{"id":5240,"date":"2022-10-03T12:19:30","date_gmt":"2022-10-03T10:19:30","guid":{"rendered":"http:\/\/select-assur.com\/?page_id=5240"},"modified":"2022-10-27T16:48:44","modified_gmt":"2022-10-27T14:48:44","slug":"formulaire-multirisque-professionnelle","status":"publish","type":"page","link":"https:\/\/select-assur.com\/formulaire-multirisque-professionnelle\/","title":{"rendered":"Formulaire Multirisque Professionnelle"},"content":{"rendered":"\t\t<div data-custom_css-type=\"wp-page\" data-custom_css-id=\"5240\" class=\"custom_css custom_css-5240\">\n\t\t\t\t\t\t\t        <section class=\"custom_css-section custom_css-top-section custom_css-element custom_css-element-bd1485a custom_css-section-boxed custom_css-section-height-default custom_css-section-height-default ct-header-fixed-none ct-row-max-none\" data-id=\"bd1485a\" data-element_type=\"section\">\n            \n                        <div class=\"custom_css-container custom_css-column-gap-default \">\n                    <div class=\"custom_css-column custom_css-col-100 custom_css-top-column custom_css-element custom_css-element-a68d3b7\" data-id=\"a68d3b7\" data-element_type=\"column\">\n            <div class=\"custom_css-widget-wrap custom_css-element-populated\">\n                        \t\t<div class=\"custom_css-element custom_css-element-eff0a61 custom_css-widget custom_css-widget-shortcode\" data-id=\"eff0a61\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"custom_css-widget-container\">\n\t\t\t\t\t<div class=\"custom_css-shortcode\"><div class='fluentform fluentform_wrapper_11'><form data-form_id=\"11\" id=\"fluentform_11\" class=\"frm-fluent-form fluent_form_11 ff-el-form-top ff_form_instance_11_1 ff-form-loading ff-form-has-steps ff_has_v3_recptcha\" data-form_instance=\"ff_form_instance_11_1\" method=\"POST\" data-recptcha_key=\"6Lc4KhIsAAAAAG0v28JTBkOOnC5YJJ-iu5pLEL-_\" ><fieldset style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;\n                                 box-shadow: none!important;outline: none!important;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;\">Assurance Multirisque Professionnelle<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='5240' \/><input type=\"hidden\" id=\"_fluentform_11_fluentformnonce\" name=\"_fluentform_11_fluentformnonce\" value=\"a33eced08b\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/php_api\/wp\/v2\/pages\/5240\" \/><div class='ff-step-container' data-name=\"step_start-11_4\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"no\" data-enable_step_page_resume=\"no\" ><div class='ff-step-header'><div class='ff-el-progress-status'><\/div>\n            <div class='ff-el-progress'>\n                <div class='ff-el-progress-bar'><span><\/span><\/div>\n            <\/div>\n            <ul style='display: none' class='ff-el-progress-title'>\n                <li>Soci\u00e9t\u00e9<\/li><li>B\u00e2timent<\/li><li>Garanties<\/li>\n            <\/ul><\/div><span class='ff_step_start'><\/span><div class='ff-step-body'><div class=\"fluentform-step active\" data-name=\"step_start-11_4\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"no\" data-enable_step_page_resume=\"no\" ><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_input_text_10' aria-label=\"Nom de l&#039;entreprise\">Nom de l'entreprise<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_10\" class=\"ff-el-form-control\" data-name=\"input_text_10\" id=\"ff_11_input_text_10\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2  '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_email' aria-label=\"E-mail\">E-mail<\/label> <\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_11_email\" class=\"ff-el-form-control\" data-name=\"email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_phone' aria-label=\"T\u00e9l\u00e9phone\">T\u00e9l\u00e9phone<\/label> <\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" data-name=\"phone\" id=\"ff_11_phone\" inputmode=\"tel\" ><\/div><\/div><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_1\" ><div class='ff-el-input--label'><label aria-label=Adresse>Adresse<\/label><\/div><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_address_1_address_line_1_' aria-label=\"Adresse\">Adresse<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_11_address_1_address_line_1_\" class=\"ff-el-form-control\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_11_address_1_address_line_2_' aria-label=\"Compl\u00e9ment d&#039;adresse\">Compl\u00e9ment d'adresse<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_2]\" id=\"ff_11_address_1_address_line_2_\" class=\"ff-el-form-control\" data-key_name=\"address_line_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_address_1_zip_' aria-label=\"Code postal\">Code postal<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[zip]\" id=\"ff_11_address_1_zip_\" class=\"ff-el-form-control\" placeholder=\"Code Postal\" data-key_name=\"zip\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_address_1_city_' aria-label=\"Ville\">Ville<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_11_address_1_city_\" class=\"ff-el-form-control\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_dropdown' aria-label=\"Cat\u00e9gorie d&#039;activit\u00e9\">Cat\u00e9gorie d'activit\u00e9<\/label> <\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_11_dropdown\" class=\"ff-el-form-control\" data-name=\"dropdown\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=true><option value=\"\"><\/option><option value=\"Bureaux \/ Sant\u00e9\"  >Bureaux \/ Sant\u00e9<\/option><option value=\"D\u00e9p\u00f4ts \/ BTP \/ Ateliers \/ Fabrication\"  >D\u00e9p\u00f4ts \/ BTP \/ Ateliers \/ Fabrication<\/option><option value=\"M\u00e9tiers de la restauration \/ Bar \/ Caf\u00e9s\"  >M\u00e9tiers de la restauration \/ Bar \/ Caf\u00e9s<\/option><option value=\"Alimentations\"  >Alimentations<\/option><option value=\"M\u00e9tiers de l&#039;Habillement\"  >M\u00e9tiers de l'Habillement<\/option><option value=\"Equipements du foyer \/ Services\"  >Equipements du foyer \/ Services<\/option><option value=\"Bricolage \/ Jardin \/ Services\"  >Bricolage \/ Jardin \/ Services<\/option><option value=\"Loisirs \/ Sport \/ Beaut\u00e9\"  >Loisirs \/ Sport \/ Beaut\u00e9<\/option><option value=\"Autres activit\u00e9s\"  >Autres activit\u00e9s<\/option><option value=\"item_2\"  >Item 2<\/option><option value=\"item_1\"  >Item 1<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_dropdown_1' aria-label=\"Activit\u00e9 Principale\">Activit\u00e9 Principale<\/label> <\/div><div class='ff-el-input--content'><select name=\"dropdown_1\" id=\"ff_11_dropdown_1\" class=\"ff-el-form-control\" data-name=\"dropdown_1\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=true><option value=\"\"><\/option><option value=\"Bureaux \/ Sant\u00e9\"  >Bureaux \/ Sant\u00e9<\/option><option value=\"D\u00e9p\u00f4ts \/ BTP \/ Ateliers \/ Fabrication\"  >D\u00e9p\u00f4ts \/ BTP \/ Ateliers \/ Fabrication<\/option><option value=\"M\u00e9tiers de la restauration \/ Bar \/ Caf\u00e9s\"  >M\u00e9tiers de la restauration \/ Bar \/ Caf\u00e9s<\/option><option value=\"Alimentations\"  >Alimentations<\/option><option value=\"M\u00e9tiers de l&#039;Habillement\"  >M\u00e9tiers de l'Habillement<\/option><option value=\"Equipements du foyer \/ Services\"  >Equipements du foyer \/ Services<\/option><option value=\"Bricolage \/ Jardin \/ Services\"  >Bricolage \/ Jardin \/ Services<\/option><option value=\"Loisirs \/ Sport \/ Beaut\u00e9\"  >Loisirs \/ Sport \/ Beaut\u00e9<\/option><option