Commercial / Business Insurance Quote  *Required fields

* Name:  

* Address City Zip:  

* Contact phone    *Business Name (dba)  

* Business Address

* Business Phone:  * Email Address:

Underwriting Information

Nature of Business   

Individual    Partnership    Corporation

Owners   Payroll of Owners   Employees Payroll of Employees     

Total Annual Gross  Business License Number  License Type

Years of Experience Years Operated Under Current Name 

Used any other business names during the past 5 years?  Yes   No  

Open 24 Hours Yes   No       Deep Frying Yes  No

Manufacturing Yes   No   Propane Tank Filling Yes  No 

Please describe the nature of your business and ANY unusual exposures.   

Building & Property Information

Total Sq Ft of Business Bldg   Total Sq Ft of your Business Only 

Square Footage of Customer Area   Stories 1   2  Ground Floor Square Footage   

Construction Type (Brick Stone Frame Masonry Frame-Stucco Masonry Veneer)                             

Roof Type   (Asphalt/Fiberglass shingles, Concrete, steel, Tile, Wood shake)  

Roof Updated Yes   No  Year Roof Updated 

Do you have a storage area more than 1500 Sq. Ft.? Yes  No

Smoke Detectors Yes No    Fire Extinguishers Yes No 

Deadbolts Yes  No      Are there circuit breakers? Yes  No

Is the electrical updated? Yes No  Full Update    Partial Update   Year Updated 

Is the HV/AC thermostatically controlled? Yes No  Is the HV/AC central? Yes  No

Is the plumbing updated? Yes  No  Full Update    Partial Update   Year Updated 

Does the building have interior automatic fire sprinklers? Yes No

Is there a theft alarm? Yes  No  Is there a fire alarm? Yes    No

Are there any restaurants in your building?   Yes    No  

Are there any restaurants in the building next to your business? Yes    No  

Claims Information 

 Where there any losses or claims in the last 5 years? Yes  No

If yes, what is the date, amount paid and description of each loss or claim?

Coverage Information  

What is the name of the current insurance company?    

How much are you paying now for Current Coverage?  

Liability limit requested? Select $100,000   $300,000   $500,000   $1,000,000

Building limit requested?   

Building deductible requested? Select  $500   $1,000  $2,500

Business personal property (contents) limit requested?

Contents deductible requested? Select $500    $1,000   $2,500

Loss of income amount requested?

 Are there any questions, comments, additional coverage, or Service You Require:

  Please contact me by: Email Telephone 

Call us at (916) 984-9320