Commercial Property Submission — PacificGuard Insurance

Commercial Property — New Business Submission

Complete all required fields and click Submit for Review. A underwriter will respond within 1 business day.

* Required fields

Applicant Information

Named Insured *

Business Name / DBA

Mailing Address *

Phone Number

Email Address

Policy Information

Requested Effective Date *

Submission Type

Submitting Agency *

Agency License Number

Existing Policy Number

Carrier NAIC Code

Location & Building Details

Property Address * Enter if different from mailing address

Location #

Building #

Building Description / Occupancy *

Construction

Construction Type *

Year Built

Number of Stories

Number of Basements

Total Square Footage

Roof Material

Building Improvements — Year Last Updated

Wiring

Roofing

Plumbing

Heating

Fire & Security Protection

Protection Class (1–10) *

Distance to Hydrant (ft)

Distance to Fire Station (mi)

Fire District

Fire Protection Description

Sprinkler Coverage %

Sprinkler System?

Yes No

Central Station Fire Alarm?

Yes No

Burglar Alarm Type

Alarm Company

Coverage Requested

Coverage A

Subject of Insurance *

Limit ($) *

Coinsurance %

Valuation

Cause of Loss

Deductible

Coverage B

Subject of Insurance

Limit ($)

Coinsurance %

Valuation

Cause of Loss

Deductible

Additional Interest / Mortgagee

Name

Interest Type

Rank / Lien Position

Mailing Address

Remarks & Authorization

Additional Remarks / Special Conditions

Authorized Representative Name *

Date *

By submitting, you confirm all information is accurate.
Questions? Call 1-800-PAC-GARD