Agent Info:
Name : Steven Longenecker
License ID : Various
Phone : (303) 808-9351
Email : [email protected]
Address : 2362 Eagleview Circle, Longmont, Colorado, 80504

General Liability

  • Applicant
  • General Info
  • Business Info
  • Business Location
  • Coverage
  • Miscellaneous
  • Finish

Applicant

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First Name *
Last Name *
Email *
Phone *

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General Info

General Information

Business Name *
DBA (If Applicable)
FEIN # (If Applicable)
Business Address
Address *
City *
State *
Zip Code *
Organization Type
Founding Date

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Business Info

Business Information

Type of Business
# Full-Time Employees
# part-Time Employees
Annual Revenue *
Annual Payroll *
Description of Business

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Business Location

location 1

Building Info

Location Address
Address *
City *
State *
Zip Code *
Construction Type
Roof Type
Total Square Feet
Year Built
Number of Stories
Number of Basements
Primary Heating Type
Other Primary Heating Type
Secondary Heating Type
Other Secondary Heating Type

Interest

Interest's Type
Interest's Name
Reference or Loan #
Interest's Address
Address *
City *
State *
Zip Code *

Building Updates

Wiring Update Year
Roofing Update Year
Plumbing Update Year
Heating Update Year

Safety

Burglar Alarm Type
Fire Protection Type
Percent of Protection that are sprinklers
Number of Wood Burning Stoves

Property Coverage

Content Coverage Amount Need
Coverage Amount Needed for Tools
Coverage Amount Needed for Computers
Contractors Equipment Coverage Amount Needed
Any Other Business Items That You Would Like Insured

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Coverage

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Miscellaneous

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