value=\"Autres activit\u00e9s\"  >Autres activit\u00e9s<\/option><option value=\"item_2\"  >Item 2<\/option><option value=\"item_1\"  >Item 1<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_input_text' aria-label=\"Code NAF\">Code NAF<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" id=\"ff_11_input_text\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_input_text_11' aria-label=\"Date de cr\u00e9ation de l&#039;entreprise\">Date de cr\u00e9ation de l'entreprise<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_11\" value=\"17\/07\/2026\" class=\"ff-el-form-control\" maxlength=\"10\" data-name=\"input_text_11\" id=\"ff_11_input_text_11\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_input_text_1' aria-label=\"Siret\">Siret<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" data-name=\"input_text_1\" id=\"ff_11_input_text_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_numeric-field' aria-label=\"Nb de salari\u00e9s\">Nb de salari\u00e9s<\/label> <\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric-field\" id=\"ff_11_numeric-field\" class=\"ff-el-form-control\" data-name=\"numeric-field\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_numeric-field_1' aria-label=\"Chiffre d&#039;affaire HT\">Chiffre d'affaire HT<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_1\" id=\"ff_11_numeric-field_1\" class=\"ff-el-form-control\" data-name=\"numeric-field_1\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">\u20ac<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group  ff_list_buttons'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"L&#039;assur\u00e9 est propri\u00e9taire des murs ?\">L'assur\u00e9 est propri\u00e9taire des murs ?<\/label> <\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=input_radio_1_b98413de4432507534c7a5ba073cdaa8><input type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Oui\"  id='input_radio_1_b98413de4432507534c7a5ba073cdaa8' aria-label='Oui' aria-invalid='false' aria-required=false> <span>Oui<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=input_radio_1_cea7838d8c6b0ae4112e951f5cf9b075><input type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Non\"  id='input_radio_1_cea7838d8c6b0ae4112e951f5cf9b075' aria-label='Non' aria-invalid='false' aria-required=false> <span>Non<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff_list_3col'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_1_f26cbf4910609a738cebac24bf7cd7c3><input type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"L&#039;assur\u00e9 est propri\u00e9taire du fond\"  id='checkbox_1_f26cbf4910609a738cebac24bf7cd7c3' aria-label='L&#039;assur\u00e9 est propri\u00e9taire du fond' aria-invalid='false' aria-required=false> <span>L'assur\u00e9 est propri\u00e9taire du fond<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_1_4400211fcfea4c80eaec356889027543><input type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Entreprise en redressement juridiciaire\"  id='checkbox_1_4400211fcfea4c80eaec356889027543' aria-label='Entreprise en redressement juridiciaire' aria-invalid='false' aria-required=false> <span>Entreprise en redressement juridiciaire<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_1_a38d01341240ba353241e6eb4e10d5a0><input type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Entreprise en liquidation\"  id='checkbox_1_a38d01341240ba353241e6eb4e10d5a0' aria-label='Entreprise en liquidation' aria-invalid='false' aria-required=false> <span>Entreprise en liquidation<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_1_246a8f299537e8a85ad399b6a454a1a4><input type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Adh\u00e9rent \u00e0 un centre de gestion agr\u00e9\u00e9\"  id='checkbox_1_246a8f299537e8a85ad399b6a454a1a4' aria-label='Adh\u00e9rent \u00e0 un centre de gestion agr\u00e9\u00e9' aria-invalid='false' aria-required=false> <span>Adh\u00e9rent \u00e0 un centre de gestion agr\u00e9\u00e9<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_1_c7b7ccf4cf97a3075c804e96d73fe4e0><input type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Franchis\u00e9 ou centrale d&#039;achat\"  id='checkbox_1_c7b7ccf4cf97a3075c804e96d73fe4e0' aria-label='Franchis\u00e9 ou centrale d&#039;achat' aria-invalid='false' aria-required=false> <span>Franchis\u00e9 ou centrale d'achat<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_1_793f329a32fcb6a73e26b71551d7b20d><input type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Le conjoint participe \u00e0 l&#039;activit\u00e9\"  id='checkbox_1_793f329a32fcb6a73e26b71551d7b20d' aria-label='Le conjoint participe \u00e0 l&#039;activit\u00e9' aria-invalid='false' aria-required=false> <span>Le conjoint participe \u00e0 l'activit\u00e9<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_11_dropdown_2' aria-label=\"Renonciation \u00e0 recours\">Renonciation \u00e0 recours<\/label> <div class=\"ff-el-tooltip\" data-content=\"S&#039;il existe une renonciation \u00e0 recours ou une assurance pour compte une copie du bail sera demand\u00e9e\"><svg width=\"16\" height=\"16\" viewBox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 0.046875)\"><\/path><\/svg><\/div><\/div><div class='ff-el-input--content'><select name=\"dropdown_2\" id=\"ff_11_dropdown_2\" class=\"ff-el-form-control\" data-name=\"dropdown_2\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"\">Aucune<\/option><option value=\" Aucune\"  >Aucune<\/option><option value=\" Renonciation \u00e0 recours contre le propri\u00e9taire\"  >Renonciation \u00e0 recours contre le propri\u00e9taire<\/option><option value=\" Renon. \u00e0 recours contre le propri\u00e9taire et son assureur\"  >Renon. \u00e0 recours contre le propri\u00e9taire et son assureur<\/option><option value=\" Renonciation \u00e0 recours contre le locataire\"  >Renonciation \u00e0 recours contre le locataire<\/option><option value=\" R\u00e9ciproque\"  >R\u00e9ciproque<\/option><option value=\" Assurance pour compte du propri\u00e9taire et du locataire\"  >Assurance pour compte du propri\u00e9taire et du locataire<\/option><option value=\" Renonciation \u00e0 recours en cas d&#039;int\u00e9r\u00eat commun\"  >Renonciation \u00e0 recours en cas d'int\u00e9r\u00eat commun<\/option><option value=\" Assurance pour compte en cas d&#039;int\u00e9r\u00eat commun\"  >Assurance pour compte en cas d'int\u00e9r\u00eat commun<\/option><option value=\" Prop. Ou Coprop. exclusion de l&#039;assurance Biens Immo.\"  >Prop. Ou Coprop. exclusion de l'assurance Biens Immo.<\/option><option value=\" Locataire exclusion de l&#039;assurance Resp. Locative\"  >Locataire exclusion de l'assurance Resp. Locative<\/option><option value=\"item_5\"  >Item 5<\/option><option value=\"item_4\"  >Item 4<\/option><option value=\"item_3\"  >Item 3<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_dropdown_3' aria-label=\"Forme juridique\">Forme juridique<\/label> <\/div><div class='ff-el-input--content'><select name=\"dropdown_3\" id=\"ff_11_dropdown_3\" class=\"ff-el-form-control\" data-name=\"dropdown_3\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=true><option value=\"\"><\/option><option value=\" Association\"  >Association<\/option><option value=\" Autre\"  >Autre<\/option><option value=\" CE\"  >CE<\/option><option value=\" Entreprise Individuelle\"  >Entreprise Individuelle<\/option><option value=\" EURL\"  >EURL<\/option><option value=\" GIE\"  >GIE<\/option><option value=\" Mutuelle\"  >Mutuelle<\/option><option value=\" SA\"  >SA<\/option><option value=\" SARL\"  >SARL<\/option><option value=\" SAS\"  >SAS<\/option><option value=\" SASU\"  >SASU<\/option><option value=\" SCA\"  >SCA<\/option><option value=\" SCC\"  >SCC<\/option><option value=\" SCI\"  >SCI<\/option><option value=\" SCM\"  >SCM<\/option><option value=\" SCP\"  >SCP<\/option><option value=\" SCS\"  >SCS<\/option><option value=\" SEL\"  >SEL<\/option><option value=\" Selafa\"  >Selafa<\/option><option value=\" Selarl\"  >Selarl<\/option><option value=\" Selas\"  >Selas<\/option><option value=\" Selca\"  >Selca<\/option><option value=\" SNC\"  >SNC<\/option><option value=\" SOS\"  >SOS<\/option><option value=\" Syndic\"  >Syndic<\/option><option value=\" Syndicat\"  >Syndicat<\/option><\/select><\/div><\/div><div class='ff-el-group  ff_list_buttons'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  aria-label=\"\u00c9tiez d\u00e9j\u00e0 assur\u00e9 ?