"Shopping Center"
 
 
Name Insured    
  Mailing Address    
  Phone Number   Cell Number
  Location of Business
  Have You Had Insurance In The Last 3 years? Any Losses    
  Amount of Loss  
  If Yes, Name of Company  
  General Liability Coverages    

 

  PROPERTY SECTION            
  Building Value Year Build  
  If Building Over 15 Years update          
  Roof Wiring Heating/AC Pluming  
  Construction of the Building    
  Tenant Type of Business    
  sqft
  Comment