Property Coverages
Pennsylvania Properties Only
Name:
      Contact Person: 
Address:
City:
    State:     Zipcode: 
Phone:
      Fax: 
E-Mail Address:
Property Location:
Requested Coverages
Building Contents Stock & Merchandise Loss of Income Deductible Liability Limit per Occurrence
Value:$  Value:$  Value:$  Value:$ 
Replacement Cost:
Depreciated Value: 		Replacement Cost:
Depreciated Value: 		How long would it take you to get back in business after a loss? 

Building Information
Type of Occupancy                     Year Built: 
Construction: 
Ground Floor Square Footage
Second Floor Ground Footage
Basement Square Footage
Number of Stories:  Roof Type: 
List Types of Occupants:
What's on the right side of building:
What's on the left side of building:
What's in the rear of building:
Burglar Alarm:
Fire Alarm:
 Sprinklered: Yes /  No

Ansul System:  Yes / No

Mortgagees
Mortgagee 1:
Name:
Address:
City:
 State:   Zipcode:
Phone:
Fax:
Mortgagee 2:
Name:
Address:
City:
 State:  Zipcode: 
Phone:
Fax:
Building Updates
Heating System Updates:
 Year:   What was done?
Plumbing Updates:
 Year:   What was done? 
Electrical Updates:
 Year:   What was done? 
Roof Updates:
 Year:   What was done? 
Claims
Date of Claim What Happened......

M c G R A T H   I N S U R A N C E   G R O U P

4170 William Penn Highway         Murrysville, PA. 15668-1890
(724) 327-8474            (FAX) (724) 327-7911
Toll Free: 1-800-977-2999            (FAX) 1-888-800-0034