Business Auto Insurance Policy

Business Auto Insurance Application

Step 1 of 5

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*
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Enter Email Confirm Email
Primary Business Address (physical location, not a P.O. Box).
Address Line 1*
Address Line 2
City*
State*
Zip Code*
- Check this box if there is a different mailing address.
Mailing Address
Address Line 1*
Address Line 2
City*
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.
Other General Liability 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*

If construction does not exactly fit one of these six standard types, select construction based on primary framing type. Any heavy timber or wood mill construction would usually fit Masonry Non-Combustible.

Type	Description
Frame	A building where the exterior walls, bearing walls, partitions, structural floors, roof and supports are wood or light-gauge metal. This includes buildings where the wood or light-gauge metal has been combined with other materials to form composite components such as wood or metal studs with brick or stone veneer, stucco, or metal siding.
Joisted Masonry	A building that has the exterior walls constructed of masonry materials such as brick, concrete block, concrete, gypsum block, clay tile, stone, or similar materials. The structural floors or roof are wood or light-gauge metal.
Non Combustible	A building that employs a system of pre-engineered rigid steel framing members. The exterior walls are metal siding, sandwich panels, or masonry, and the roof is clad with metal roofing or sandwich panels.
Masonry Non-Combustible	A building where the structural floors and roof are unprotected non-combustible materials such as metal decking or concrete on metal decking, and are supported by an unprotected structural steel frame, fire resistive exterior walls, or a combination of both.
Modified Fire Resistive	A building where the structural floors, roof, and their supports are of non-combustible construction with a fire rating of not less than one hour. A building very similar to Masonry Non-Combustible; however, in Modified Fire Resistive, the non-combustible floor, roof, and framing components are protected with sprayed-fiber fireproofing.
Fire Resistive	A building where the structural floors and roof and their supports are of materials such as precast or poured-in-place reinforced concrete, with a fire resistive rating of not less than two hours.

Building Construction Type*

Number of stories*

Percentage of the building covered by operational sprinklers*

enter 0, if none

Burglar - Fire Alarm Type

Do you have more than 50% interest in any other business?

Is the other business listed as a named insured in this application?

Have you included the exposures associated with the other business in this application?

Please list the named insured(s) not included in this application.*

Please 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?*

Do any or all the businesses the insured has more than 50% ownership interest in work out of the same location?*

Any losses in the past 3 years?

Prior general liability / business owners 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 coverage in place in the past 3 years?

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?*

Reason for Cancellation/Decline*

Indicate the frequency of non-payment*

What is Business Auto Insurance

Whether you use vehicles to provide mobility for your employees, equipment or products, you cannot operate without comprehensive business auto insurance. Commercial auto insurance can include:

Auto liability
Medical payments
Comprehensive coverage
Collision coverage
Uninsured and underinsured motorists coverage
Coverage for autos you borrow or rent
Coverage for employees using their cars for the business

Business Auto Insurance Policy

Business Auto Insurance Application

Step 1 of 5

General Information

Business Operations

Prior Insurance Information

Workers Compensation Insurance application

Prior Workers Compensation Insurance Information

Business Auto Insurance Application

Vehicle 1

Vehicle 2

Vehicle 3

Vehicle 4

Vehicle 5

Vehicle 6

Coverages

Umbrella Detail

What is Business Auto Insurance