Davis Insurance Services LLC

2005 Study Reveals
That the number of workplace lawsuits are decreasing. Sexual harassment is down 4% from 2004. Mandatory training by 90% of companies surveyed is believed to be main reason.

Auto Insurers are dropping their rates beginning in September 2005 by 3-7%.
Take advantage of these new cost savings, call Don @847-577-1400.

Instructions

Please complete the information below, then click on the Continue button.

General Information

Name of Insured:
Address:
City:
State:
Zip:
Phone:
Fax:
Email Address:
Location Address:
City:
State:
Zip:

Property Questions

Year Building was Built:
Type of Building Construction:
Number of Stories:
Other Occupancies:
Square Feet You Occupy:

If the building is over 25 years old, please answer the following:

Year Electricity was Updated:

Is it on Circuit Breakers:

Year Plumbing was Updated:

Copper or Galvanized Plumbing:

	Copper
	Galvanized
	Other

Year of Last Re-roofing:

Type of Roofing Material:

Type of Heating System:

Protective Devices

Burglar Alarm:
Type of Alarm:
Alarm Company:
Sprinkler System in Building:
Smoke Detectors:

Liability Questions

Previous Carrier:
Policy Number:
Prior Premium:
Policy Renewal Date:

Business Information

Years in Business:
Projected Gross Annual Receipts:	$
Projected Annual Payroll:	$

Describe your Business, Products, or Services:

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Comment:

5105 Tollview Drive,Suite 109 Rolling Meadows,IL 60008
Phone: 847 .577 .1400
Fax: 847 .577 .7312

11.02.06
A recent survey by the NPA (National Product Association) found that XYZ's products were the best quality in the world.

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