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Business Insurance Quote
Company Information
Company Name
DBA
Legal Owner's Name
Date of Birth
Social Security Number
Company Address
Phone Number
Email Address
Business
Type of Business
Retail
Wholesale
Office
Automotive
Restaurant
Entertainment
Kiosk/Vendors
Contractor
Storage
Others
Type of Ownership
Sole Proprietor
Partnership
Corporation
Limited Liab. Corp.
Business Start Up Date
Number of Years of Experience
What's your estimated annual gross income?
Any loss within the last 5 years:
Yes
No
Please provide explanation of loss
Do you own the building?
Yes
No
Do you need coverage for the building?
Yes
No
If yes, what's the fair market value of the building?
What year is the building built?
What is the construction type?
What type of roof?
When is Improvements Done
Plumbing
Electrical Wiring
Roof
Heating
What's the Square footage of the space you occupied?
Any type of Security?
Alarm
Surveillance Camera
Window Bars
Others
Any Fire Sprinkler?
Yes
No
Commercial General Liability
General Aggregate Limit (Other Than Products/Completed Operational)
$1,000,000
$2,000,000
$5,000,000
$10,000,000
Products Completed Operations Aggregate Limit
$500,000
$1,000,000
$2,000,000
$5,000,000
$10,000,000
Personal and Advertising Injury Limit
$500,000
$1,000,000
$2,000,000
$5,000,000
Each Occurrence Limit
$500,000
$1,000,000
$2,000,000
$5,000,000
$10,000,000
Damage To Premises Rented To You Limit
$100,000
$200,000
$300,000
$500,000
$1,000,000
Medical Expense Limit
$1,000
$2,000
$5,000
$10,000
Commercial Property
Subject of Insurance (list personal properties and amount)
1.
2.
3.
4.
5.
Total
Deductible
Bodily Injury
Property Damage
Additional Insured
Name
Address
Phone
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