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Request a Quote for Commercial Property Insurancecpskdeveloper2019-05-15T13:21:29-05:00

REQUEST A COMMERCIAL PROPERTY INSURANCE QUOTE

Name

First

Last

Email *

Phone

Tell us about Location #1

Address

Address Line 1

Address Line 2

City

State

Zip Code

Total Sq. Ft.

Merchant Sq. Ft.

City Limits

Inside
Outside

Interest

Owner
Tenant

% Occupied

Basement

Yes
No

Construction Type

Year Built

# of Stories

Roof Update Year

Plumbing Update Year

Electrical Update Year

Heating Update Year

Building Coverage

RC/ACV: *

RC
ACV

Co Ins% *

Ded

Contents/BPP *

RC/ACV: *

RC
ACV

Co Ins% *

Ded *

Annual Revenue *

Sign *

Metal
Frame
Other

Distance to Fire Hydrant *

Fire Station *

Is applicant a subsidiary of another entity? *

Mechanical Breakdown/Boiler *

Other Occupancies *

Area Leased *

Alarm System *

Yes
No

Central Station *

Yes
No

% Sprinklered *

Yes
No

Central Station *

Yes
No

Front Exposure & Distance *

Rear Exposure & Distance *

Right Exposure & Distance *

Left Exposure & Distance *

Any exposure to flammables, chemicals, or explosives? If yes, please explain? *

Lein Holder / Additional Insured? *

Is a formal safety program in operation? If yes, please explain. *

Any policy or coverage declined, cancelled, or non-renewed during prior 3 years? If yes, please explain. *

Loss History - 3 year minimum (please explain below or email within 5 days)

Tell us about Location #2

Address

Address Line 1

Address Line 2

City

State

Zip Code

Total Sq. Ft.

Merchant Sq. Ft.

City Limits

Inside
Outside

Interest

Owner
Tenant

% Occupied

Basemen

Yes
No

Construction Type

Year Built

# of Stories

Roof Update Year

Plumbing Update Year

Electrical Update Year

Heating Update Year

Building Coverage

RC/ACV:

RC
ACV

Co Ins%

Ded

Contents/BPP *

RC/ACV:

RC
ACV

Co Ins%

Ded *

Annual Revenue

Sign

Metal
Frame
Other

Distance to Fire Hydrant

Fire Station

Is applicant a subsidiary of another entity?

Mechanical Breakdown/Boiler

Other Occupancies

Alarm System

Yes
No

Central Station

Yes
No

% Sprinklered *

Yes
No

Central Station

Yes
No

Area Leased

Front Exposure & Distance

Rear Exposure & Distance

Right Exposure & Distance

Left Exposure & Distance

Any exposure to flammables, chemicals, or explosives? If yes, please explain?

Lein Holder / Additional Insured?

Phone

Contact Us

(816) 380-3800

2765 Cantrell Rd.
Harrisonville, MO 64701

We are located inside the Mill-Walk Mall.

JOHN SOUTHARD
john@cpskinsurance.com

RANDY MAY
randy@cpskinsurance.com

AMANDA TABER
amanda@cpskinsurance.com

CHANDRA TURNER
chandra@cpskinsurance.com

SUMMER SMITH
summer@cpskinsurance.com

REQUEST A QUOTE

INSURANCE SERVICES

2765 Cantrell Rd.
Harrisonville, MO 64701

Phone: (816) 380-3800

Copyright 2019 CPSK Insurance Services Inc. | All Rights Reserved