Property Preservationists Exposure Profile

This program's primary focus in the placement of well structured and cost effective commercial general liability coverage only. Other lines of coverage such as auto, property, contractor's equipment, errors & omissions, workers compensation coverage is not being offered with limited exceptions followng a specific request by the applicant.

This program is not available to companies in Alaska, Hawaii, Idaho, Iowa, Louisiana, New Mexico, North Dakota, South Dakota, Washington or Wyoming.

There may be exceptions available for company's with $500K or more in field payroll.

* Required

First Name: *

Last Name: *

Email: *

Phone Number: *

Name of Entity: * 🛈

Sole Proprietor, Inc. or LLC? *

EIN# or SS # *

Date of Birth (dd/mm/yyyy) * +

Are their other Entities with Insurable Interest? *

If Yes, please list all of the entities along with a description of their interest.

Years in Operation * 🛈

Estimated Total Annual Revenue for the Coming Year $: *

Handy Person Payroll $: * 🛈

Landscape Gardening Payroll $: * 🛈

For startup companies a minimum revenue / payroll amount of $20,000 will be used.

Address:

Street: *

City: *

State: *

Zip: *

Mailing Address (if different than above):

Street:

City:

State:

Zip:

Description of Operations:

Inspection: *

If Yes, describe types of properties, frequency, number of locations etc:

Maintenance: *

If Yes, describe work done:

Current Insurance Information

Current Carrier:

Expiration Date of Current Policy(ies): +

Current Agent:

Upload Current Policy if Available: 🛈

Loss History

Overview of Loss History: *

Thank you for utilizing this system. You should recieve confirmation of your request via email. A KMRD representative will reach out to you with questions if we have them. If you do not hear from us, feel free to call at 866-957-KMRD (5673) or contactus@kmrdpartners.com

This form is for communication purposes only. This form does not bind coverage