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Hotels / Motels Insurance

CALIFORNIA, ARIZONA, NEVADA, ONLY

Corporation       Individual       Partnership        Other

Name *
Email Address *
Company
Mailing Address
Subject Address
City
County
State
Zip Code
Phone Number
Email Address *
Fax Number
Contact Person
General Liability Limits
Exp. Date Liability
Workers Comp. Exp. Date
Liability Limits Umbrella
Sign
Building Value Deductible
Personal Property Deductible
Automobile, Buses, Other Deductible
Non-Owned Auto
Business Income
(Actual Loss Sustained)

Number of Buildings
Number of Stories
Age of Building
Roof Update
Plumbing Update
Heat/Air Update
Number of Units Per Building
Square Footage
If over 25 years, provide year of:
Electrical Update
Swimming Pool                                    Yes No
Fire Sprinklers                                     Yes No

Construction Type
Gross Sales
Payroll
Current Carrier
Policy Number Exp. Date
Premium
   
Specify Losses in the Last 3 Years