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Commercial Insurance Quote
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Account Details
Risk State
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Select Risk State
AZ
CA
IA
KS
LA
MD
MS
OH
SC
SD
TX
WA
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Business Operations
Please describe your business operations
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Tell us what your business does, the type of work performed, and the services you provide.
Business Name
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Years in Business
Years of Experience
Gross Sales
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Total Payroll
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# of Employees
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Insured & Business Contact
First Name
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Last Name
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Business Phone
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Business Email
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Website or Facebook URL
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Physical Address (No PO Boxes)
Street Address
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Address Line 2
City
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ZIP Code
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Coverage & Timing
Effective Date
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Coverage Types Needed
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Commercial Property & Liability
Workers Compensation
Commercial Auto
Inland Marine
Bond
Cyber
E&O
D&O
EPLI
Other
Additional Comments
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Preferred Contact Method
Contact Method
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Call
Text
Email
Best Time
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Morning
Afternoon
Evening
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Entity & General Info
Entity Type
Select Entity Type
Limited Liability Company
S Corporation
C Corporation
Partnership
Sole Proprietorship
Non-Profit
Other
Federal Tax ID
Has Active Property Liability Policy
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Yes
No
Prior Coverage End Date
Officers / Members / Partners
Current Renewal Date
Owns Other Businesses
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Yes
No
Other Business Types
Has High Public Profile
Select
Yes
No
Is Social Media Influencer
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Yes
No
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Liability, Payroll & Auto
Liability Occurrence Limit
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$300,000
$500,000
$1,000,000
Medical Expense Limit
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$5,000
$10,000
Property Damage Deductible
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$250
$500
$1,000
$2,500
Property Damage Deductible Type
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Per Claim
Per Occurrence
Bodily Injury Deductible
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$500
$1,000
$1,500
$2,500
Full Time Employees
Part Time Employees
Hired / Non-Owned Auto Requested
Select
Yes
No
Delivery Percentage
Has Driver Monitoring Program
Select
Yes
No
Drivers Have 3+ Years Experience
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Yes
No
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Optional & Professional Coverages
Damage to Premises Limit
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$50,000
$100,000
$250,000
$500,000
$1,000,000
$2,000,000
Data Compromise Requested
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Yes
No
Data Compromise Limit
Select
$50,000
$100,000
$250,000
Had Data Breach Last 12 Months
Select
Yes
No
Electronic Data Limit
Employee Dishonesty Limit
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$10,000
$25,000
$50,000
$100,000
Forgery / Alteration Limit
Select
$10,000
$25,000
$50,000
$100,000
Computer Interruption Limit
Off Premises Personal Property Limit
Select
$25,000
$50,000
$100,000
$250,000
$500,000
$1,000,000
Terrorism Coverage Requested
Select
Yes
No
Misc Professional Liability Requested
Select
Yes
No
Misc Professional Liability Limit
Select
$100,000
$250,000
$500,000
$1,000,000
Misc Professional Retro Date
Misc Professional Claims Last 5 Years
Select
Yes
No
Cyber Suite Requested
Select
Yes
No
Cyber Suite Limit
Select
$50,000
$100,000
$250,000
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HR, Legal & Employment Practices Liability Insurance
Background Checks Performed
Select
Yes
No
Document Retention Policy
Select
Yes
No
Cyber Security Measures In Place
Select
Yes
No
Records Stored Securely
Select
Yes
No
Blanket Additional Insured Requested
Select
Yes
No
Waiver of Subrogation Requested
Select
Yes
No
Employee Benefits Liability Requested
Select
Yes
No
Employee Benefits Limit
Employee Benefits Retro Date
EPLI Requested
Select
Yes
No
EPLI Limit
EPLI Deductible
EPLI Retro Date
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Loss History
Policy Cancelled Last 3 Years
Select
Yes
No
Losses Last 4 Years
Select
Yes
No
Loss History Details
Past Fraud Convictions
Select
Yes
No
Past Financial Issues
Select
Yes
No
Past Abuse Claims
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Yes
No
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Building Information
Building Near Fire Station
Select
Yes
No
Building Near Fire Hydrant
Select
Yes
No
Years in Business at Location
Occupancy
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Non-owner Occupied Building/lessors risk (NO)
Owner Occupied Building - more than 10% (OM)
Owner Occupied Building - 10% or less (OL)
Tenant (TE)
Building Type
Select
Located in enclosed mall
Located in strip mall
Standalone building
Sole Occupant
Select
Yes
No
Building Industry
Select
Apartments & Condo Association
Auto repair/service & car washes
Contractors and landscapers
Grocery, Convenience Stores, & Gas Stations
Offices
Restaurants & Hotels
Retail Stores & Service Providers
Wholesalers
Restaurant Occupied Part
Select
Yes
No
Construction Type
Select
Fire Resistive
Frame
Joisted masonry
Masonry Non-Combustible
Modified Fire Resistive
Non-Combustible
Year Built
Total Building SF
Occupied SF
Automatic Sprinkler System
Select
Yes
No
Burglar Alarm
Select
Central Station
Local
None
Fire Alarm
Select
Central Station
Local
None
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Class Specific Questions
Building Coverage Needed
Select
Yes
No
Building Occupancy Percent
Structural Renovations
Select
Yes
No
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Building & Personal Property Coverages
Building Coverage Limit
Valuation Type
Select
Replacement Cost
Actual Cash Value
Functional Building Valuation
Inflation Guard Percent
Select
2%
4%
6%
8%
10%
12%
14%
16%
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