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Home
Business Insurance Policies
Business Owners Policy (BOP)
Commercial Automobile Insurance
Commercial Property
General Liability Insurance
Professional & Management Liability
Contractors Professional Liability
Technology & Cyber Liability Insurance
Directors & Officers Liability (D&O)
Employment Practices Liability Insurance
Liquor Liability
Malpractice Insurance
Professional Liability Insurance (PL) / Errors & Omissions (E&O)
Surety & Bonding
Umbrella & Excess Liability
Workers’ Compensation
Industries Served
Industries We Insure
Specialized Insurance Programs
About Us
Why Us?
Media
Blog
Join Our Team
Contact Us
Menu
Home
Business Insurance Policies
Business Owners Policy (BOP)
Commercial Automobile Insurance
Commercial Property
General Liability Insurance
Professional & Management Liability
Contractors Professional Liability
Technology & Cyber Liability Insurance
Directors & Officers Liability (D&O)
Employment Practices Liability Insurance
Liquor Liability
Malpractice Insurance
Professional Liability Insurance (PL) / Errors & Omissions (E&O)
Surety & Bonding
Umbrella & Excess Liability
Workers’ Compensation
Industries Served
Industries We Insure
Specialized Insurance Programs
About Us
Why Us?
Media
Blog
Join Our Team
Contact Us
Get a Quote
Quote Request
Business Name
*
Business Website
Contact Name
*
First
Last
Contact Email
*
Contact Phone
*
Where is your business headquartered?
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
How long have you been in business?
*
New Business
Less than 1 year
1 to 3 years
More than 3 Years
Briefly describe your business operations.
Interested in:
Business Owner's Policy
Commercial Auto
Commercial Property
General Liability
Professional & Management Liability
Risk Assessment
Worker's Compensation
Other
What type of coverage are you interested in?
Commercial Property Information:
Does your company own or rent property used for business purposes?
Yes
No
Own
Rent
What is the physical address of the primary business property?
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Year Built
Square footage of the building
Number of stories
What is the construction type?
Is the building sprinklered?
Yes
No
Is there a fire alarm system?
Yes
No
Has the building been updated?
Yes
No
Roof
Yes
No
Plumbing
Yes
No
Electrical
Yes
No
HVAC
Yes
No
Cost to replace building contents?
Furniture, desks, fixtures, computers, etc.
Cost to replace building?
What is the current insured value of the building?
What is the current deductible?
Does your company use 25% or more of this building?
Yes
No
Are there other tenants in your building?
Yes
No
Does this entity have more than one location?
Yes
No
If more than one property, are they all common ownership?
Yes
No
Physical addresses of additional business properties.
Street Address
Street Address 2
City
State
ZIP Code
General Liability Information
What are the business annual gross receipts?
What are the business annual subcontractor costs? (If any)
Commercial Automobile Information
Does your company have vehicles/trucks?
Yes
No
How many?
1-5
6-9
10-15
15-20
20+
Number of Drivers
1-5
6-9
10-15
15-20
20+
Do you run MVR's on all drivers at least 1x per year?
Yes
No
Worker's Conpensation Information
What is your estimated total annual payroll expense including Subcontractors (if any)?
How many employees do you have?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
20-50
50+
Do you use subcontractors?
Yes
No
What % of your annual payroll do subcontractors or 1099's make up?
Please enter a number less than or equal to
100
.
Worker's Compensation — Payroll
Class Code
Approx. Annual Payroll
What is your current deductible for your Workers Compensation policy?
Does your company have a drug free workplace certification?
Yes
No
Umbrella / Excess Liability Information
What limits does your business require?
Terms of Service
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*
Terms of Service
Revision Date: May 6th 2020
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