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J L Arend Agency
P.O. Box 35
Emery, SD 57332

Phone: (605) 296 3481
Fax: (605) 296 3504
E-mail: jlarendagy@unitelsd.com

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General Information
Company/Business Name:*
Business Address:
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Contact Person Information
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Please Tell Us About Your Business
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Annual Gross Sales (Before Tax) ($): Cost of Any Sub Contracted Work ($):
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Location 1 Information
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Year Built In: % Occupied:
Building Value ($): Contents ($):
Type of Ownership:    
Construction Type:
Number of Basements: Area (Sq. Feet):
Burglar Alarm:       Sprinklers:      
 
Location 2 Information
Address:
City: State:
Zip: Country: United States
Year Built In: % Occupied:
Building Value ($): Contents ($):
Type of Ownership:      
Construction Type:
Number of Basements: Area (Sq. Feet):
Burglar Alarm:       Sprinklers:      
 
Current Insurance Information
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Any Losses In Last 3 Years?       Same Company Policy Since?
 
Please Provide An Approximate Amount For The Type Of Coverage You Want
Choose The Type of Coverage You Are Looking For:
Liability Coverage (Ex. $300,000, $500,000, $1 Million, etc.): Building Coverage ($):
Business Content Coverage ($): Miscellaneous Coverage ($) (All Coverage including Loss of Earnings, Valuable Papers, etc.):
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