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Areas Of Specialization
BioTech & Life Sciences
Restaurants and Breweries
Government Contractors
Information Technology Industry
Management Liability
Non-Profit Organizations & Associations
Professional Cleaning Services Program
Professional Liability
International Insurance Solutions
Business Insurance
Cyber Liability Insurance
Management & Professional Liability
Commercial Property & Liability
Workers’ Compensation
Business Travel Accident
Business Automobile
Umbrella Liability
Surety Bonding
Personal Insurance
Personal Umbrella Liability
Watercraft
Investment Property
Homeowners
Valuable Items
Motorcycle
Renters Insurance
Personal Automobile
Flood Insurance
Motorhome
Individual Life & Disability Insurance
Employee Benefits
Group Health Insurance
Group Dental Insurance
Group Life Insurance
Group Disability Insurance
Supplemental Insurance
About Us
Client Central
MoodyHR
Claims
Business Clients
Add/Delete A Driver
Add/Delete A Vehicle
Add/Change Location
Personal Clients
Add/Delete A Driver
Add/Delete Vehicle
Insurance Companies/Specialty Markets
Resources
Blog
Search
Add/Change Location
GENERAL INFORMATION
Business Name (incl Corp and T/A names)
Date
MM slash DD slash YYYY
Requestor Name & Contact Information (phone / email)
Delete Current Location?
Yes
No
Effective Date of Deletion
Address of Location to Delete
Effective date to Add Location
Use New Location for Mailing?
Yes
No
New Location Address
LOCATION / BUILDING INFORMATION
Type of building (office, mall, industrial, etc.)
Owner or Tenant?
Sq Ftg You Occupy
Stories
Approx Year Built
Construction (Frame, Masonry, Noncombustible, Fire Resistive, etc)
% of Bldg Sprinklered
If bldg over 30 yrs old, Year(s) Updated for Wiring, Heating, Plumbing, Roof
Alarm? Burglar or Fire? Local or Central Station?
COVERAGE LIMITS REQUESTED
Building
* Contents Replacement Value
Improvements & Betterments
Business Income & Extra Expense
Computer Hardware
Computer Software (data & media)
Valuable Papers
Accounts Receivable
Exterior Sign?
Building Glass (measurements)
Other Property Used or Stored Off Premises (describe & value)
Total Misc Mobile Tools & Equipment (max $,1000 value per item)
Scheduled Mobile Equipment (for individual items exceeding $1,000 in value)
ATTACH SCHEDULE
Do you rent or loan equipment to others? If Yes, please provide details
Yes
No
* Contents may include, but is not limited to: Leasehold Improvements, Leased Property, Inventory, Furniture/Fixtures, Equipment, Printed Materials, Consumables, and Property of Others in Your Care. Please consult your lease requirements when choosing the coverage and limits for this location.
OTHER
** Issue Certificate of Insurance to Landlord?
Yes
No
** List Landlord as Additional Insured?
Yes
No
Landlord Name and Address:
Comments / Additional Information / Instructions
** Please carefully review your lease for all insurance requirements.
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