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Home / Tenant / Condo Car Commercial Boat Trucking Motorcycle Name E-mail Address City Province Postal code Phone Number Age of building < 1 year 1 - 20 years 20 - 35 years > 35 years Construction of building Frame Masonry Non-Combustible Fire Resistive Is the building sprinklered? Yes No Neighborhood descriptor Urban - primarily residential Urban - primarily commercial Urban - primarily industrial Non-urban centre - business area Non-urban centre - remainder Rural or isolated location Burglary protection Standard physical protection Superior physical protection Security guards Local alarm & standard physical protection Local alarm & superior physical protection Monitored alarm & standard physical protection Monitored alarm & superior physical protection Not applicable Is there a hydrant within 500 ft. (150 m.)? Yes No Is there a fire hall within 3 miles (5 kms)? Yes No Does the applicant install a service pay products? Yes No What type of business? Retail Office Building ownership Wholesale operation Farm Service operation Garage operation Contractor Manufacturer other Have there been any insurance claims in the last 3 years? no <= 2 >= 3 What are the annual receipts? Up to $50,000 $51,000 to $100,000 $101,000 to $500,000 $501,000 to $1,000,000 Over $1,000,000 What is the annual payroll? Up to $50,000 $51,000 to $100,000 $101,000 to $500,000 $501,000 to $1,000,000 Over $1,000,000

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