5 minutes can save you up to 15% on your hotel/motel property & liability insurance!

Please complete this form and fax back to (916) 536-0202 Attn: John Glover

Business Name:___________________________Owners Name:_______________________ Years in Business:______

Location Address:_____________________________________ City/State/Zip__________________________________

Phone Number:____________________ Fax:_________________________ Email:______________________________

Number of buildings?_____ Number of Units?_____ Total Hotel Building(s) square footage?________ Year Built?______

Location owned or leased?__________ Has Wiring/Plumbing/AC/Heat/Roof been updated?_______ If so when?_______

Construction type? (frame,masonry,wood.metal, etc.)_______________ #of Stories?______ Sprinklers?______________

Roof Type?__________ # of Elevators?_______ # of Pools?________ #of Spas?_________ Alarm type?____________

Annual Gross Receipts?________________ Building Value?_______________ Contents Value?___________________

# of Employees?______ Annual Employee Payroll?_____________ Do you operate a shuttle van?_________________

Do you operate a Restaurant?________ Restaurant Gross Receipts?_________ Restaurant Square Feet_____________

Current Insurance Company?___________________________ When does your current policy expire_______________

Liability Limits?___________________ Sign Limits?________________ Deductible?_____________

Do you have an umbrella policy?_____________ if so, what insurer and limits?__________________________________

Any claims or lawsuits in past 5 years? If yes please explain_________________________________________________

Questions? Call John Glover at (800) 353-9292 Sheppard & Neilson Insurance Services – Hotel Insurance Pros
35 Years Experience – Over 1000 properties insured- “A” Rated Insurance – Package Coverage – Free Quotes