Online Commercial Property Liability Insurance Quotation

Welcome to our online commercial property/liability quote page. Please take a few minutes to fill out the questionnaire below, submit and we will e-mail back your free quotation within 48 hrs. Please complete all of the following information fields so that we are able to provide you with an accurate quotation.

Note: All fields must be complete in order to process your quotation, except for those fields or sections marked as "optional".

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Business Name:
Contact Name:
Position:		Manager Owner President CEO Accountant Other
Mailing Address:
City:
Postal Code:
Email Address:
Daytime Phone:
Effective Date:
Current Insurer:
Multiple Location
Please submit a new form for each property or business owned.
This is location: 1 2 3 4 5 of 1 2 3 4 5
Street
City:
Postal Code:
General Information
Type of Business: Automotive Services Business and Professional Contractor and Trade Hospitality Realty Retail Wholesale Other
Form of Business: Individually Owned Corporate
Type of Products and /or Services Sold:
Manufacture Own Products: Yes No
Target Premium:
Policy Deductible: 500 1000 2500
Building
Please complete the following even if leasing.
Value (if owned):
Is all or a portion of this building rented to others: Yes No If yes, amount of annual rent collected:
Year Built:
Construction: Walls: Frame Brick Veneer Masonry Concrete Block Steel Claddng Floor: Wood Concrete Concrete Slab Asphalt Tar/Gravel Other Roof: Wood Deck Steel Deck Concrete Wood Joist (Peaked)
Number of Floors:
Basement: Yes No
Square Footage of Building:
Square Footage you Occupy:
Occupied by Others as:
Adjacent Occupancies: Please state business types/residencies surrounding your location. (i.e. Left Side - Law Firm, Right Side - Variety Store, Front - House, Behind - Alley) Left Side: Front: Right Side: Behind:
Distance to Closest Fire Station: None 1-8 KM 8-25 KM More than 25 KM
Distance to Closest Fire Hydrant: None 1-8 KM 8-25 KM More than 25 KM
Alarm System: Monitored Local None
Alarm Alerts for: Intrusion Smoke Fire CO22
Number of Fire Extinguishers: 1 2 3 4 5 More
Serviced Annually: Yes No
If deep fat frying is done on the premises, is an overhead fire suppression in place: Yes No If yes,type: CO2 Dry Chemical Other Is there a service contract in place: Yes No When was the filters last cleaned:
If the building is older than 20 years please provide dates (or approx. dates) when the following were last updated:
Plumbing:
Primary Heating:
Roof:
Wiring:
Indicate type of service:
Plumbing:		Copper / ABS Galvanized Steel
Primary Heating:		Forced Air Gas Radiant (Steam) Electric Oil Propane Other
Supplementary Heating: Yes No Type: Solid Fuel Stove Space Heater Electric
Roof:		Wood Deck Steel Deck Concrete Wood Joist (Peaked)
Wiring:		100 amp 200 amp Other
Transformer on Premises: Yes No
Air Compressor on Premises: Yes No
If any of the following are attached to the building please state value:
Sign (value):
Clock (value):
Antennas/Towers (value):
Glass Coverage Required: Yes No
Linear Footage of Glass:
Contents
Production Equipment (value):
Total Stock (value):
Perishable Stock (value):
Work in Progress (value):
Tools on Premises (value):
Leasehold Improvements (value):
Office Equipment (value):
Computer & EDP Equipment (value):
Computer Software (value):
Property of Others (value):
Crime
Is cash kept on premises: Yes No
Amount (value):
Overnight (value):
Daily Deposit Amount:
Safe on Premises: Yes No
Class & Fire Rating:
Employee Dishonesty Coverage: No 2,500 5,000 10,000
Employee Bonding Required: No 2,500 5,000 10,000
Additional Coverages
Water Escape/Sewer Backup: Yes No
Flood: Yes No
Earthquake: Yes No
Exterior Sign(s) (value):
Transit (value):
Temp Locations (value):
Tool Floater (value): Less than $1000 Actual Value: Note: Upon binding, Tool List will be required More than $1000 Actual Value: Note: Upon binding, Tool List will be required
Equipment Floater (value): Less than $1000 Actual Value: Upon binding, Equipment List will be required More than $1000 Actual Value: Upon binding, Equipment List will be required
Misc. Equipment:
Other (describe) : (value)
Operations / Liability
Amount of Liability: 1,000,000 2,000,000 3,000,000 5,000.000
Total Annual Sales (value):
Liquor Sales (value):
Sales to U.S. (value):
Cost of Sales (value):
Ordinary Payroll (value):
Key Person Payroll:
Number of Employees:
Years in Business:
Years in this Industry:
Do your employees use their own vehicles on behalf of your business: Yes No
Cranes or Hoists on premises: Yes No If yes, value of highest amount hoisted (value):
Are you interested in a quote for a Liability Umbrella? Yes No If yes, amount: 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 10,000,000 How many vehicles do you own: 1 2 3 4 5 or more
Insurance History
Current or Most Recent Insurer:
Policy Renewal Date or Last Date Insured:
Number of years consecutively insured: 1 2 3 4 5 6 7 8 9 10
List all Claims in the past 5 years: Claim #1: Date: Type: Amount Paid: Claim #2: Date: Type: Amount Paid: Claim #3: Date: Type: Amount Paid: More than 3 claims: Yes No
Please list any additional information in the box below:
This quotation is based on the information you provide. If the quote is satisfactory and a policy is desired, an insurance claims and experience history will be obtained. If information differs from the information stated, policy premium may be affected. Please be accurate.