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Commercial Building Insurance
Insured's Name
Phone Number
Fax Number
Email Address
Insured is:
Business Name

Location
Property Address
City
Zip Code CA
No. of Stories
No. of Units
SQ. Footage
Year Built
Pool
Garage
Year Remodeled
Plumbing
Electrical
Roof Age Material

Loss History
Prior carrier and loss history for the past three years
From Mo. Yr. To Mo. Yr.
Company name
Policy number
Claims and Losses: Number Amount
Cancelled or Non-renewed
Reason

Desired Coverages		  
Liability Limit
Building
Loss of Rent
Deductible

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How did you hear about us

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AUTO | BOND | CONTRACTORS | EARTHQUAKE | EVENTS | GARAGE | LIABILITY | RESTAURANT | WORKERS COMP
 
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TELEPHONE (310) 551-1235 & (310) 551-1236 Fax (310) 551-1250
400 South Beverly Drive, Suite 318, Beverly Hills, Ca 90212. USA.
E-MAIL sales@concordgeneralinsurance.com

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