\">\u00c9tiez d\u00e9j\u00e0 assur\u00e9 ?<\/label> <\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=input_radio_887354965ff499114763c92a0a44008e><input type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Oui\"  id='input_radio_887354965ff499114763c92a0a44008e' aria-label='Oui' aria-invalid='false' aria-required=true> <span>Oui<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=input_radio_1b811d78ae234b83a8bef6931e05110b><input type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Non\"  id='input_radio_1b811d78ae234b83a8bef6931e05110b' aria-label='Non' aria-invalid='false' aria-required=true> <span>Non<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_11_input_text_2' aria-label=\"Nb. Mois de suspension\">Nb. Mois de suspension<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" data-name=\"input_text_2\" id=\"ff_11_input_text_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_input_text_3' aria-label=\"Ancienne compagnie\">Ancienne compagnie<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_3\" class=\"ff-el-form-control\" data-name=\"input_text_3\" id=\"ff_11_input_text_3\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_11_input_text_4' aria-label=\"Ancien num\u00e9ro\">Ancien num\u00e9ro<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_4\" class=\"ff-el-form-control\" data-name=\"input_text_4\" id=\"ff_11_input_text_4\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group has-conditions  ff_list_inline'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_aa4e5213a9a852313ce4897d5adc90e0><input type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"R\u00e9siliation par la compagnie\"  id='checkbox_aa4e5213a9a852313ce4897d5adc90e0' aria-label='R\u00e9siliation par la compagnie' aria-invalid='false' aria-required=false> <span>R\u00e9siliation par la compagnie<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_input_text_5' aria-label=\"Motif\">Motif<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_5\" class=\"ff-el-form-control\" data-name=\"input_text_5\" id=\"ff_11_input_text_5\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_11_numeric-field_3' aria-label=\"Nombre de sinistres dans les 36 derniers mois\">Nombre de sinistres dans les 36 derniers mois<\/label> <\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric-field_3\" id=\"ff_11_numeric-field_3\" class=\"ff-el-form-control\" data-name=\"numeric-field_3\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=false><\/div><\/div>        <div data-type=\"repeater_field\" data-name=\"repeater_field\" class=\"ff-el-group ff-el-repeater js-repeater has-conditions\" data-root_name=\"repeater_field\"  >\n            <div class='ff-el-input--label asterisk-right'><label aria-label='Nature de sinistres' for=''>Nature de sinistres<\/label><\/div>            <div class='ff-el-input--content'>\n                <table data-max_repeat=\"\" data-root_name=\"repeater_field\" class=\"ff_repeater_table ff_flexible_table\">\n                    <thead>\n                    <tr>\n                                                    <th><div class='ff-el-input--label asterisk-right'><label aria-label='Date' for=''>Date<\/label><\/div><\/th>\n                                                    <th><div class='ff-el-input--label asterisk-right'><label aria-label='Circonstance' for=''>Circonstance<\/label><\/div><\/th>\n                                                    <th><div class='ff-el-input--label asterisk-right'><label aria-label='Montant' for=''>Montant<\/label><\/div><\/th>\n                                                <th><\/th>\n                    <\/tr>\n                    <\/thead>\n                    <tbody>\n                    <tr>\n                                                    <td data-label=\"Date\">\n                                                                <div class='ff-el-group'><div class='ff-el-input--content'><input type=\"text\" value=\"17\/07\/2026\" name=\"repeater_field[0][]\" id=\"ff_11_repeater_field_0\" data-repeater_index=\"0\" data-type=\"repeater_item\" data-name=\"repeater_field_0_0\" data-error_index=\"repeater_field[0]\" class=\"ff-el-form-control\"  aria-invalid=\"false\" aria-required=false><\/div><\/div>                            <\/td>\n                                                    <td data-label=\"Circonstance\">\n                                                                <div class='ff-el-group'><div class='ff-el-input--content'><input type=\"text\" name=\"repeater_field[0][]\" id=\"ff_11_repeater_field_1\" data-repeater_index=\"1\" data-type=\"repeater_item\" data-name=\"repeater_field_1_0\" data-error_index=\"repeater_field[1]\" class=\"ff-el-form-control\"  aria-invalid=\"false\" aria-required=false><\/div><\/div>                            <\/td>\n                                                    <td data-label=\"Montant\">\n                                                                <div class='ff-el-group'><div class='ff-el-input--content'><input type=\"text\" name=\"repeater_field[0][]\" id=\"ff_11_repeater_field_2\" data-repeater_index=\"2\" data-type=\"repeater_item\" data-name=\"repeater_field_2_0\" data-error_index=\"repeater_field[2]\" class=\"ff-el-form-control\"  aria-invalid=\"false\" aria-required=false><\/div><\/div>                            <\/td>\n                                                <td class=\"repeat_btn\"><div class=\"ff-el-repeat-buttons-list js-repeat-buttons\"><span class=\"repeat-plus\"><svg width=\"20\" height=\"20\" viewBox=\"0 0 512 512\"><path d=\"m256 48c-115 0-208 93-208 208 0 115 93 208 208 208 115 0 208-93 208-208 0-115-93-208-208-208z m107 229l-86 0 0 86-42 0 0-86-86 0 0-42 86 0 0-86 42 0 0 86 86 0z\"><\/path><\/svg><\/span><span class=\"repeat-minus\"><svg width=\"20\" height=\"20\" viewBox=\"0 0 512 512\"><path d=\"m256 48c-115 0-208 93-208 208 0 115 93 208 208 208 115 0 208-93 208-208 0-115-93-208-208-208z m107 229l-214 0 0-42 214 0z\"\"><\/path><\/svg><\/span><\/div><\/td>\n                    <\/tr>\n                    <\/tbody>\n                <\/table>\n            <\/div>\n        <\/div>\n        <div class='step-nav ff_step_nav_last'><button  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary'>Pr\u00e9c\u00e9dent<\/button><button  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary'>Suivant<\/button><\/div><\/div><div class=\" fluentform-step\" data-name=\"form_step-11_1\" ><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_dropdown_4' aria-label=\"Nature des locaux\">Nature des locaux<\/label> <\/div><div class='ff-el-input--content'><select