2. 
3. BUSINESS AND EMERGENCY RECORD

   
   

   
   

   CONFIDENTIAL

   
   

   
   

5. 1. The information you fill in below is valuable in the event an after-hours emergency requires entrance to the business or contact with the owner/manager.
   2. Please complete all sections and return to the El Cerrito-Kensington Fire Department by hitting SUBMIT at the end of the form.
7. Date*
   Date
9. Business Name:*
10. Business Telephone:*
12. Business Address/Location*
13. City

    El Cerrito

14. Zip Code

    94530

16. Business Email Address*
17. Type of Business*
19. El Cerrito Business License*
20. License Expiration Date*
22. Manager/Operator's Name*
23. Manager/Operator's Direct Phone*
25. Manager/Operator's Direct Email Address*
27. Manager/Operator's Mailing Address
28. City
29. Zip Code
31. Building Owner*
32. Building Owner Direct Phone*
34. Building Owner Mailing Address
35. City
36. Zip Code

38. Contacts To Notify In An Emergency (list persons who have key to the business)

40. Name*
41. Contact Phone #*
43. Name
44. Contact Phone #

46. Alarm System Information

48. Security Alarm?*

    1. Yes
    2. No
49. Fire Alarm?*

    1. Yes
    2. No
50. Monitored by Alarm Co?*

    1. Yes
    2. No
52. Alarm System Company:
53. Alarm Co. Phone #

55. KNOX BOX KEY SYSTEM

57. Do You Have a Knox Box?*

    1. Yes
    2. No
58. If Yes, are the keys current?

    1. Yes
    2. No

60. Fire Insurance Information

62. Insurance Carrier?*
63. Phone #*
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

* indicates a required field