Renewal Information Update

Profile Information

name insured
Jane Teel
Policy Number
12333312
Mailing Address
jane@teel.com

No changes to filed address

Renewal Questions:

1Have there been any changes to your organization such as location changes or exposure changes within the last 12 months?

YES

no

please explain
This is a explain from brokers form.

2What are the current...

total sales
12,331,712
Square Footage of area occupied
400
Payroll
12,000
Square Footage of vacant land or building
550

I certify the representations in this renewal application to be true and complete, and understand that the policy, if issued, is conditioned upon the truth and completeness of the representation in this application. This renewal application will be made part of any policy offered.

upload Authorized Signature
Print name
Jane Teel
date
February 2, 2024