name=\"dropdown_4\" id=\"ff_11_dropdown_4\" class=\"ff-el-form-control\" data-name=\"dropdown_4\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=true><option value=\"\"><\/option><option value=\" Bureau\"  >Bureau<\/option><option value=\" Commerce\"  >Commerce<\/option><option value=\" Atelier\"  >Atelier<\/option><option value=\" D\u00e9p\u00f4t\"  >D\u00e9p\u00f4t<\/option><option value=\" Autre\"  >Autre<\/option><\/select><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_input_text_6' aria-label=\"Autre locaux\">Autre locaux<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_6\" class=\"ff-el-form-control\" data-name=\"input_text_6\" id=\"ff_11_input_text_6\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group  ff_list_buttons'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"D\u00e9pendances (\u00e0 une adresse diff\u00e9rente du risque)\">D\u00e9pendances (\u00e0 une adresse diff\u00e9rente du risque)<\/label> <\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=input_radio_2_dd8789e1856f2800a77ca94a828505dc><input type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Oui\"  id='input_radio_2_dd8789e1856f2800a77ca94a828505dc' aria-label='Oui' aria-invalid='false' aria-required=false> <span>Oui<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=input_radio_2_3a84684f8b7b97283e0e27c83c513e7b><input type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Non\"  id='input_radio_2_3a84684f8b7b97283e0e27c83c513e7b' aria-label='Non' aria-invalid='false' aria-required=false> <span>Non<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_input_text_7' aria-label=\"Superficie\">Superficie<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"text\" name=\"input_text_7\" class=\"ff-el-form-control\" data-name=\"input_text_7\" id=\"ff_11_input_text_7\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">m\u00b2<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_input_text_8' aria-label=\"Adresse\">Adresse<\/label> <\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_8\" class=\"ff-el-form-control\" data-name=\"input_text_8\" id=\"ff_11_input_text_8\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_input_text_9' aria-label=\"Capitaux\">Capitaux<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"text\" name=\"input_text_9\" class=\"ff-el-form-control\" data-name=\"input_text_9\" id=\"ff_11_input_text_9\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">\u20ac<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_description_1' aria-label=\"Descriptif d\u00e9taill\u00e9 * (indiquez nature, protection, mat\u00e9rialit\u00e9 et garanties)\">Descriptif d\u00e9taill\u00e9 * (indiquez nature, protection, mat\u00e9rialit\u00e9 et garanties)<\/label> <\/div><div class='ff-el-input--content'><textarea aria-invalid=\"false\" aria-required=true name=\"description_1\" id=\"ff_11_description_1\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description_1\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_numeric-field_4' aria-label=\"Surface d\u00e9velopp\u00e9e des locaux d&#039;exploitation\">Surface d\u00e9velopp\u00e9e des locaux d'exploitation<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_4\" id=\"ff_11_numeric-field_4\" class=\"ff-el-form-control\" data-name=\"numeric-field_4\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">m\u00b2<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group  ff_list_buttons'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"Le b\u00e2timent fait-il plus de 20000 m\u00b2 ?\">Le b\u00e2timent fait-il plus de 20000 m\u00b2 ?<\/label> <\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=input_radio_3_6eb4eb50c41c2c671a9b31320bf291ac><input type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Oui\"  id='input_radio_3_6eb4eb50c41c2c671a9b31320bf291ac' aria-label='Oui' aria-invalid='false' aria-required=false> <span>Oui<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=input_radio_3_214935a11ebfe5b59f3f3d5c44b401ca><input type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Non\"  id='input_radio_3_214935a11ebfe5b59f3f3d5c44b401ca' aria-label='Non' aria-invalid='false' aria-required=false> <span>Non<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_11_numeric-field_5' aria-label=\"Surface totale du b\u00e2timent\">Surface totale du b\u00e2timent<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_5\" id=\"ff_11_numeric-field_5\" class=\"ff-el-form-control\" data-name=\"numeric-field_5\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=false><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">m\u00b2<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_dropdown_5' aria-label=\"Occupant du local\">Occupant du local<\/label> <\/div><div class='ff-el-input--content'><select name=\"dropdown_5\" id=\"ff_11_dropdown_5\" class=\"ff-el-form-control\" data-name=\"dropdown_5\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=true><option value=\"\"><\/option><option value=\"Total\"  >Total<\/option><option value=\"Partiel\"  >Partiel<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_11_dropdown_6' aria-label=\"Situation du commerce\">Situation du commerce<\/label> <\/div><div class='ff-el-input--content'><select name=\"dropdown_6\" id=\"ff_11_dropdown_6\" class=\"ff-el-form-control\" data-name=\"dropdown_6\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"\"><\/option><option value=\" Rez de chauss\u00e9\"  >Rez de chauss\u00e9<\/option><option value=\" Etage\"  >Etage<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_9891a5f9d6f188d9961e4e9c0fe85777><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"B\u00e2timent faisant objet d&#039;un classement ou d&#039;une inscription en tout ou partie au titre des monuments historiques.\"  id='checkbox_2_9891a5f9d6f188d9961e4e9c0fe85777' aria-label='B\u00e2timent faisant objet d&#039;un classement ou d&#039;une inscription en tout ou partie au titre des monuments historiques.' aria-invalid='false' aria-required=false> <span>B\u00e2timent faisant objet d'un classement ou d'une inscription en tout ou partie au titre des monuments historiques.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_329cf18ed0fd3a14db68f31dfeffde80><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"B\u00e2timent de plus de 28 m\u00e8tres de haut.\"  id='checkbox_2_329cf18ed0fd3a14db68f31dfeffde80' aria-label='B\u00e2timent de plus de 28 m\u00e8tres de haut.' aria-invalid='false' aria-required=false> <span>B\u00e2timent de plus de 28 m\u00e8tres de haut.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for=checkbox_2_bb3044a57e7a2fb6aca15e42ff5e5e5b><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" checked=\"1\" value=\"B\u00e2timent construit et couvert en dur \u00e0 plus de 80%.\"  id='checkbox_2_bb3044a57e7a2fb6aca15e42ff5e5e5b' aria-label='B\u00e2timent construit et couvert en dur \u00e0 plus de 80%.' aria-invalid='false' aria-required=false> <span>B\u00e2timent construit et couvert en dur \u00e0 plus de 80%.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_909639486f4501db0acd563d2ef7807c><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Pr\u00e9sence de bardage et\/ou d&#039;une charpente m\u00e9tallique.\"  id='checkbox_2_909639486f4501db0acd563d2ef7807c' aria-label='Pr\u00e9sence de bardage et\/ou d&#039;une charpente m\u00e9tallique.' aria-invalid='false' aria-required=false> <span>Pr\u00e9sence de bardage et\/ou d'une charpente m\u00e9tallique.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_0cb8a37c5d5781cd5033f6eff3757c66><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Implantation dans une galerie marchande, un centre ou un passage commercial.