SCU

Commercial Submission Form

Fill in the following details to submit a commercial risk to our Underwriting team.

Agent

Email Address: Agency: Agency Contact:

Insured

Name Insured: DBA: Insured Phone: Description of Operations: Years in Business: Years Experience: Losses: Deductible: Current Carrier: Premium: Expiration Date: Coverage Form:

• Basic
• Broad
• Special w/Theft
• Special w/o Theft

Requested Effective Date:

Location

Address 1: Address 2: City: State: Zip:

Property

Construction: Protection Class: Age of Building: Square Footage Alarm System: Roof Update: Value (Bldg, BPP, Additions, Bus Inc): Wiring Update: Heating Update: Plumbing Update: Fire Protection:

Liability

Limits: Area: Cost of Subcontracted Work: Payroll: Receipts:

Notes

Additional Remarks:

Submit