Application for Property Insurance
General Information

Facility Name (dba):
Legal Name:
Location Address:
Street:
City:
State:
ZIP:
Mailing Address:
(if different from above)
Street:
City:
State:
ZIP:
Contact Information:
Manager’s name:
Phone: -
Fax: -
E-mail:
Web Site:
How did you learn about The Monument Sports Group?:USIndoor web site
GOAL Indoor
Friend
Search engine (Google, Yahoo!, etc.)
Other:


Facility Information

Type of Facility:Soccer Facility   Other:    
Years in business:
Number of Buildings:
Year Building built:
County:
Total square feet:
(per building)
Sprinklered:Yes   No   
% Sprinklered:
Fire alarm:Yes   No   
Burglar alarm:Yes   No   
Distance to fire hydrant: ft
Distance to fire station: miles
Name of the monitoring company:
Building Construction:
Roof Construction:
If steel,coated with fire proofing material   uncoated   
Updates to the Building: (if building is over 25 years old)
Restaurant on Premises:Yes   No   
If Yes, please describe:
Liquor Sold on Premises:Yes   No   
Building
Replacement Cost, $:
Boiler and
Machinery Coverage
(Heating system/AC), $:		 Included aboveYes   No   
Contents
Replacement Cost, $:
Gross Receipts
(Loss of income), $:
Deductible, $:
Effective Date: (MM/DD/YYYY)
Current
Insurance Company:
Current
Annual Premium, $:
Losses or claims –
last five years:
(please fax loss runs to 804-354-9022)
Mortgagees or loss
payees (address):
Date:
 Name of a person completing the form:
 Title:
Company:
 Email:
Phone:
-
Fax:
-

The Monument Sports Group manages your insurance needs so that you can concentrate on growing your business.
Copyright © Monument Sports Group, 2003