HOTELS & MOTELS QUOTE FORM (Acord 125) QUOTE TAKER'S NAME: Today's Date: Email Address: What is the name of your corporation: What is your DBA: What is your location address: City: State: Zip Code: What is your First Name: What is your Last Name: What is your Home Phone Number: Cell Number: What is your Work Phone Number:  Fax Number: Is your Business a hotel or motel: PROPERTY (Acord 140) How much building coverage do you need: How much contents coverage do you need: Total square footage of each building: Square footage of each room: Do you have Central Station Alarm : Yes No Sprinkler System: Yes No What is your building construction type: What year was it built: What is your occupancy rate: Average room rate : Sign:$ --Acord 125-------------------------------------------------------------------------------------- Do you have a manager room: Yes No A restaurant: Yes No (Cooking): Yes No Sell Liquor: Yes No Have a pool: Yes No Fenced Pool : Yes No How many buildings: Number of floors: Number of rooms: Do you have federal ID available: Who is your current insurance company: Expiration date: Current premium: $ Do you have claim or losses: (Only if this business has or has had Insurance, request 3-year loss runs) Say: "Please fax us your 3-year loss history" LIABILITY (Acord 126) How much liability coverage do you need: $ What are your annual gross sales : $ NOTES