Business

Select a category and fill out the necessary information. Once your quote is submitted, we will contact you shortly via your preferred method.

Commercial Auto Insurance Quote

Contact Information

Your Name*

Address*

Best way to contact you?*

Phone Number*

Contact Email*

When is the best time to contact you?*

Please describe your business*

Vehicle Information

Make*

Model*

Year*

17-character vehicle identification number (VIN)*

Is this vehicle a truck?*

If yes, what is the gross vehicle weight?*

Do you have a loan on this vehicle?*

If yes, name and address of financial institution*

Do you lease this vehicle?*

If yes, name and address of financial institution*

Who is the registered owner of the vehicle?*

How will this vehicle be used?*

If other, please describe

Is there any customization on the vehicle?*

If yes, please describe and indicate the value*

Where will this vehicle be parked at the end of the day?*

What is your radius of operation with this vehicle?*

What is the cost new of this vehicle?*

Primary Driver Information

Driver's Full Name*

Prefix*

Date of Birth*

Gender*

Marital Status*

Driver's license number*

State where driver's license was issued*

Current license status*

Coverage

What liability limit would you like us to quote?*

What uninsured/underinsured motorist limit would you like us to quote?*

Would you like comprehensive coverage on the vehicle?*

If yes, what deductible would you like quoted for the comprehensive coverage?*

Would you like collision coverage on the vehicle?*

If yes, what deductible would you like quoted for the collision coverage?*

Would you like rental reimbursement to apply to the vehicle? This coverage is not available for trucks or tractors*

Would you like towing coverage to apply to the vehicle? Towing coverage is not available for trucks and tractors*

Current Insurance Information

Do you currently have insurance for your commercial auto?*

Name of insurance company*

Policy Number*

Date coverage expires

Reason for requesting a quote*

Additional Information

How did you hear about us?

Comments and Questions (optional)

Did You Know that you need special coverage for an employee who drives a company car and does not have a personal auto in his/her household?

Would you like someone to contact you about this?*

Commercial Property Insurance Quote

Contact & Personal Information

Your Name*

Name of Business*

Business Phone*

Mobile Phone*

Contact Email*

Website (optional)*

Type of Business*

Physical address of business*

Mailing address*

New in business*

Number of years experience*

Property Information

Location of business*

No. of miles from fire dept.*

No. of miles from fire hydrant*

Occupancy*

Annual receipts (if lessor's risk)*

Square Feet of Building*

Square Feet of Parking Lot*

Building Value*

Business Personal Property Value*

Construction Type*

Year Built*

Describe any recent renovations*

Name and address of Mortgagee*

Current Insurance Information

Do you currently have commercial property insurance?*

Name of insurance company*

Date coverage expires

Coverage

Do you need General Liability Insurance?*

Do you need Workers Comp Insurance?*

Do you need Automobile Insurance?*

Business Owner’s Policy Quote

Contact & Business Information

Contact Name*

Contact Email*

Phone*

Please describe your business*

What is your business address*

How many years have you been in business?*

Type of Business*

What is your expected revenue (sales) for the next 12 months?*

How many employees do you have?*

Property Information

Do you own the building you are located in?*

Is there a mortgage on the building?*

What year was the building built?*

Describe any updates to roof, heating, and electrical systems*

What is the construction of the building?*

How far away is the building from a fire hydrant?*

What is the square foot area of the building? Indicate the square foot area for the portion of the building that you occupy *

Do you have a sign?*

Is the sign attached to the building?*

What is the value of the sign?*

Does the building have glass plates?*

Please provide the dimensions of the glass by plate*

What is the value of your contents? (including inventory)*

Does your inventory value fluctuate more than 25% for a certain season?*

Do you have possession of property of others as a general course of business?*

If, yes please describe*

Coverage

Non-Canadian businesses, what liability limit would you like us to quote?*

CANADIAN businesses, what liability limit would you like us to quote?*

Would you like employee benefits liability included in the quote?*

Do you own any vehicles?*

Current Insurance Information

Do you currently have insurance for your business?*

Name of insurance company*

What is the amount of building coverage on your current policy?*

Policy number*

Date coverage expires

Please describe any claims you have had in the past five years*

Additional Information

How did you hear about us?

