ࡱ>   Root EntryZ O2e CONTENTS CompObjVSPELLING(*,Nh0,F   T l  (dfhj(2"'( ) @S  4"5% ,0RX   j "PS"  "PS"  "  ""  WW " " ttjj(WTimes New Roman " " "XXddddSamsung ML-1740 Series odXXPRIVp dCourier NewH(winspoolSamsung ML-1740 SeriesUSB001CHNKWKS  TEXTTEXTj FDPPFDPPFDPCFDPCSTSHSTSHSTSHSTSH2SYIDSYIDPSGP SGP dINK INK hBTEPPLC lBTECPLC FONTFONT<STRSPLC :PRNTWNPR FRAMFRAMTITLTITLZ2DOP DOP (2"'( ) @S  4"5%Commercial Worksheet Date:_______ Name:________________________________________________ Business Name:______________________________________________________________ Ind._____ Part_____ Corp.____ Federal ID_______________________ Address:____________________________________________________________________ Phone:_______________________ Fax:____________________________________ Mailing Address:_____________________________________________________________ Email Address:_______________________________________________________________ General Liability - Amount of coverage requested below Location Premises #1______________ #2______________ #3________________ Construction Type #1______________ #2______________ #3________________ Building Amount #1______________ #2______________ #3________________ BPP Amount #1______________ #2______________ #3________________ Workers Comp. Job Description #1_______________ #2______________ #3________________ W-2 Payroll #1_______________ #2______________ #3________________ Auto Vehicle #1: Year:______ Make/Model:___________ Value of Vehicle:_________ VIN #:___________________________________________________________________________ Comp. Y/N Collision. Y/N Towing Y/N Rental Reimbursement Y/N Vehicle #2: Year:______ Make/Model:___________ Value of Vehicle:_________ VIN #:___________________________________________________________________________ Comp. Y/N Collision. Y/N Towing Y/N Rental Reimbursement Y/N Vehicle #3: Year:______ Make/Model:___________ Value of Vehicle:_________ VIN #:___________________________________________________________________________ Comp. Y/N Collision. Y/N Towing Y/N Rental Reimbursement Y/N " F"\""V"$c"` "``""A."@"\""V"$c"` "``"."commercial worksheet.wps"p"pp (" ________ Building Amount #1______________ # Z O2Quill96 Story Group Class9qyyy