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Step 1 of 7 - Line of Business
14%
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:
*
Select
Individual / Sole Proprietor
Partnership
LLC
Corporation
Non-Profit
Other
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
(physical location, not a P.O. Box).
Physical Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mailing Address
*
Same as physical address above
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Do you have an additional physical location?
*
Yes
No
Address of Second Physical Location
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP 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:
Date Format: MM slash DD slash YYYY
Select desired effective date:
*
Date Format: 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.
Select
$300,000 each occurrence / $600,000 aggregate limit
$500,000 / $1,000,000
$1,000,000 / $2,000,000
$2,000,000 / $4,000,000
Other
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:
*
Select
Frame
Joisted Masonry
Non Combustible
Masonry Non-Combustible
Modified Fire Resistive
Fire Resistive
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:
Select
None - None
Central/monitored Burglar - Central/monitored Fire
Central/monitored Burglar - Local Fire
Central/monitored Burglar - None
Central/monitored Burglar - Other
Central/monitored Burglar - Smoke
Local Burglar - Central/monitored Fire
Local Burglar - Local Fire
Local Burglar - None
Local Burglar - Other
Local Burglar - Smoke
None - Central/monitored Fire
None - Local Fire
None - Other
None - Smoke
Other - Central/monitored Fire
Other - Local Fire
Other - None
Other - Other
Other - Smoke
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
Edit
Delete
There are no
Claims.
Add Claim
Maximum number of claims reached.
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:
*
Select
Non-Payment
Losses
Change of Business Operation
Carrier Withdrew
Other
Indicate the frequency of non-payment:
*
Select
Once in the prior year
Once in the past 2 years
Once in the past 3 years
More than once in the past 3 years
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?
Date Format: MM slash DD slash YYYY
Select desired effective date:
*
Date Format: MM slash DD slash YYYY
Tax ID # (SSN):
*
Select Workers Compensation insurance limit:
*
Select
State minimum required
$1,000,000 each accident / $1,000,000 Each Employee / $1,000,000 Policy Limit
$2,000,000 / $2,000,000 / $2,000,000
Do you want to include coverage for the owners / officers?
*
Yes
No
Owners' and Employees' Payroll Info
*
Please include owners payroll in the corresponding Annual Payroll field.
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, including owner's
For each company owner / officer please provide:
*
Name
Title/Relationship
Ownership %
Duties
Annual Payroll
Include or Exclude?
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 Compensation insurance losses details
*
To enter multiple claims click on (+) sign
Date of claim
Claim details
How much was paid
Claim status (open or closed)
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
*
Select
Non-Payment
Losses
Change of Business Operation
Carrier Withdrew
Other
Indicate the frequency of non-payment
*
Select
Once in the prior year
Once in the past 2 years
Once in the past 3 years
More than once in the past 3 years
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?
Date Format: MM slash DD slash YYYY
Desired Effective Date
*
Date Format: MM slash DD slash YYYY
Drivers:
*
Please provide information about each driver you want to be covered by this policy.
To enter multiple drivers click on (+) sign
First Name
Middle Name
Last Name
DOB
DL#
DL State
Marital Status
How many vehicles do you want to add to your policy?
*
Please enter a number from
1
to
100
.
Vehicle 1
Vehicle Details
*
VIN
Year
Make
Model
Vehicle coverage:
*
Liability Only
Full Coverage
Operations Details:
*
Primary Use (personal, business or both)
Current Vehicle Value
Garaging Zip Code
Average daily driving radius
Average jobsites per day
Operations Details:
*
Primary Use (personal, business or both)
Current Vehicle Value
Garaging Zip Code
Average daily driving radius
Average jobsites per day
Comprehensive Deductible
Collision Deductible
Vehicle 2
Vehicle Details:
*
VIN
Year
Make
Model
Vehicle coverage:
*
Liability Only
Full Coverage
Operations Details:
*
Primary vehicle use (business, personal or both)
Current Vehicle Value
Garaging Zip Code
Average daily driving radius
Average jobsites visited per day
Operations Details:
*
Primary vehicle use (business, personal or both)
Current Vehicle Value
Garaging Zip Code
Average daily driving radius
Average jobsites visited per day
Comprehensive Deductible
Collision Deductible
Vehicle 3
Vehicle Details:
*
VIN
Year
Make
Model
Vehicle coverage:
*
Liability Only
Full Coverage
Operations Details:
*
Primary Use (personal, business or both)
Current Vehicle Value
Garaging Zip Code
Average daily driving radius
Average jobsites per day
Operations Details:
*
Primary Use (personal, business or both)
Current Vehicle Value
Garaging Zip Code
Average daily driving radius
Average jobsites per day
Comprehensive Deductible
Collision Deductible
Vehicle 4
Vehicle Details:
*
VIN
Year
Make
Model
Vehicle coverage:
*
Liability Only
Full Coverage
Operations Details:
*
Primary Use (personal, business or both)
Current Vehicle Value
Garaging Zip Code
Average daily driving radius
Average jobsites per day
Operations Details:
*
Primary Use (personal, business or both)
Current Vehicle Value
Garaging Zip Code
Average daily driving radius
Average jobsites per day
Comprehensive Deductible
Collision Deductible
Vehicle 5
Vehicle Details:
*
VIN
Year
Make
Model
Vehicle coverage:
*
Liability Only
Full Coverage
Operations Details:
*
Primary Use (personal, business or both)
Current Vehicle Value
Garaging Zip Code
Average daily driving radius
Average jobsites per day
Operations Details:
*
Primary Use (personal, business or both)
Current Vehicle Value
Garaging Zip Code
Average daily driving radius
Average jobsites per day
Comprehensive Deductible
Collision Deductible
Vehicle 6
Vehicle Details:
*
VIN
Year
Make
Model
Vehicle coverage:
*
Liability Only
Full Coverage
Operations Details:
*
Primary Use (personal, business or both)
Current Vehicle Value
Garaging Zip Code
Average daily driving radius
Average jobsites per day
Operations Details:
*
Primary Use (personal, business or both)
Current Vehicle Value
Garaging Zip Code
Average daily driving radius
Average jobsites per day
Comprehensive Deductible
Collision Deductible
Coverage Options
in thousands of dollars, i.e. 50/100 = $50,000 / $100,000
Bodily Injury Split Limit / Combined Single Limit:
*
Select
No Coverage
15/30 split limit
25/50 split limit
50/100 split limit
100/300 split limit
250/500 split limit
100 CSL
300 CSL
500 CSL
750 CSL
1000 CSL
Uninsured/Underinsured Bodily Injury:
*
Select
No Coverage
15/30
25/50
30/60
50/100
100/100
100/300
250/500
300/300
500/500
750/750
1000/1000
Property Damage:
*
Select
No Coverage
10
15
25
50
100
Property Damage:
Included in Combined Single Limit
Medical Payments:
*
Select
No Coverage
1
2
5
10
Uninsured Motorist Property Damage:
*
Select
No Coverage
3.5
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
*
Please select
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
$8,000,000
$9,000,000
$10,000,000
