Name
Contact Information
Address	AK AL AR AZ CA CO CT WY DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV PR DC VI AS FM GU PW
Business Name
FEIN Number
Location
Named Insured
Street Name & Number
Construction Type - ISO 1 –Frame (combustible walls and/or roof) ISO 2 –Joisted Masonry (JM) (noncombustiblemasonry walls with wood frame roof) ISO 3 -Non Combustible Metal Building ISO 4 -Masonry Non Combustible
ISO Prot Class
Year Built
Updates (what & when performed)
TENANTS
COMMENTS
Sq Ft
Smoke Alarms
% Sprinklered
Cost/ft
Building
Contents
Business Income Loss Loss of Rents Extra Expense
TOTAL VALUES
AOP Deductible
Wind & Hail Deductible
Flood Deductible
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