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Do you own or rent the business premises?
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If you are a tenant include betterments & improvements.
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List Owners Names & Annual Payroll Per Owner:
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Eligibility Questions
During the past three years has any company ever cancelled, declined, or refused to issue similar insurance to the application?
Yes
No
If yes, please explain.
Has the insured or applicant had prior coverage?
Yes
No
Has the insured or applicant had any prior claims or losses in the last 3 years?
Yes
No
If Yes, please provide loss information.
Has the applicant filed for bankruptcy in the past 5 years?
Yes
No
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