Manufacturing Quote for Manufacturing Insurance Contact Person* Phone Number* E-mail Address* Address Address 2 City State Zip Fax Years in Business Building Square Feet Own of Lease Premises Yes No Number of Stories Basement Yes No Construction Type masonry masonary n/c frame Year Built Roof type composition Shingle Tile Other Roof Age Is there an automatic sprinkler system Yes No What type of product do you manufacture Claims in last three years Yes No Number of Employees Total Payroll Bankruptcies or Tx in past 5 years Yes No What types of alarms protect premises Do you imported materials used in your production from other countries Yes No Do you use materials that require special storage practices Yes No If Yes, explain your storage practices Are you participating in the research & development of any new product or are you planning any new products for sale in the next 12 months Yes No Third Choice If Yes, please explain Do you services repair products you did not manufacture Yes No Do you have a specific program to withdraw known or suspected defective products Yes No Have any of your products been subject to voluntary recall Yes No Policy Effective Date Policy Renewal Date Number of Vehicles to Insure Approximate Current Premium Current Insurance Carrier Δ