It's essential that all the information you give us is correct. If it isn't, your insurance policy may not be valid or your insurer may refuse to pay any claim you make. Tell us about your business What type of business?* Legal Name* DBA (optional) Physical Address* City* State* Zip* Is your mailing address the same?* YesNo Mailing Address City State Zip Business Website Year Business Established Years of Experience* Legal Entity* -Choose Entity-Corporation (Inc.)Limited Liability Company (LLC)PartnershipLimited PartnershipAssociationTrustEstateOther Next Step Contact Information Title* -Select Title-Mr.Ms.Mrs.Dr. First Name* Last Name* Email Address* Phone Number* Alternate Phone Number (optional) By providing your details you confirm you agree with our Terms and Conditions and Privacy Policy* I agree Tell us about your Employees Total Number of Employees* Total Payroll* Do you use temporary or casual workers?* YesNo Do you use sub-contractors?* YesNo What percentage annually? Previous StepNext Step General LiabilityA standard insurance policy issued to business organizations to protect them against liability claims for bodily injury (BI) and property damage (PD) arising out of premises, operations, products, and completed operations; and advertising and personal injury (PI) liability. The CGL policy was introduced in 1986 and replaced the "comprehensive" general liability policy. Do you need General Liability coverage?* YesNo Select Desired Liability Limits -Select Option-1,000,0002,000,0005,000,00010,000,000 What are your estimated annual sales? Does your business do any installation? YesNo Installation Annual Sales Percent of Installation Does your business serve alcohol? YesNo Liquor Liability -Select Option-$1,000,000$2,000,000 Liquor Sales Liquor License Number Do you offer Employee Benefits? YesNo Employee Benefits Liability Limit -Select Option-$1,000,000$2,000,000 Retroactive Date —Other Options— Cyber Liability YesNo Cyber Limit -Select Option-$1,000,000$2,000,000 Sales From Online Only Employment Practices YesNo Employment Limit -Select Option-$1,000,000$2,000,000 Professional Liability YesNo Professional Liability Limit -Select Option-$1,000,000$2,000,000 Do you currently have General Liability insurance? YesNo Carrier Name Premium Effective Date Any claims in the last 4 years? YesNo Previous StepNext Step Commercial PropertyFirst-party insurance that indemnifies the owner or user of property for its loss, or the loss of its income-producing ability, when the loss or damage is caused by a covered peril, such as fire or explosion. In this sense, property insurance encompasses inland marine, boiler and machinery (BM), and crime insurance, as well as what was once known as fire insurance, now simply called property insurance: insurance on buildings and their contents. Do you need Commercial Property coverage?* YesNo Number of Properties -Select Option-123 —Property 1— Use this address? YesNo Address City State Zip Address City State Zip Do you own your building? YesNo Building Limit Tenant Improvements & Betterments Limit Business Personal Property Limit Is stock included in your personal property? YesNo Stock Limit Do you hold personal property of others? YesNo Personal Property of Others Limit Business Income Limit Property Deductible -Select Option-$500$1,000$2,500$5000$10,000 —Location Information— Construction type -Frame-Joisted MasonrySteelConcrete Tilt upMasonrySuperior non-combustible Square Feet Occupied Total Building Square Feet Year Built Number of Stories -Select Option-012345678910111213141516171819202122232425262728293031323334353637383940 —Updates— Wiring -Select Option-200020012002200320042005200620072008200920102011201220132014201520162017 Electrical -Select Option-200020012002200320042005200620072008200920102011201220132014201520162017 Plumbing -Select Option-200020012002200320042005200620072008200920102011201220132014201520162017 Roof -Select Option-200020012002200320042005200620072008200920102011201220132014201520162017 Any Other location? YesNo Address City State Zip Do you currently have Property insurance? YesNo Carrier Name Premium Effective Date Any claims in the last 4 years? YesNo —Property 2— Address City State Zip Do you own your building? YesNo Building Limit Tenant Improvements & Betterments Limit Business Personal Property Limit Is stock included in your personal property? YesNo Stock Limit Do you hold personal property of others? YesNo Personal Property of Others Limit Business Income Limit Property Deductible -Select Option-$500$1,000$2,500$5000$10,000 —Location Information— Construction type -Frame-Joisted MasonrySteelConcrete Tilt upMasonrySuperior non-combustible Square Feet Occupied Total Building Square Feet Year Built Number of Stories -Select Option-012345678910111213141516171819202122232425262728293031323334353637383940 —Updates— Wiring -Select