Commercial Building Insurance Questionaire

Midwest Underwriters is a leading, minority held, independent insurance agency in the state of Michigan.

Commercial Questionaire - Building Owner / Restaurant or Tavern Tenant

Please complete the following form so that we can start the process of completing your quote.

Business Information
Business Name
DBA?
Your Name
Phone Number
Email Address*
Type of Operation
Year Business Started
If new business, how many years experience?
Current Insurance Information
Building Information
Square Footage
Number of Stories
Year Built
Construction of Building
Central Station Alarm?	Yes No
Sprinkler System?	Yes No
Coverage Information
Amount of Building Coverage Desired
Amount of Contents Coverage Desired
Amount of Business Income Coverage Desired
General Liability Limit Desired
Annual Sales (Building owner only)
Estimated Annual Payroll
Current Insurance Expiation
Current Carrier
Current Premium
Explain any losses in the past 3 years
When where the following last updated?
Wiring
Roof
Plumbing
Heating
Complete the following if you are a restaurant/tavern tenent
Name of Fire Supression System
How often is the system serviced or cleaned by a service contractor?
How often are the filters cleaned?
Amount of Tenants Improvement Coverage Desired
Food Spoilage Limit Desired
General Liability Limit Desired
Annual Gross Food Sales
Liquor Liability Limit Desired
Any Live Entertainment?	Yes No
List any amusment devices. (Pool table, jukebox, etc.)
List any Riding Devices
Square Feet of Dance Floor
Operating Hours
Square Feet of Parking Lot
Valet Info (ie Employees or Contracted)