Markel BOP application | Markel Service, Incorporated

State

Effective Date

Description of Business Operations

Insured Information

Business Name

Doing Business As (DBA)

FEIN

Business Phone

Email

Website

Are you an agent? no yes

Agency name:

Producer contact name:

Producer email address:

Are you a business owner? no yes

Business contact name:

Email address:

Please note that Markel can send most insurance documents by email. Please provide a valid email address if you wish to receive your documents electronically.

Locations

Address

City

State

ZIP

County

Exposures outside state?

Same as Mailing address?

Limits

General Liability - Per Occurrence/General Aggregate

Medical Expenses

Deductibles

Property Deductible

Property Damage Liability Deductible

Coverage Essential Essential 1 100 Essential 2 200

Click here to view the BOP Essential Coverage Highlights

Would you like to include Terrorism Coverage? Yes No

History

Years with Property/Liability Insurance

Last Year's Premium

Building 1

Step 1 Risk Information

Location

Applicant Type

Step 2 Building Characteristics

Constuction Type

Year Built

Stories

Occupied Square Feet

Occupied %

Annual Gross Sales

Is this a single occupancy building? Yes No

Distance to hydrant

Distance to fire station

Fire alarm

Is the building sprinklered? Yes No

Is this a Condo Commercial Unit Owner? Yes No

Have any updates/renovations been made? Yes No

Step 3 Coverages/Limits

Building Limit

Business Personal Property Limit

Add another building?

Building 2

Step 1 Risk Information

Location

Applicant Type

Step 2 Building Characteristics

Construction Type

Year Built

Stories

Occupied Square Feet

Occupied %

Annual Gross Sales

Is this a single occupancy building? Yes No

Distance to hydrant

Distance to fire station

Fire alarm

Is the building sprinklered? Yes No

Is this a Condo Commerical Unit Owner? Yes No

Have any updates/renovations been made? Yes No

Step 3 Coverages/Limits

Building Limit

Business Personal Property Limit

Additional Insured

Blanket additional insured coverage is provided at no additional cost when required by written contract. However, if the applicant is required to name an additional insured using an individual endorsement please select from the list below. Additional premium may apply.

Is the applicant required to specify an additional insured by endorsement? Yes No

Underwriter Questions

General Questions

Any prior coverage declined/cancelled/non-renewed (last 3 yrs?) (Not applicable in MO) Yes No

Other Questions

Please enter the Nature of Business/Description of Operations and explanations for any "Yes" answers above and any information you feel is relevant to this application.

I attest that the information provided on this and previous pages is a complete, true, and accurate representation of this business. By checking the box below, I understand that any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material hereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and civil penalties.

By checking this box, I am agreeing to the above statements.

Businessowners policy application

Please note: