March 5, 2021
WHO WE ARE
MISSION STATEMENT
LOCATIONS
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CONTACT US
WHAT WE DO
COMMERCIAL INSURANCE
CONSTRUCTION
WELDING SUPPLY / COMPRESSED GAS
DRILLERS PROGRAM
BUSINESS QUOTE
AUTO INSURANCE
LIFE / HEALTH / RETIREMENT
HEALTH & LIFE QUOTE
FAQ's
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INSURANCE NEWS
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2017 Insurance Topics
PARTNERS
CLAIMS REPORTING
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FLOOD QUOTE
FLOOD INSURANCE
WHAT DOES A FLOOD POLICY COVER?
FAQs ABOUT FLOOD INSURANCE
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FORMS
SUPPLEMENTAL FORMS
2017 Insurance Topics
Business Quote
General Information
Contact Name *
Email *
Business Name
Address
City
State
Zip
County
Business Phone
Fax
Current Insurance Company
(not agency)
Company Name
Policy Expiration Date
Current Insurance Coverages
CurrentCoverages
Bond
Commercial Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors & Officers Liability
Disability
Group Health
Group Life
Professional Liability
Workers' Compensation
Other
Business Information
# of Full-Time Employees
# of Part-Time Employees
How long in Business? (yrs)
How many locations?
Please give a brief description of your business and clientele
Property/Premises Information
Address
Occupancy Status
Owner
Tenant
Year Built
% Occupied
Sprinklers
Yes
No
Construction Type
Frame
Brick Veneer
Stucco
Metal
Concrete
Stories
# Basements
Sq. Footage
Burglar Alarm
Yes
No
Building Value
Contents
Other Property (specify)
Insurance Information
Other
Annual Gross Sales: (before taxes)
Number of Employees
Annualized Payroll
Cost of any Subcontracted Work
Limits Requested
$300,000
$500,000
$1,000,000
$2,000,000
Describe any claims you've had in the past 5 years
Additional Comments
* = Required Field
Disclaimer Notice
- The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.
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