Business Owners Quote

Business Owners Insurance Quote

Name * First Last
Full Legal Business Name
Mailing Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Physical Address Location (if different from Mailing Address)
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Contact Name
Contact Phone # * - (###) - ### ####
Fax #
Email
Type of Organization Corporation Partnership Proprietorship Individual **Other
**If other, please specify:
Years in Business
Describe Your Business Operations
Name of Current Insurance Company (not Agency or Broker name)
How Long Have You Been Insured With Current Company
Reason for leaving:
Tell Us About Your Property:
Age of the Building / Year Built
Type of Building Construction:
**If other, please specify type of building construction:
# of Stories in Building
Square Feet That You Occupy
Other Occupanices and Square Feet Occupied By Each Occupancy
If Building Is Over 25 Years Old:
Year Electrical Was Updated:
Is Electrical Service on Circuit Breakers? Yes No
Year Plumbing Was Updated:
Type of Plumbing: Copper Galvanized **Other
**If other, please specify type of plumbing:
Year of Roofing Update
Type of Roofing Material:
Type of Heating System in the Building:
Burglar Alarm in Building? Yes No
Central Station Alarm or Local Alarm? Central Station Alarm Local Alarm
Name of Alarm Company
Is The Building Sprinklered? Yes No
% of Building Sprinklered Fully Sprinklered - 100% Partial
Does The Building Have Smoke Detectors? Yes No
Tell Us About Your Business
Years in Business
Projected Gross Annual Payroll $
Projected Gross Annual Receipts $
Describe your Business, Services, or Products:
Coverages / Limits
Building Limit $
Business Personal Property Limit $ (Contents, Equipment, Inventory, Supplies, etc.)
Deductible: $100 Deductible $250 Deductible $500 Deductible $1,000 Deductible $2,000 Deductible $5,000 Deductible **Other
**Other, please specifiy other deductible amont:
Loss of Income $
Money and Securities $
Glass or Sign $
General Liability Limit: $500,000 / $1,000,000 $1,000,000 / $2,000,000 $2,000,000 / $4,000,000 **Other
**If other, please specify General Liability limit:
Hired & Non-owned Auto Liability needed? * Yes No
NON-OWNERSHIP AUTOMOBILE LIABILITY: This coverage provides liability insurance for the employer when an employee or a volunteer uses their vehicle on the employers business and causes damages. Anyone with employees who run errands must have this coverage. Even those who do not deliver should purchase the coverage for the occasional delivery that may be done for them by an employee. HIRED CARS rented or hired by the business for the operator can be insured to cover the liability exposure for their operation.
Is Liquor Liability needed? Yes No
Comments / Additional Information:

Business Owners Quote

Business Owners Quote

Tell Us About Your Property:

If Building Is Over 25 Years Old:

Tell Us About Your Business

Coverages / Limits