Renewal Information Update

Profile Information

name insured
Mike Murray
Policy Number
33192381203
Mailing Address

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 of organization changes.

2What are the current...

total sales
1,731,312
Square Footage of area occupied
300
Payroll
32,021
Square Footage of vacant land or building
500

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
Mike Murray
date
February 2, 2024