BOP Application 

BOP (Business Owners Policy) Application

Designed specifically for small businesses, a Business Owners Policy (BOP) is a combination commercial policy that covers property, general liability, and business interruption. It is written with strict underwriting guidelines including maximum allowable square footage for office, retail, or apartment risks. A BOP is most appropriate for small, "main street" businesses such as: hardware stores, barbershops, greeting card shops, accountant offices, or low-density apartment houses. Discuss the option of a BOP with your broker-agent, as the premium for qualifying businesses can be very competitive.
 
1. General Information
Company Name:
 Full Name:
Mailing Address
Street Address
City
State
 Zip
Phone
 Fax
Email
 
Business Address
Street Address
City
State
 Zip
Phone
 Fax
Business entity:   Other
Underwriting Information
1. Completely describe the operations at this location:
 
2. How long has applicant been in this type of business: years
3. How long has applicant been at this location: years
4. Is any portion of the applicant's premises subleased: Yes No
5. Describe all adjoining or adjacent occupancies and/or vacancies:
  
6. Is location on a pier, dock, or waterfront: Yes No
7. Annual gross receipts: $
Please list approximate annual sales by category:
A. Food sales: $ C. Gas sales: $
B. Alcohol sales: $ D. Other: $
8. Enter # of individual owners & partners:
9. Enter # of employees, excl. owners & clerical: FT: PT:
10. Total area (in square feet): Total customer area:
11. Parking area or number of spaces:
12. Will business be closed for remodelling/building construction work during the policy period:
Yes No If yes, explain:
13. Number of floors:
14. Plate glass: linear feet
15. Electrical system protected by: Fuses Circuit breakers
16. Type of fire protection equipment on premises:
Fire extinguishes Sprinklers Smoke detectors
17. Fire alarm: Local Central station None
Burglar alarm: Local Central station None
18. Name of alarm company: Phone #:
19. Does the applicant do any direct importing: Yes No
20. Are there any rental operations: Yes No
Describe:
21. Is there any pick-up or delivery service: Yes No
Describe:
22. Describe all unusual operations or business practices not customary to this type of business:
23. Five-year policy history (Company/Policy Number/Dates):
24. Loss history for the past four years (include claims reported, unreported, and known occurrences which may result in claims):
Description Date Amount Open/Closed
$
$
$
$
25. Has the applicant had a fire loss at this or other property or business within 20 years:
Yes No
If yes, describe:
26. Is the subject risk currently insured for both Property and Liability: Yes No
27. Any prior coverage declined, cancelled, or non-renewed in the past three years:
Yes No
If yes, explain:
Building and Personal Property Information
Is this the predominant location/building? Yes No
If Building to be covered, enter value: $
Enter Business Personal Property Value: $ Minimum $10000
Select Deductible: Other: $
Select Liability Limit: Other: $
If owner is an occupant, enter % occupied:
Percent of building that is sprinklered:
Select Construction Type: Other:
Elect Off-Premise Power Failure Coverage:
Employee Benefit Liability Coverage (EBL):
Loss or Earning Coverage: Monthly $ Aggregate $
Theft Coverage (must have alarm):
Other Coverages required:
Enter Building's Year Built:
Enter year Plumbing last updated:
Enter year Electrical last updated:
Enter year Heating last updated:
Enter year Roofing last updated:
Hired Auto/Non-Owned Auto coverage?
Your Comments


 

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LICENSE #: OD80851

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Last Updated Monday, September 8, 2008
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