Providing businesses and individuals
peace of mind
155 N. Ft. Thomas Ave.
Ft. Thomas, KY 41075
859-441-4100 phone
859-572-3056 fax
www.penderyins.com
Commercial Submission
Please complete the following submission and click 'Submit.' A representative will contact you shortly.
Need by Date Agent
Requested Effective Date Requested Expiration Date
Preferred Payment Plan Annual Semi-Annual Quarterly Monthly
General Information
Owner Name
DBA
Mailing Address
Premises Address
County
Cell Phone Business Phone Fax
Is Your Business a Corporation Sole Proprietor LLC Other
Federal ID# Social Security #
E-mail Address Date Business Started
Current Insurance Carrier Name and Address:
Policy # How Long
Coverages Requested
General Liability Property Auto Inland Marine Umbrella Crime
Other
Loss History in Last 3 Years:
Description of Business Operations:
Property Information
Location# Building#
Construction of Building Year Built # of Stories Total Area
Inside City Limits: Yes No Interest: Owner Tenant
Percent Occupied
Building Improvements and Dates:
Type of Security System
Sprinklered? Yes No
Amount of Building Coverage $ Amount of Contents Coverage $
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Address, if different:
Coverages (apply to all buildings and locations unless otherwise noted)
To provide a quote, our insurance companies use information such as driving records, claims and credit history from consumer reporting agencies.
NT____ AWAY AT SCHOOL ______ WITH VEHICLE OR WITHOUT
To provide a quote, our Insurance companies use information such as driving records, claims and credit history from consumer reporting agencies.