Comments and questions (optional)

Commercial Umbrella Policy Quote

Contact & Business Information

What is the name of your business?*

What is your address?*

What is your name?*

What is your phone number*

What is your Email address?*

Please describe your business*

What is your total estimated revenue (sales) for the coming 12 months?*

How many power vehicles are included in the business fleet?*

Current Insurance Information

Will this umbrella policy be in addition to another umbrella policy?*

Do you currently have general liability coverage?*

What is the occurance limit of your existing general liability policy*

What is the name of the insurance company who writes the general liability policy?*

What is your general liability policy number?*

What is the policy term for your general liability policy?*

Do you currently have commercial auto coverage?*

What is the occurance limit of your existing auto liability policy*

What is the name of the insurance company who writes the auto liability policy?*

What is your auto liability policy number?*

What is the policy term for your auto liability policy?*

Do you currently have worker's compensation employers' liability coverage?*

What is the employer's liability limit of your existing workers' compensation policy?*

What is the name of the insurance company who writes the workers' compensation policy?*

What is your workers' compensation policy number?*

What is the policy term for your workers' compensation policy?*

Do you currently have employee benefits liability?*

Do you currently have any professional liability?*

If you have professional liability, please describe*

What date would you like this quote to be effective?

Coverage

What umbrella limit would you like us to quote?*

Additional Information

How did you hear about us?

Comments and questions (optional)

General Liability Policy Quote

Contact & Business Information

Contact name?*

Email address?*

Business phone*

Mobile phone*

Website (optional)

Description of Operations*

Nature of Business*

Business Address*

Mailing Address*

Number of locations*

New business*

Number of years experience*

What type of entity is the business*

Annual payroll*

Annual sales*

How many employees do you have*

Coverage

What liability limit would you like us to quote?*

Do you need Auto Insurance?*

Do you need worker comp insurance?*

Do you need property insurance?*

Current Insurance Information

Do you currently have liability insurance?*

What is the name of the insurance company?*

What is the liability limit on your current policy?*

Date coverage expires

Additional Information

How did you hear about us?

Comments and questions (optional)

Professional Liability Policy Quote

Contact Information

Contact name?*

Address*

City*

State*

Zip*

Email address*

Phone*

When is the best time to contact you?*

Business Information

What is the nature of your business?*

Year business started*

Owner's years of experience in the business*

Number of owners and/or partners*

Number of part-time employees*

Number of full-time employees*

Number of sub-contractors*

How many transactions do you process each month?*

Do you have a bank account?*

What type of entity is the business?*

Coverage

What liability limit would you like quoted?*

Current Insurance Information

Do you currently have professional liability insurance?*

What is the name of the insurance company?*

What is the policy number?*

Date coverage expires

What is your annual premium?*

What is the reason you are requesting a quote?*

Additional Information

How did you hear about us?

Comments and questions (optional)

Employment Practices Liability Quote

Contact Information

Name*

Email address*

Phone Number*

When is the best time to contact you?*

Business Information

Type of business*

Year business was organized*

Do you have any subsidiaries?*

If yes, please describe*

Number of full-time employees*

Number of part-time employees*

Number of employees within salary range of $1 to $30,000*

Number of employees within salary range of $30,001 to $50,000*

Number of employees within salary range of $50,001 to $100,000*

Number of employees with a salary higher than $100,001*

Within the past 5 years, has any administrative hearing/claim been made or is now pending?*

If yes, please describe*

Is any person aware of any fact or circumstance that may give rise to a claim under this policy?*

If yes, please describe*

Do you have written policies/procedures on hiring and firing?*

Do you have written policies/procedures on sexual harassment?*

Do you have written policies/procedures on discrimination?*

Do you have a human resource department?*

Has there been or is there expected to be any reduction in staff in the past/future 12 months?*

If yes, please describe*

Do you have an "Employment at Will" statement?*

Current Insurance Information

Is employment practices liability coverage in place currently?*

If yes, who is the current insurance carrier?*

Date coverage expires

What date did you first have this coverage?*

Additional Information

How did you hear about us?

Comments and questions (optional)

Workers Comp Policy Quote

Contact Information

Name*

Name of business*

Business Address*

Mailing Address*

Business Phone*

Mobile Phone*

Email address*

Website (optional)

Business Information

What type of entity is the business?*

Fed ID#*

SIC Code*

Experience Modifier*

If yes, which is...*

Description of your business?*

What is the nature of your business?*

Primary Location*

Other locations (optional)*

Annual payroll*

Number of employees*

Payroll broken down by classes*

Loss Runs - last 5 years*

Would you like the payroll for the owner, partners, or principals included or excluded?*

Indicate the classification and payroll amount for the excluded officers*

Current Insurance Information

Do you currently have worker's comp insurance?*

Insurance company?*

Date coverage expires

Additional Information

How did you hear about us?

Comments and questions (optional)