2 City State ZIP Code

Phone*

Fax

Email*

Property Characteristics

1. What year was the building in which you are located constructed?

2. Construction Type

Brick
Frame
Other

3. List other occupants in your building (if any)

4. Please indicate your ownership interest in the practice

Tenant / Leasee
Condominium Unit Owner
Building Owner

5. List the alarms present in your building

Fire
Smoke
Burglar
Sprinkler
Fire Extinguisher

Business Owner's Coverage

Business Personal Property (contents): Amount needed to replace everything in your business (heavy equipment, office equipment, tools, furniture, supplies, improvements & betterments, etc.)

6. How much would you need to cover these items?*

7. Amount of Accounts Receivable required*

8. Limit of General Liability coverage required*

Building (if owned):

9. Total cost to replace (rebuild) your building:*

10. Current BOP carrier

11. Premium

12. Expiration

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Business Owner’s Property (BOP) Quote Form

Property Characteristics

Business Owner's Coverage