\"  id='checkbox_2_0cb8a37c5d5781cd5033f6eff3757c66' aria-label='Implantation dans une galerie marchande, un centre ou un passage commercial.' aria-invalid='false' aria-required=false> <span>Implantation dans une galerie marchande, un centre ou un passage commercial.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_ad9d498c99994c963dbf90f21168760c><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Risque isol\u00e9 (situ\u00e9 \u00e0 plus de 50 m de toute habitation).\"  id='checkbox_2_ad9d498c99994c963dbf90f21168760c' aria-label='Risque isol\u00e9 (situ\u00e9 \u00e0 plus de 50 m de toute habitation).' aria-invalid='false' aria-required=false> <span>Risque isol\u00e9 (situ\u00e9 \u00e0 plus de 50 m de toute habitation).<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_4c4a5b8d84a69cbee9e3bdad05a1368d><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Implantation en zone industrielle ou artisanale.\"  id='checkbox_2_4c4a5b8d84a69cbee9e3bdad05a1368d' aria-label='Implantation en zone industrielle ou artisanale.' aria-invalid='false' aria-required=false> <span>Implantation en zone industrielle ou artisanale.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_56c076c5dfe2c4a97a6845e380b262dd><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Pr\u00e9sence de risque aggravant (station service, discoth\u00e8que, dancing, bowling, etc...).\"  id='checkbox_2_56c076c5dfe2c4a97a6845e380b262dd' aria-label='Pr\u00e9sence de risque aggravant (station service, discoth\u00e8que, dancing, bowling, etc...).' aria-invalid='false' aria-required=false> <span>Pr\u00e9sence de risque aggravant (station service, discoth\u00e8que, dancing, bowling, etc...).<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_ce5f2facae9d63ff13c659a959fe556b><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Local vide, inutilis\u00e9, sans activit\u00e9 effective.\"  id='checkbox_2_ce5f2facae9d63ff13c659a959fe556b' aria-label='Local vide, inutilis\u00e9, sans activit\u00e9 effective.' aria-invalid='false' aria-required=false> <span>Local vide, inutilis\u00e9, sans activit\u00e9 effective.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_9968c79dedcc7bb1b201ed1f97fd9bd5><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Local \u00e0 usage d&#039;habitation annexe.\"  id='checkbox_2_9968c79dedcc7bb1b201ed1f97fd9bd5' aria-label='Local \u00e0 usage d&#039;habitation annexe.' aria-invalid='false' aria-required=false> <span>Local \u00e0 usage d'habitation annexe.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_db16ff953a1022c7a421f6c0988a0ac1><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Fermeture des locaux &gt; 30 jours par an.\"  id='checkbox_2_db16ff953a1022c7a421f6c0988a0ac1' aria-label='Fermeture des locaux &gt; 30 jours par an.' aria-invalid='false' aria-required=false> <span>Fermeture des locaux > 30 jours par an.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_870c01546c7cfc278449415a9cfed814><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Pr\u00e9sence d&#039;un garage.\"  id='checkbox_2_870c01546c7cfc278449415a9cfed814' aria-label='Pr\u00e9sence d&#039;un garage.' aria-invalid='false' aria-required=false> <span>Pr\u00e9sence d'un garage.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_fbce7fa899fe0ec068655fc932d8e73c><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Risque situ\u00e9 \u00e0 plus de 1000 m d&#039;altitude et hors agglom\u00e9ration dot\u00e9e d&#039;un centre de secours.\"  id='checkbox_2_fbce7fa899fe0ec068655fc932d8e73c' aria-label='Risque situ\u00e9 \u00e0 plus de 1000 m d&#039;altitude et hors agglom\u00e9ration dot\u00e9e d&#039;un centre de secours.' aria-invalid='false' aria-required=false> <span>Risque situ\u00e9 \u00e0 plus de 1000 m d'altitude et hors agglom\u00e9ration dot\u00e9e d'un centre de secours.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_da27922c621a9f2b072e8e7abe950129><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Risque situ\u00e9 dans une infrastructure destin\u00e9e au transport des voyageurs, telle que gare, a\u00e9roport, station de m\u00e9tro, etc...\"  id='checkbox_2_da27922c621a9f2b072e8e7abe950129' aria-label='Risque situ\u00e9 dans une infrastructure destin\u00e9e au transport des voyageurs, telle que gare, a\u00e9roport, station de m\u00e9tro, etc...' aria-invalid='false' aria-required=false> <span>Risque situ\u00e9 dans une infrastructure destin\u00e9e au transport des voyageurs, telle que gare, a\u00e9roport, station de m\u00e9tro, etc...<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_194d4abc90dbf8c8da65e33eda28d1aa><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Extincteur mobile v\u00e9rifi\u00e9 annuellement par une entreprise qualifi\u00e9e.\"  id='checkbox_2_194d4abc90dbf8c8da65e33eda28d1aa' aria-label='Extincteur mobile v\u00e9rifi\u00e9 annuellement par une entreprise qualifi\u00e9e.' aria-invalid='false' aria-required=false> <span>Extincteur mobile v\u00e9rifi\u00e9 annuellement par une entreprise qualifi\u00e9e.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_2_da610134cf21dbf2858593c97cc7a141><input type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Electricit\u00e9 conforme et v\u00e9rifi\u00e9e.\"  id='checkbox_2_da610134cf21dbf2858593c97cc7a141' aria-label='Electricit\u00e9 conforme et v\u00e9rifi\u00e9e.' aria-invalid='false' aria-required=false> <span>Electricit\u00e9 conforme et v\u00e9rifi\u00e9e.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_numeric-field_6' aria-label=\"Surface concernant l&#039;implantation dans une galerie marchande, un centre ou un passage commercial\">Surface concernant l'implantation dans une galerie marchande, un centre ou un passage commercial<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_6\" id=\"ff_11_numeric-field_6\" class=\"ff-el-form-control\" data-name=\"numeric-field_6\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">m\u00b2<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_numeric-field_23' aria-label=\"Surface concernant local \u00e0 usage d&#039;habitation annexe\">Surface concernant local \u00e0 usage d'habitation annexe<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_23\" id=\"ff_11_numeric-field_23\" class=\"ff-el-form-control\" data-name=\"numeric-field_23\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">m\u00b2<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_numeric-field_22' aria-label=\"Surface du garage\">Surface du garage<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_22\" id=\"ff_11_numeric-field_22\" class=\"ff-el-form-control\" data-name=\"numeric-field_22\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">m\u00b2<\/span><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary'>Pr\u00e9c\u00e9dent<\/button><button  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary'>Suivant<\/button><\/div><\/div><div class=\" fluentform-step\" data-name=\"form_step-11_2\" ><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_4  '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 25%;'><div class='ff-el-group  ff-custom_html' data-name=\"custom_html-11_3\" ><p>Responsabilit\u00e9 Civile<\/p>\n<div id=\"gtx-anchor\" style=\"width: 44.3px;height: 17.6px\">\u00a0<\/div>\n<div class=\"jfk-bubble gtx-bubble\" role=\"alertdialog\" aria-describedby=\"bubble-2\">\n<div id=\"bubble-2\" class=\"jfk-bubble-content-id\">\n<div id=\"gtx-host\" style=\"min-width: 200px;max-width: 400px\">\u00a0<\/div>\n<\/div>\n<div