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Select Line of Business Insurance
Get a quote for:*
Select one or several lines of business insurance. Multi-line discounts are available for 2 or more lines of business insurance placed with one carrier.
Click here for PRODUCT LIABILITY INSURANCE QUOTES
- General Liability
- Business Owners: Liability and Property
- Professional Liability / E&O
- Workers Compensation
- Commercial Auto
- Umbrella
- Directors & Officers (D&O)

General Information
Legal Entity:*
Business Entity - Other:*
Please provide more information
First and Last name:*
Enter the name of the business owner
DBA:
Doing Business As
Business Name:*
Contact Phone:*
Email:*
We respect your privacy and do not tolerate spam and will never sell, rent, lease or give away your information to a 3rd party. Nor will we send you unsolicited emails.
Enter Email Confirm Email
Primary Business Address*
(provide your physical location; P.O. Box not allowed)

Street Address Address Line 2 City State ZIP Code
Mailing Address*
Same as previous

Street Address Address Line 2 City State ZIP Code
Referral Code
If you were referred to us please provide the referral code.

Business Operations
Provide Description of Business Operations:*
Describe in detail all the products, services, and/or operations the business provides. Please include business website, if available.
How many years in business under current ownership?*
How many Owners/Officers?*
How many years of management experience of owner?*
How many full time employees?*
enter 0, if none
Number of part time employees?*
enter 0, if none
Total Gross Annual Payroll:*
(Excluding Owners/Officers). Enter 0, if none.

General Liability / Business Owners Insurance Application
Do you currently have General Liability or Business Owners Insurance?
- Yes
- No
Expiration date of the present General Liability or Business Owners insurance policy:
MM slash DD slash YYYY
Select desired effective date:*
MM slash DD slash YYYY
Annual Gross Sales / Receipts / Commissions:*
If new business or no prior sales, please enter estimated amount for the next 12 months.
Square Feet of Space Occupied by Applicant:*
If working from home, enter the sq.f. area at your home office.
Select General Liability insurance limit:*
General Liability Limit - this is the amount of coverage desired for your products and/or premises. This coverage protects you if someone or something is hurt or damaged by your work or your product or while at your premises.
Other general liability insurance limit:*
Building Limit:
Building Limit - the expected cost to rebuild the building you own. If the building burned to the ground, what would it cost to rebuild it? The Building Limit also includes any equipment that is permanently attached to the building (air conditioners, etc).
Business Personal Property Limit:*
The amount of insurance you need to cover all items inside of your building. This should include furniture, fixtures, computers, etc.
Year building built:*
Building Construction Type:*
Number of stories in the building:*
Percentage of the building covered by operational sprinklers:*
enter 0, if none
Select Burglar and/or Fire Alarm type:
Do you have more than 50% interest in any other business?
- Yes
- No
Is the other business listed as a named insured in this application?
- Yes
- No
Have you included the exposures associated with the other business in this application?
- Yes
- No
List the named insured(s) not included in this application:*
Describe your other ownership interest, including the entities and associated exposures that are not part of this application:*
Are the named insureds and exposures insured elsewhere?*
- Yes
- No
Do any or all the businesses the insured has more than 50% ownership interest in work out of the same location?*
- Yes
- No
Any losses in the past 3 years?
- Yes
- No

Prior general liability / business owners insurance losses details

Date of Claim	Claim Details	How much was paid	Claim Status	Actions

There are no Claims.

Any coverage in place in the past 3 years?
- Yes
- No
Prior Insurance Information
Prior Insurance Information:*
Year Insurance Carrier Annual Premium
In the last 3 years, has any insurance company either declined to issue a policy, or cancelled, or failed to renew existing coverage for the business?*
- Yes
- No
Reason for Cancellation/Decline:*
Indicate the frequency of non-payment:*

Workers Compensation Insurance application
If Workers Comp. coverage is not needed, please navigate back to the Select Line of Business Insurance screen by clicking the "Previous" button several times, and deselect the Workers Compensation checkbox.
Do you currently have Workers Compensation Insurance?
- Yes
- No
When does your present Workers Compensation insurance policy expire?
MM slash DD slash YYYY
Select desired effective date:*
MM slash DD slash YYYY
Tax ID # (SSN):*
Select Workers Compensation insurance limit:*
Do you want to include coverage for the owners / officers?*
- Yes
- No

Owner/Officer Info

Owner/Officer/Executive Full Name	Position with the company	Percentage owned	Workers Comp. Coverage selection	Actions

There are no Owners/Officers.

Employee Payroll Info*
To enter multiple class codes click on (+) sign
For example:
Class Code | Duties | Full Time | Part Time | Payroll
8810 Clerical 0 1 $34,000
Class code, if known Duties Full Time Part Time Annual Payroll
Any losses in the past 4 years?*
- Yes
- No

Prior Workers Comp. Losses

Date of Claim	Claim Details	How much was paid	Claim Status	Actions

There are no Claims.

Any Workers Compensation coverage in place in the past 4 years?
- Yes
- No
Prior Workers Compensation Insurance Information
Prior Insurance Information*
Year Insurance Carrier Annual Premium
In the last 4 years, has any insurance company either declined to issue a policy, or cancelled, or failed to renew existing coverage for the business?*
- Yes
- No
Reason for Workers Comp. policy Cancellation/Decline*
Indicate the frequency of non-payment*
Enter experience modification (x-mod), if known

Business Auto Insurance Application
If Business Auto coverage is not needed, please navigate back to the Select Line of Business Insurance screen by clicking the "Previous" button several times, and deselect the Business Auto checkbox.
Do you currently have Business Auto Insurance?
- Yes
- No
When does your present Business Auto insurance policy expire?
MM slash DD slash YYYY
Desired Effective Date*
MM slash DD slash YYYY

Vehicle Info

VIN	Year	Make	Model	Vehicle Use	Annual Mileage	Date Purchased	Current Odometer Reading	Ownership Status	Garaged at Different Address	Address	Medical Payments	Full coverage or liability only?	Uninsured Motorist Property Damage	Comprehensive Deductible	Collision Deductible	Glass Deductible	Limited Waiver of Collision Deductible	Roadside Assistance	Rental Reimbursement	Actions

There are no Autos.

Driver Info

Name	Date of Birth	Gender	Marital Status	License Number	License State	U.S. Date Licensed	Actions

There are no Drivers.

Coverage Options
in thousands of dollars, i.e. 50/100 = $50,000 / $100,000
Bodily Injury Split Limit / Combined Single Limit:*
Uninsured/Underinsured Bodily Injury:*
Property Damage:*
Property Damage:
Hired / Non-Owned Auto:
- Include Hired Auto
- Include Non-Owned Auto

Umbrella Detail
If Umbrella coverage is not needed, please navigate back to the Select Line of Business Insurance screen by clicking the "Previous" button several times, and deselect the Umbrella checkbox.
Umbrella Limit*

Get a Quote Now

Step 1 of 8 - Line of Business

Select Line of Business Insurance

General Information

Business Operations

General Liability / Business Owners Insurance Application

Prior Insurance Information

Workers Compensation Insurance application

Prior Workers Compensation Insurance Information

Business Auto Insurance Application

Coverage Options

Umbrella Detail

Directors & Officers

Employment Practices(EPL)

Class code, if known	Duties	Full Time	Part Time	Annual Payroll