Commercial Quote Information Sheet Step 1 of 8 12% Does customer have current coverage?Effective Dates: MM slash DD slash YYYY Current Carrier:Current Premium:Company Name(Required)Contact Name(Required) First Last Business Location Address Street Address Address Line 2 City ZIP Code Is billing address same as above? Yes No PhoneCell PhoneEmail FEIN/SS#Year Business StartedBusiness TypeSole ProprietorCorporationPartnershipSubchapter "S"Managers/Owners Years Experience:Annual Gross SalesExpiration Date of Current Policy MM slash DD slash YYYY Insurance Needed GL Auto Equipment Property Land Lord Property Umbrella Work Comp Description of Operations General LiabilityLimits$1,000,000/$2,000,000$2,000,000/$4,000,000Total Employee PayrollAre you a Contractor?YesNoAre Sub Contractors UsedTotal Sub-Contacted Work Cost: $Insured Sub Cost $Uninsured Sub Cost: $% Commercial Work:% Residential Work:% Work Sub-Contracted::Type of Work Sub-ContractedAre Certificates Required on Subs?Notes*complete description or operations on first page will be fine to use as rating class for General Liability Workers' CompensationLimits Required:$100/500/100 (State Required Minimum)$500/500/500$1Mil/1 Mil/lMil*These limits are in hundreds of thousandsNumber of Employees?Job Descriptions:Job Description# of Employees# of Full Time Employees# of Part Time EmployeesPayroll: $ Add RemoveClick Plus Sign to add additional entries.Payroll for Sub Contractors (if any)Excluded officers/ owners·.NameDOBDutiesTitle% OwnedPayroll $ Add RemoveClick Plus Sign to add additional entries.Notes EquipmentTotal Value of EquipmentPlease Attach EquipmentMax. file size: 100 MB. I will email it over later. Storage Practice:Employee Tools Value (If any):Rented/Leased Contractors Tools & Equipment Value: $(If you rent or lease equipment enter the maximum value of equipment below)Notes AutoHow many vehicles do you need to insure?Please Attach VehiclesMax. file size: 100 MB. I will email it over later. (Vehicles) Limits of Liability: $$100,000$300,000$500,000$1,000,000Comprehensive:Collision:Rental Reimbursement: Yes No How many drivers do you need to insure?Please Attach DriversMax. file size: 100 MB. I will email it over later. (Drivers) Notes PropertyHow many properties would you like to add?12345678910Property 1Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Business Personal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesProperty 2Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Business Personal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesProperty 3Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Business Personal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesProperty 4Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Business Personal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesProperty 5Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Business Personal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesProperty 6Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Business Personal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesProperty 7Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Business Personal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesProperty 8Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Business Personal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesProperty 9Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Business Personal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesProperty 10Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Business Personal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. Notes Landlord PropertyYOUR PROPERTY REQUESTS WILL INCLUDE GENERAL LIABILITYHow many LandLord properties would you like to add?12345678910Landlord Property 1What is the total annual Rental revenue for this property? $Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesLandlord Property 2What is the total annual Rental revenue for this property? $Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesLandlord Property 3What is the total annual Rental revenue for this property? $Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesLandlord Property 4What is the total annual Rental revenue for this property? $Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesLandlord Property 5What is the total annual Rental revenue for this property? $Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesLandlord Property 6What is the total annual Rental revenue for this property? $Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesLandlord Property 7What is the total annual Rental revenue for this property? $Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesLandlord Property 8What is the total annual Rental revenue for this property? $Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesLandlord Property 9What is the total annual Rental revenue for this property? $Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. NotesLandlord Property 10What is the total annual Rental revenue for this property? $Is this Address the same as Primary Business Location Address? Yes No Location Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select all that apply: Owner Occupant Tenant Lessors Risk (If Rental) Type of Operation:Building ValuePersonal Property Limit $:Construction Type Frame Masonry Other Other:Approximate Year Built:Total Area:Number of StoriesBasement Yes No Is the Building Sprinklered? Yes No Alarm Type: Local Monitored None Approximate Year of last updates for: HEATApproximate Year of last updates for: PLUMBINGApproximate Year of last updates for: WIRINGApproximate Year of last updates for: ROOFPlease attach Building Photos / Copy of Current Policy / Anything esle that may be applicaple.Max. file size: 100 MB. Notes UmbrellaUmbrella Yes No Notes