class=\"jfk-bubble-closebtn-id jfk-bubble-closebtn\" role=\"button\" aria-label=\"Close\">\u00a0<\/div>\n<div class=\"jfk-bubble-arrow-id jfk-bubble-arrow jfk-bubble-arrowup\">\n<div class=\"jfk-bubble-arrowimplbefore\">\u00a0<\/div>\n<div class=\"jfk-bubble-arrowimplafter\">\u00a0<\/div>\n<\/div>\n<\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_11_numeric-field_7' aria-label=\"Effectif Total\">Effectif Total<\/label> <\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric-field_7\" id=\"ff_11_numeric-field_7\" class=\"ff-el-form-control\" data-name=\"numeric-field_7\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_11_numeric-field_8' aria-label=\"Dont temps partiels\">Dont temps partiels<\/label> <\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric-field_8\" id=\"ff_11_numeric-field_8\" class=\"ff-el-form-control\" data-name=\"numeric-field_8\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-4' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_11_numeric-field_9' aria-label=\"Dont saisonniers\">Dont saisonniers<\/label> <\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric-field_9\" id=\"ff_11_numeric-field_9\" class=\"ff-el-form-control\" data-name=\"numeric-field_9\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_4  '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 25%;'><div class='ff-el-group  ff_list_buttons'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_20_039c0d0b74ed73825017023582fce59b><input type=\"checkbox\" name=\"checkbox_20[]\" data-name=\"checkbox_20\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"RC Exploitation\"  id='checkbox_20_039c0d0b74ed73825017023582fce59b' aria-label='RC Exploitation' aria-invalid='false' aria-required=false> <span>RC Exploitation<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 25%;'><div class='ff-el-group  ff_list_buttons'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_21_58f368c51e83524e8e1f481a66aefdcd><input type=\"checkbox\" name=\"checkbox_21[]\" data-name=\"checkbox_21\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"RC Professionnelle\"  id='checkbox_21_58f368c51e83524e8e1f481a66aefdcd' aria-label='RC Professionnelle' aria-invalid='false' aria-required=false> <span>RC Professionnelle<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 25%;'><div class='ff-el-group  ff_list_buttons'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_22_6653a77a13c8b40d457addc8a5dfffed><input type=\"checkbox\" name=\"checkbox_22[]\" data-name=\"checkbox_22\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Suppression de la RC locative\"  id='checkbox_22_6653a77a13c8b40d457addc8a5dfffed' aria-label='Suppression de la RC locative' aria-invalid='false' aria-required=false> <span>Suppression de la RC locative<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-4' style='flex-basis: 25%;'><div class='ff-el-group  ff_list_buttons'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_23_c5f44a4e9546c1ccc74f8e9019bc8ed7><input type=\"checkbox\" name=\"checkbox_23[]\" data-name=\"checkbox_23\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"RC sur bien confi\u00e9s par la client\u00e8le sup\u00e9rieurs \u00e0 8000 \u20ac\"  id='checkbox_23_c5f44a4e9546c1ccc74f8e9019bc8ed7' aria-label='RC sur bien confi\u00e9s par la client\u00e8le sup\u00e9rieurs \u00e0 8000 \u20ac' aria-invalid='false' aria-required=false> <span>RC sur bien confi\u00e9s par la client\u00e8le sup\u00e9rieurs \u00e0 8000 \u20ac<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_1  '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_24_cda503619f874d4635ae69c0668d39c6><input type=\"checkbox\" name=\"checkbox_24[]\" data-name=\"checkbox_24\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Perte d&#039;exploitation\"  id='checkbox_24_cda503619f874d4635ae69c0668d39c6' aria-label='Perte d&#039;exploitation' aria-invalid='false' aria-required=false> <span>Perte d'exploitation<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_11_numeric-field_17' aria-label=\"Chiffre d&#039;affaire HT\">Chiffre d'affaire HT<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_17\" id=\"ff_11_numeric-field_17\" class=\"ff-el-form-control\" data-name=\"numeric-field_17\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=false><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">\u20ac<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_11_numeric-field_18' aria-label=\"Marge brute HT\">Marge brute HT<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_18\" id=\"ff_11_numeric-field_18\" class=\"ff-el-form-control\" data-name=\"numeric-field_18\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=false><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">\u20ac<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_11_numeric-field_19' aria-label=\"Masse salariale\">Masse salariale<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_19\" id=\"ff_11_numeric-field_19\" class=\"ff-el-form-control\" data-name=\"numeric-field_19\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=false><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">\u20ac<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions  ff_list_inline'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_25_6239db800e67886007cd05afe538863c><input type=\"checkbox\" name=\"checkbox_25[]\" data-name=\"checkbox_25\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Apr\u00e8s incendie, DDE et risque annexes\"  id='checkbox_25_6239db800e67886007cd05afe538863c' aria-label='Apr\u00e8s incendie, DDE et risque annexes' aria-invalid='false' aria-required=false> <span>Apr\u00e8s incendie, DDE et risque annexes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_25_2c1d2230f0ef7161693e62fa0c5f850d><input type=\"checkbox\" name=\"checkbox_25[]\" data-name=\"checkbox_25\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Apr\u00e8s vol et risque annexes\"  id='checkbox_25_2c1d2230f0ef7161693e62fa0c5f850d' aria-label='Apr\u00e8s vol et risque annexes' aria-invalid='false' aria-required=false> <span>Apr\u00e8s vol et risque annexes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_25_146b61fbf94fb74fdf3c4ed8bb0131d6><input type=\"checkbox\" name=\"checkbox_25[]\" data-name=\"checkbox_25\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Apr\u00e8s bris de machine\"  id='checkbox_25_146b61fbf94fb74fdf3c4ed8bb0131d6' aria-label='Apr\u00e8s bris de machine' aria-invalid='false' aria-required=false> <span>Apr\u00e8s bris de machine<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_25_bb38c6fe225e4f0ac4ca6c6cd7715dfc><input type=\"checkbox\" name=\"checkbox_25[]\" data-name=\"checkbox_25\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Impossibilit\u00e9 d&#039;acc\u00e8s\"  id='checkbox_25_bb38c6fe225e4f0ac4ca6c6cd7715dfc' aria-label='Impossibilit\u00e9 d&#039;acc\u00e8s' aria-invalid='false' aria-required=false> <span>Impossibilit\u00e9 d'acc\u00e8s<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_25_70afedf238e90bac7fc17b44343997b1><input type=\"checkbox\" name=\"checkbox_25[]\" data-name=\"checkbox_25\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Carence des fournisseurs\"  id='checkbox_25_70afedf238e90bac7fc17b44343997b1' aria-label='Carence des fournisseurs' aria-invalid='false' aria-required=false> <span>Carence des fournisseurs<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_dropdown_11' aria-label=\"P\u00e9riode de couverture\">P\u00e9riode de couverture<\/label> <\/div><div class='ff-el-input--content'><select