MONOLINE
					PROPERTY
	Insureds Name:
	DBA Name:
	Mailing Address:
	State:		Select Maryland Pennsylvania Delaware New Jersey Virginia Washington DC			Zip:
	County:
	Description of business:
	Property Schedule
	Building #1:
	Address:
	Occupied as:
	Year built:						Year
	In the past 10 years:						Updated
	Wiring updated:			Select Yes No
	Roofing updated:			Select Yes No
	Plumbing updated:			Select Yes No
	Heating updated:			Select Yes No
	Burglar or Fire alarm:			Select None Burglar Alarm Fire Alarm Both Burglar & Fire Alarm
	Construction:			Select Frame Masonry Joist Noncombustible Masonry Noncombustible Fire Resistive
	Number of stories:			Select One Two Three Four Five Other
	Protection class:			Select 1 2 3 4 5 6 7 8 9 10
	Building coverage limit:
	Contents coverage limit:
	Loss of rents limt:
	Loss of earnings limit:
	Other coverage & limit:
	Total square footage:
	Building #2 (if applicable)
	Address:
	Occupied as:
	Year built:						Year
	In the past 10 years:						Updated
	Wiring updated:			Select Yes No
	Roofing updated:			Select Yes No
	Plumbing updated:			Select Yes No
	Heating updated:			Select Yes No
	Burglar or Fire alarm:			Select None Burglar Alarm Fire Alarm Both Burglar & Fire Alarm
	Construction:			Select Frame Masonry Joist Noncombustible Masonry Noncombustible Fire Resistive
	Number of stories:			Select One Two Three Four Five Other
	Protection class:			Select 1 2 3 4 5 6 7 8 9 10
	Building coverage limit:
	Contents coverage limit:
	Loss of rents limt:
	Loss of earnings limit:
	Other coverage & limit:
	Total square footage:
	Building #3 (if applicable):
	Address:
	Occupied as:
	Year built:						Year
	In the past 10 years:						Updated
	Wiring updated:			Select Yes No
	Roofing updated:			Select Yes No
	Plumbing updated:			Select Yes No
	Heating updated:			Select Yes No
	Burglar or Fire alarm:			Select None Burglar Alarm Fire Alarm Both Burglar & Fire Alarm
	Construction:			Select Frame Masonry Joist Noncombustible Masonry Noncombustible Fire Resistive
	Number of stories:			Select One Two Three Four Five Other
	Protection class:			Select 1 2 3 4 5 6 7 8 9 10
	Building coverage limit:
	Contents coverage limit:
	Loss of rents limt:
	Loss of earnings limit:
	Other coverage & limit:
	Total square footage:
	Building #4 (if applicable):
	Address:
	Occupied as:
	Year built:						Year
	In the past 10 years:						Updated
	Wiring updated:			Select Yes No
	Roofing updated:			Select Yes No
	Plumbing updated:			Select Yes No
	Heating updated:			Select Yes No
	Burglar or Fire alarm:			Select None Burglar Alarm Fire Alarm Both Burglar & Fire Alarm
	Construction:			Select Frame Masonry Joist Noncombustible Masonry Noncombustible Fire Resistive
	Number of stories:			Select One Two Three Four Five Other
	Protection class:			Select 1 2 3 4 5 6 7 8 9 10
	Building coverage limit:
	Contents coverage limit:
	Loss of rents limt:
	Loss of earnings limit:
	Other coverage & limit:
	Total square footage:
	Building #5 (if applicable):
	Address:
	Occupied as:
	Year built:						Year
	In the past 10 years:						Updated
	Wiring updated:			Select Yes No
	Roofing updated:			Select Yes No
	Plumbing updated:			Select Yes No
	Heating updated:			Select Yes No
	Burglar or Fire alarm:			Select None Burglar Alarm Fire Alarm Both Burglar & Fire Alarm
	Construction:			Select Frame Masonry Joist Noncombustible Masonry Noncombustible Fire Resistive
	Number of stories:			Select One Two Three Four Five Other
	Protection class:			Select 1 2 3 4 5 6 7 8 9 10
	Building coverage limit:
	Contents coverage limit:
	Loss of rents limt:
	Loss of earnings limit:
	Other coverage & limit:
	Total square footage:
	Proposed effective date:
	Deductible requested:			Select 500 1,000 2,500 5,000
	Causes of Loss:			Select Basic Broad Special without Theft Special with Theft
	Co-Insurance:			Select 80% 90% 100%
	Valuation:			Select Actual Cash Value Replacement Cost
	Any Claims past 3 Years:				Select Yes No
	If claims, please provide details:
	Prior Carrier:
	Prior Premium:
	Is there any additional information you would like us to know about this risk:
	Agency Name:
	Agency Address:
	Agency Phone:
	Agency Fax:
	Agency Contact:
	Contact E-Mail Address:
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