Renewal Information Update

Profile Information

name insured
Drew Pall
Policy Number
3312312331
Mailing Address
drew@pall.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
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2What are the current...

total sales
312,554
Square Footage of area occupied
145
Payroll
9,833
Square Footage of vacant land or building
235

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
Drew Pall
date
February 2, 2024
Print Broker Information
ledgebrook.com