name=\"dropdown_11\" id=\"ff_11_dropdown_11\" class=\"ff-el-form-control\" data-name=\"dropdown_11\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=true><option value=\"\"><\/option><option value=\"12 mois\"  >12 mois<\/option><option value=\"24 mois\"  >24 mois<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_26_9001ee810ac7ad60b697bb9da5a54ca8><input type=\"checkbox\" name=\"checkbox_26[]\" data-name=\"checkbox_26\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Valeur v\u00e9nale fond de commerce\"  id='checkbox_26_9001ee810ac7ad60b697bb9da5a54ca8' aria-label='Valeur v\u00e9nale fond de commerce' aria-invalid='false' aria-required=false> <span>Valeur v\u00e9nale fond de commerce<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_numeric-field_20' aria-label=\"Montant\">Montant<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_20\" id=\"ff_11_numeric-field_20\" class=\"ff-el-form-control\" placeholder=\"750 000,00\" data-name=\"numeric-field_20\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">\u20ac<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_27_4f359e64cbc6e17278625e72ead7ef39><input type=\"checkbox\" name=\"checkbox_27[]\" data-name=\"checkbox_27\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Bris de mat\u00e9riels \u00e9lectriques et\/ou \u00e9lectroniques\"  id='checkbox_27_4f359e64cbc6e17278625e72ead7ef39' aria-label='Bris de mat\u00e9riels \u00e9lectriques et\/ou \u00e9lectroniques' aria-invalid='false' aria-required=false> <span>Bris de mat\u00e9riels \u00e9lectriques et\/ou \u00e9lectroniques<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_numeric-field_21' aria-label=\"Montant\">Montant<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_21\" id=\"ff_11_numeric-field_21\" class=\"ff-el-form-control\" data-name=\"numeric-field_21\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">\u20ac<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions  ff_list_buttons'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_28_3fb7ead11da97d238908033086e4dbbc><input type=\"checkbox\" name=\"checkbox_28[]\" data-name=\"checkbox_28\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Perte de marchandise en atmosph\u00e8re control\u00e9e\"  id='checkbox_28_3fb7ead11da97d238908033086e4dbbc' aria-label='Perte de marchandise en atmosph\u00e8re control\u00e9e' aria-invalid='false' aria-required=false> <span>Perte de marchandise en atmosph\u00e8re control\u00e9e<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions  ff_list_buttons'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"Volume chambre froide &gt; 75 m3 ?\">Volume chambre froide > 75 m3 ?<\/label> <\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=input_radio_4_422feb8b0fe544e694dbb209cfa2c91a><input type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Oui\"  id='input_radio_4_422feb8b0fe544e694dbb209cfa2c91a' aria-label='Oui' aria-invalid='false' aria-required=false> <span>Oui<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=input_radio_4_a54e32cdec3d9fc98c44f015f08a3b80><input type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Non\"  id='input_radio_4_a54e32cdec3d9fc98c44f015f08a3b80' aria-label='Non' aria-invalid='false' aria-required=false> <span>Non<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_29_1bce22ec0fe3d74954ed1b899b95aeae><input type=\"checkbox\" name=\"checkbox_29[]\" data-name=\"checkbox_29\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Dommages \u00e9lectriques\"  id='checkbox_29_1bce22ec0fe3d74954ed1b899b95aeae' aria-label='Dommages \u00e9lectriques' aria-invalid='false' aria-required=false> <span>Dommages \u00e9lectriques<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_dropdown_12' aria-label=\"Montant\">Montant<\/label> <\/div><div class='ff-el-input--content'><select name=\"dropdown_12\" id=\"ff_11_dropdown_12\" class=\"ff-el-form-control\" data-name=\"dropdown_12\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=true><option value=\"\"><\/option><option value=\"5 000 \u20ac\"  >5 000 \u20ac<\/option><option value=\"10 000 \u20ac\"  >10 000 \u20ac<\/option><option value=\"15 000 \u20ac\"  >15 000 \u20ac<\/option><option value=\"20 000 \u20ac\"  >20 000 \u20ac<\/option><option value=\"30 000 \u20ac\"  >30 000 \u20ac<\/option><option value=\"45 000 \u20ac\"  >45 000 \u20ac<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_30_dd38e1c3023ff55d378fc1f338bcf943><input type=\"checkbox\" name=\"checkbox_30[]\" data-name=\"checkbox_30\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Valeur \u00e0 neuf sur le contenu\"  id='checkbox_30_dd38e1c3023ff55d378fc1f338bcf943' aria-label='Valeur \u00e0 neuf sur le contenu' aria-invalid='false' aria-required=false> <span>Valeur \u00e0 neuf sur le contenu<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_31_cbf865e38b1c117b69d75a56917e6795><input type=\"checkbox\" name=\"checkbox_31[]\" data-name=\"checkbox_31\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Protection juridique Etendue\"  id='checkbox_31_cbf865e38b1c117b69d75a56917e6795' aria-label='Protection juridique Etendue' aria-invalid='false' aria-required=false> <span>Protection juridique Etendue<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_32_2d9b29c1048ba974f1f6d3400bff212c><input type=\"checkbox\" name=\"checkbox_32[]\" data-name=\"checkbox_32\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Autres garanties\"  id='checkbox_32_2d9b29c1048ba974f1f6d3400bff212c' aria-label='Autres garanties' aria-invalid='false' aria-required=false> <span>Autres garanties<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class='ff-el-input--content'><textarea aria-invalid=\"false\" aria-required=false name=\"description_2\" id=\"ff_11_description_2\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description_2\" ><\/textarea><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_5\"  class='ff-t-container ff-column-container ff_columns_total_1  '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_8_a08459e614be0463514a9dcf88254ed4><input type=\"checkbox\" name=\"checkbox_8[]\" data-name=\"checkbox_8\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Incendie\"  id='checkbox_8_a08459e614be0463514a9dcf88254ed4' aria-label='Incendie' aria-invalid='false' aria-required=false> <span>Incendie<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_numeric-field_10' aria-label=\"Montant\">Montant<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_10\" id=\"ff_11_numeric-field_10\" class=\"ff-el-form-control\" data-name=\"numeric-field_10\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">\u20ac<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"Dont\">Dont<\/label> <\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_9_f8f1c61a0aee34a712a432016c43b912><input type=\"checkbox\" name=\"checkbox_9[]\" data-name=\"checkbox_9\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Produits dangereux et ou inflammables (&gt;300 l)\"  id='checkbox_9_f8f1c61a0aee34a712a432016c43b912' aria-label='Produits dangereux et ou inflammables (&gt;300 l)' aria-invalid='false' aria-required=false> <span>Produits dangereux et ou inflammables (>300 l)<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_10_f8004b3e3153d05fa58681e162cdc843><input type=\"checkbox\" name=\"checkbox_10[]\" data-name=\"checkbox_10\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"D\u00e9gats des eaux\"  id='checkbox_10_f8004b3e3153d05fa58681e162cdc843' aria-label='D\u00e9gats des eaux' aria-invalid='false' aria-required=false> <span>D\u00e9gats des