Option-200020012002200320042005200620072008200920102011201220132014201520162017 Electrical -Select Option-200020012002200320042005200620072008200920102011201220132014201520162017 Plumbing -Select Option-200020012002200320042005200620072008200920102011201220132014201520162017 Roof -Select Option-200020012002200320042005200620072008200920102011201220132014201520162017 Any other location? YesNo Address City State Zip Do you currently have Property insurance? YesNo Carrier Name Premium Effective Date Any claims in the last 4 years? YesNo —More than 3 Properties— Please let us know if you have more properties to report. Previous StepNext Step Business AutoA commercial auto policy that includes auto liability and auto physical damage coverages; other coverages are available by endorsement. Except for auto-related businesses and motor carrier or trucking firms, the business auto policy (BAP) addresses the needs of most commercial entities as respects auto insurance. Do you need Business Auto coverage?* YesNo Select Liability -Select Option-$1,000,000$2,000,000$3,000,000$4,000,000$5,000,000 Select Deductible -Select Option-$500$1,000$2,500 Number of Vehicles -Select Option-12345 Vehicle 1 -Select Use-CommercialRetail DeliveryTo and From Job Sites Vehicle 2 -Select Use-CommercialRetail DeliveryTo and From Job Sites Vehicle 3 -Select Use-CommercialRetail DeliveryTo and From Job Sites Vehicle 4 -Select Use-CommercialRetail DeliveryTo and From Job Sites Vehicle 5 -Select Use-CommercialRetail DeliveryTo and From Job Sites Hired and Non-Owned YesNo Rental Reimbursement YesNo Towing and Labor YesNo Any filings? YesNo Do you currently have Business Auto insurance? YesNo Carrier Name Premium Effective Date Any losses or claims in the last 4 years? YesNo Previous StepNext Step Workers CompensationAn insurance policy that provides coverage for an employer's two key exposures arising out of injuries sustained by employees. Part One of the policy covers the employer's statutory liabilities under workers compensation laws, and Part Two of the policy covers liability arising out of employees' work-related injuries that do not fall under the workers compensation statute. In most states, the standard workers compensation and employers liability policy published by the National Council on Compensation Insurance (NCCI) is the required policy form. Do you need Workers Compensation coverage?* YesNo FEIN # Exclude Owners YesNo Title Name Ownership Percentage -Select Option-5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100% Prior Year Payroll Number of Classes -Select Option-12345 Class 1 Class 2 Class 3 Class 4 Class 5 Do you currently have Workers Compensation insurance? YesNo Carrier Name Premium Effective Date Any losses or claims in the last 4 years? YesNo Previous StepNext Step Umbrella LiabilityA policy designed to provide protection against catastrophic losses. It generally is written over various primary liability policies, such as the business auto policy (BAP), commercial general liability (CGL) policy, watercraft and aircraft liability policies, and employers liability coverage. The umbrella policy serves three purposes: it provides excess limits when the limits of underlying liability policies are exhausted by the payment of claims; it drops down and picks up where the underlying policy leaves off when the aggregate limit of the underlying policy in question is exhausted by the payment of claims; and it provides protection against some claims not covered by the underlying policies, subject to the assumption by the named insured of a self-insured retention (SIR). Do you need Umbrella coverage?* YesNo Select Desired Limits -Select Option-$1,000,000$2,000,000$3,000,000$4,000,000$5,000,000other Do you currently have Umbrella insurance? YesNo Carrier Name Premium Effective Date Any losses or claims in the last 4 years? YesNo Previous StepNext Step Other PoliciesEarthquake, Glass, Flood, Pollution Liability, Professional Liability (E&O), Standalone Cyber Liability, Crime, Directors and Officers, Bonds, Product Recall and many more. These policies require more information and someone will be in contact with you. Do you need other types of coverage?* YesNo Previous StepNext Step General Questions Do any employees work at heights above 15 Feet? YesNo Has your business done (or do you plan to do) any work on contracts outside the USA? YesNo Does your business have a formal safety plan? YesNo Any exposure to flammables, explosives or chemicals? YesNo Any policy or coverage declined, cancelled or non-renewed during the prior 3 years? YesNo Are you aware of any circumstances over the last 5 years that could give rise to a claim being made against you or the company? YesNo Does the company have any current or ongoing legal or contractual disputes? YesNo Are there any ongoing legal disputes with current or former employees? YesNo Any additional comments? YesNo Δ