This application may be used for up to 3 buildings. Larger schedules must be submitted on a Commercial Acord form!

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Applicant Applicant Information
Named Insured
Mailing Address
Applicant Type
Contact Information
Policy Dates
Broker Broker Information (if applicable)
Agent/Broker Name
Agent/Broker Address
Contact Information
License Information
Policy Delivery
Delivery Type

Legend: - Review Location - Edit Location - Delete Location - Location Is Not Completely Filled Out
  Loc #Bld #Building Address 
Building Building Information
Same as Mailing Address
Building Address
Basic Information
Basic Information
Any Vacant Buildings or Lots on Either Side of Your Building?
Commercial Occupancy
Elevator Information
(if yes, provide a copy)
Property Features
If Battery, is There a Battery Replacement Program?
Please Provide certificate.
Any Uncorrected Type "B" or "C" Building violations in the Prior Three(3) Years?
How Many Units have Children Under the Age of Ten (10) Years Residing on Premises?
Do You Ask if any Children Under Age Ten (10) Reside on Premises When a Lease is Signed?
Do You Send an Annual Notice to All Tenants Asking if Any Children Under Age Ten (10) Reside on Premises?
Are All Units with Children Under Age Ten (10) Visually Inspected at Lease Signing and Annually?
Are These Units Equipped with Child Window Guards?
Are There Any Dogs on the Premises? Authorized on Lease?
Swimming Pools
Are There Any Swimming Pools Including Wading Pools?
If Yes, are There Any Slides? Any Diving Boards?
Building Updates
Any Renovations Currently Under Way or Planned Withing the Next Three (3) Years?
(if yes, please describe):
Indicate Year Next to Each Building Update:
Is anything currently installed on the roof?
Heating System
If Yes, Have They Been Relined?
Plumbing and Fixtures
Is Roof Material Shake or Wood Shingle
If Yes, Treated with Fire Retardant Material?
Other Information
Basement Finished?
Are Stairways Steel or Steel Reinforced?
Any Armed Guards?
Property Property Section
Basic Information
Coverage Limits
Inland Marine Floaters
Mysterious Disappearance
Additional Coverage
2% Minimum Deductible Applies
Additional Interest
Mortgagee Name
Mortgagee Address
Additional Information
Please save location information before proceeding to the next step!

Liability Liability Section
Basic Information
If Directors & Officers Liability is Included the D&O Supplemental Applications Needs to be Completed
Additional Coverage
Commercial Crime
Prior Carrier Prior Carrier Information - NEW PURCHASE?
General Information
Has Any Policy or Coverage Cancelled or Been Non-renewed During the Past 3 Years?
Loss History Loss History - Enter all claims for the Prior 3 Years OR CHECK HERE IF NONE
Check Here if Currently with Brownstone (if so, loss records will be on file with agency)
Has There Ever Been a Lead or Mold Claim(s) or Complaint? (if yes, describe below)
Date of Occurrence Type/Description of Claim Date of Claim Amount Paid Amount Reserved Claim Status
Umbrella Commercial Umbrella Coverage Supplement - Annual Policy Only
Note: This section must be completed in its entirety before binding coverage.
3 Years of Currently Valued Loss History
Has the insured had any individual losses exceeding $100,000?
If so, please provide Date of Loss:
Amount Paid/Reserved:
Has the insured had aggregate losses exceeding $50,000?
Does the insured require and document certificates of insurance and hold harmless agreements favoring the insured from all commercial occupancies and contractors working on the premises?
General Information
Is the insured a housing project, section 8, or affordable housing?
Does the insured receive a government subsidy of any kind?
Is the insured location owned by a housing authority?
Fire Escapes? Smoke Detectors in Units? Sprinkler Type:
Is there minimum of two means of egress from each floor?
If yes, describe:
# of Stairwells - Enclosed # of Stairwells - Open
Is there a doorman or concierge?
Is there a buzzer or intercom system?
Are entry doors locked?
Is there a business automobile exposure?

Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which subjects the person to criminal and (NY: substantial) Civil Penalties. *Not applicable in CO, HI, NE, OH, OK, OR, ME and VA. Insurance benefits may also be denied).

Allstate Agent's Information
Send To:
Agent Name & Phone #:
Agent E-Mail:
Please completely fill out all required information for locations labelled by before submitting the application!