eaux<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_numeric-field_11' aria-label=\"Montant\">Montant<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_11\" id=\"ff_11_numeric-field_11\" class=\"ff-el-form-control\" data-name=\"numeric-field_11\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">\u20ac<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_11_c760c4936239e821708dcae09c3a5e57><input type=\"checkbox\" name=\"checkbox_11[]\" data-name=\"checkbox_11\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Bris de glaces\"  id='checkbox_11_c760c4936239e821708dcae09c3a5e57' aria-label='Bris de glaces' aria-invalid='false' aria-required=false> <span>Bris de glaces<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_numeric-field_12' aria-label=\"Montant\">Montant<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_12\" id=\"ff_11_numeric-field_12\" class=\"ff-el-form-control\" data-name=\"numeric-field_12\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">\u20ac<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"Dont\">Dont<\/label> <\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_12_4977fb31642ed477e3d9e1262a5d7e0e><input type=\"checkbox\" name=\"checkbox_12[]\" data-name=\"checkbox_12\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Pr\u00e9sence d&#039;une enseigne\"  id='checkbox_12_4977fb31642ed477e3d9e1262a5d7e0e' aria-label='Pr\u00e9sence d&#039;une enseigne' aria-invalid='false' aria-required=false> <span>Pr\u00e9sence d'une enseigne<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_12_555db18de79960525210931a859db17e><input type=\"checkbox\" name=\"checkbox_12[]\" data-name=\"checkbox_12\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Am\u00e9nagements int\u00e9rieurs\"  id='checkbox_12_555db18de79960525210931a859db17e' aria-label='Am\u00e9nagements int\u00e9rieurs' aria-invalid='false' aria-required=false> <span>Am\u00e9nagements int\u00e9rieurs<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_12_e43050bafd9df8cb0f5184e94cc15a21><input type=\"checkbox\" name=\"checkbox_12[]\" data-name=\"checkbox_12\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Garantie des v\u00e9randas\"  id='checkbox_12_e43050bafd9df8cb0f5184e94cc15a21' aria-label='Garantie des v\u00e9randas' aria-invalid='false' aria-required=false> <span>Garantie des v\u00e9randas<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_dropdown_7' aria-label=\"Capital v\u00e9randa\">Capital v\u00e9randa<\/label> <\/div><div class='ff-el-input--content'><select name=\"dropdown_7\" id=\"ff_11_dropdown_7\" class=\"ff-el-form-control\" data-name=\"dropdown_7\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=true><option value=\"\"><\/option><option value=\"5 000 \u20ac\"  >5 000 \u20ac<\/option><option value=\"10 000 \u20ac\"  >10 000 \u20ac<\/option><option value=\"15 000 \u20ac\"  >15 000 \u20ac<\/option><\/select><\/div><\/div><div class='ff-el-group  ff_list_inline'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_13_b5c4709e3c4f3e98063977e8ed7eff52><input type=\"checkbox\" name=\"checkbox_13[]\" data-name=\"checkbox_13\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Vol \/ Vandalisme\"  id='checkbox_13_b5c4709e3c4f3e98063977e8ed7eff52' aria-label='Vol \/ Vandalisme' aria-invalid='false' aria-required=false> <span>Vol \/ Vandalisme<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_numeric-field_16' aria-label=\"Montant\">Montant<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_16\" id=\"ff_11_numeric-field_16\" class=\"ff-el-form-control\" data-name=\"numeric-field_16\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">\u20ac<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"Dont\">Dont<\/label> <\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_14_b5c6246e115a86c83b51cb42fabee755><input type=\"checkbox\" name=\"checkbox_14[]\" data-name=\"checkbox_14\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Vol en devanture sans p\u00e9n\u00e9tration\"  id='checkbox_14_b5c6246e115a86c83b51cb42fabee755' aria-label='Vol en devanture sans p\u00e9n\u00e9tration' aria-invalid='false' aria-required=false> <span>Vol en devanture sans p\u00e9n\u00e9tration<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_14_83dcf9b78f0fce801229caf530eb7598><input type=\"checkbox\" name=\"checkbox_14[]\" data-name=\"checkbox_14\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Fonds et valeurs\"  id='checkbox_14_83dcf9b78f0fce801229caf530eb7598' aria-label='Fonds et valeurs' aria-invalid='false' aria-required=false> <span>Fonds et valeurs<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_14_85b4999909e909ef012f86fa47ca74e8><input type=\"checkbox\" name=\"checkbox_14[]\" data-name=\"checkbox_14\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Objets pr\u00e9cieux et de valeur\"  id='checkbox_14_85b4999909e909ef012f86fa47ca74e8' aria-label='Objets pr\u00e9cieux et de valeur' aria-invalid='false' aria-required=false> <span>Objets pr\u00e9cieux et de valeur<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_14_d3d391f7655a6ff8475d8ba8461ec0e8><input type=\"checkbox\" name=\"checkbox_14[]\" data-name=\"checkbox_14\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Locaux avec gardiennage ou habitation sur place\"  id='checkbox_14_d3d391f7655a6ff8475d8ba8461ec0e8' aria-label='Locaux avec gardiennage ou habitation sur place' aria-invalid='false' aria-required=false> <span>Locaux avec gardiennage ou habitation sur place<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_dropdown_8' aria-label=\"Fonds et valeurs montant\">Fonds et valeurs montant<\/label> <\/div><div class='ff-el-input--content'><select name=\"dropdown_8\" id=\"ff_11_dropdown_8\" class=\"ff-el-form-control\" data-name=\"dropdown_8\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=true><option value=\"\"><\/option><option value=\"2 500 \u20ac\"  >2 500 \u20ac<\/option><option value=\"5 000 \u20ac\"  >5 000 \u20ac<\/option><option value=\"7 500 \u20ac\"  >7 500 \u20ac<\/option><option value=\"10 000 \u20ac\"  >10 000 \u20ac<\/option><\/select><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_numeric-field_14' aria-label=\"Objets pr\u00e9cieux et de valeur montant\">Objets pr\u00e9cieux et de valeur montant<\/label> <\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric-field_14\" id=\"ff_11_numeric-field_14\" class=\"ff-el-form-control\" data-name=\"numeric-field_14\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">\u20ac<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group  ff_list_inline'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=checkbox_15_276feb128941aa49688a200e83955e79><input type=\"checkbox\" name=\"checkbox_15[]\" data-name=\"checkbox_15\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Garantie Biens Professionnels Transport\u00e9s\"  id='checkbox_15_276feb128941aa49688a200e83955e79' aria-label='Garantie Biens Professionnels Transport\u00e9s' aria-invalid='false' aria-required=false> <span>Garantie Biens Professionnels Transport\u00e9s<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_numeric-field_15' aria-label=\"Nombre de v\u00e9hicules en Biens Professionnels Transport\u00e9s\">Nombre de v\u00e9hicules en Biens Professionnels Transport\u00e9s<\/label> <\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric-field_15\" id=\"ff_11_numeric-field_15\" class=\"ff-el-form-control\" data-name=\"numeric-field_15\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_11_dropdown_9' aria-label=\"Niveaux de 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