Harmon Insurance & Bonding Agency

Property Insurance - Business


Name:
Address: City: 
     State: Zip:  
Email: Business #
Fax # Home
Name of Business: Type Business:
Location:           Address County
                                  City State

IF MORE THAN ONE LOCATION/BUILDING CONTACT US

Building Construction:

           Wall Support:       Exterior of Wall:
           Roof Structure:   Building Sq Ft:      Date Built
           Builders Risk:

Values:
          Building $     Furniture & Fixtures $
          Machinery $ Inventory $ ;(large fluctuation, )

Protection: Responding Fire Dept.: Distance: Miles

          Hydrant within 1,000 ft: Sprinklered: Alarms:

          Central Station Alarm:

Flood     Zone: * Elevation:  ft.
         Coastal Barrier Island Area:      Distance to water:

Liability:   Limit Desired:

Rating Info: Annual Sales: $  Subcontracted Work  $

          Annual Payroll: $   Number of Employees: 
          Years in Business

Prior Losses:    List all losses within the past 3 years
No Prior Losses  
Current Insurance Co. 
Remarks:

Contact our office for Crime or Fidelity Bond coverage.

     

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