Business Owners Quote Request


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Please send this information with attention to:

i. Contact Information: (* = required fields)

*Business Name:
*Office Phone:
*Contact Name:
Cell Phone:
*Business Address:
Fax #:
*City:
   
*State:
 *Zip:    

*Email Address:
*Confirmation of Email Address:

When is the best time to reach you? What is the best way to reach you?

ii. Prior Insurance Information:

Are you currently insured?
  If yes, then:
  Who is your current Insurance Carrier?
  Approximately how much are you paying for your Commercial Insurance Coverage?

iii. Business Information - Tell us about your business:

What type of entity is your business?

How many officers/owners are there in your business?

Please give a detailed description of your business operations?
The more information you give will help us best classify your business. (required field)

iv. Building Information:

Please enter the office/building information:
 
Address:
Office Phone:
 
Address:
Office Fax:
 
City:
    
 
State:
 Zip:    

Check all that apply: Other Information:
  Automatic Fire Alarm
Type of Building:
  Sprinkler System
Year Built:
  Fire Extinguishers
Total # of Square Feet:
  Security System
Stories:
  Security Contract
Building Material:

Do you wish to insure this building? Yes No
  If yes, then:
  How much do you think this building should be insured for?
  What deductible would you like on this building?

v. Contents Information:

What's the value of the business "stuff" in this building? This includes things like couches, desks, chairs, file cabinets, etc.
This figure should not include computers or computer systems.

What's the value of the computers or computer systems?

vi. Liability Information:

What Liability limits do you need?

vii. Gross Receipts Information:

How much estimated, annual sales [before taxes & payroll] to you plan to bring in during the next year for each type of work you do?
  For example:
    For Plumbing operations, I plan on making $200,000.
    For Electrical operations, I plan on making $150,000.
    For Interior Trim operations, I plan on making $25,000.
 
Type of Work
Estimated, Annual Sales
 
 
 
 
 
 

viii. Payroll Information:

Please give a one or two word job description for each type of employee with their estimated, annual payroll.
  For example:
    For 2 Clerical Employees, I pay $60,000 in total.
    For 5 Sales Associates, I pay $80,000 in total.
    For 6 Installation Technicians, I pay $120,000 in total.
   
# of Employees
Type of Employees
Estimated, Annual Payroll
   
   
   
   
   
   

ix. Sub-Contracted Work Information:

Do you use sub-contractors? Yes No
  If yes, then:
  What percent of the work is sub-contracted (1-100)?
  Are all those sub-contractors insured? Yes No -- If no, what percent of those are uninsured (1-100)?

x. Other Coverages:

Are you interested in any of the following:

Workers' Compensation
Business Automobile
Other

 
 
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