Fire Protection

Fire Suppression Application

* Denotes required field.

First Name * Required
Last Name
Comments
Business name *
Location
Phone *
Email  *
Contact name  *
Year Established 
# of Owners 
# of Field Employees 
# Vehicles
Owner Duties

Type of business (please check all that apply)

Sprinkler Systems Contractor (Water Based Systems)
Sprinkler Systems Annual Sales
Sprinkler Systems Field Payroll(exclude owners payroll)
Restaurant/Special Systems Contractor
Restaurant/Special Systems Annual Sales
Restaurant/Special Systems Field Payroll(exclude owners payroll)
Fire Extinguisher Systems Contractor (Portable)
Fire Extinguisher Systems Annual Sales
Fire Extinguisher Systems Field Payroll(exclude owners payroll)
Alarm/Security Systems Contractor
Alarm/Security Systems Annual Sales
Alarm/Security Systems Field Payroll(exclude owners payroll)
Hood Cleaning and Service
Hood Cleaning and Service Annual Sales
Hood Cleaning and Service Field Payroll(exclude owners payroll)
Other
Other Annual Sales
Other Field Payroll(exclude owners payroll)

Please indicate the business sectors represented by the insured’s customers and show the estimated percentage of the insured’s overall receipts generated by each

Operations

% New Install
% Retrofit
% Service/Repair
% Testing
% Design

Client Base

% Apartments
% Hotel/Motel
% Retail/Office
% Restaurants/Food Svc
% Other (describe)
% Condominiums
% Single Family Homes
% Industrial/Manufacturing
% Hospitals/HealthCare
Does the insured hire subcontractors?
If Yes, annual cost of work subcontracted
Type of work subcontracted
Does the insured perform work on aircrafts, automobiles, mobile equipment, boats, and yachts?
If Yes, please describe
Does the insured inspect, test or certify systems installed by others?
If Yes, what percentage of the Insured’s Entire Business receipts are generated from these services?
Does the insured use CPVC piping for any sprinkler installations?
If Yes, what percentage of total receipts are generated from these services?
Does the insured sell safety equipment other than fire extinguishers?
If yes, total sales
If Yes, please list
Does the insured perform work in buildings over 5 stories?
Over 20 stories?
Does the insured install/monitor Medical Emergency/ Nurse call systems?
If yes, total sales call systems
Is alarm monitoring subcontracted out or handled by a third party?
If yes, total cost subcontracted
Does the insured design sprinkler systems, alarm systems. or extinguisher systems?
If Yes, what qualifications do the designers have?



If Other, Type Qualification
If Yes, does insured provide design work for others?
Current Carrier
Premium
Expiration Date
Association Memberships
Please describe in detail any claims from the past 5 years
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