"QUOTEME" - The Morgan Insurance Group

formerly Morgan Insurance Group

Copyright MIG13, LLC © 2022. All rights reserved.
Today's Date

MonthDayYear
Date

About You [Named Insured's / Owner(s) / Occupant(s)]*

	Full Name	Date of Birth	Relationship	Occupation (used in rating by some carriers)	Highest Level of Education (used in rating by some carriers)
Person #1
Person #2
Person #3
Person #4

Is there a LLC, Trust, or other entity we will need to list?
[if listed on the title or deed]
Phone Number*
[Best number to reach you at]
Alternate phone number
[Please enter an alternate phone number]
Email*
[example@example.com]
How did you hear about us?*

FriendB2B (Example: Realtor)WebAdvertisementWalk-inOther
Your friend's name?
The name of the business that referred you and the person that works there?
What advertisement?

	$2,000	$5,000	$10,000	Do Not Want Cov'g
Med Pay

	Occupancy?	If Tenant Occupied	# of floors in bldg	# of units in bldg
About Your Unit

Umbrella Liability Insurance

* Requires adjustments in underlying Auto & Home liability limits
Physical Address of Your Home*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from Physical Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Amount of Insurance Requested*

$1,000,000$2,000,000$5,000,000$10,000,000
Do you want Uninsured/Underinsured Motorist Excess Liability of $1,000,000?*
* Requires the Auto Policy have a minimum required UM Limit depending on the insurer
Auto Liability Limit*
* Umbrella usually requires a minimum auto liability limit of $250k/$500K
Home Liability Limit*
* Umbrella usually requires a minimum home liability limit of $300k
Number of Rental Properties*
What other motorized vehicles do you own?*
Please list type and number
Do you own dogs? If so, what breeds?*
Special requests for coverage, additional details, or questions*
(if none, Type NONE)

Builders Risk

Homes or Business Properties in the course of construction
Your Construction Project is....*
Risk Type*

ResidentialCommercial

Insured Information*

	Mailing Address	Business Type	Description
Insured Information

Builder/Contractor Information*

	Full Name	Years of Experience	# of Structures Built in the Last 12 months	Projected # of Structures to be built/remodeled in the next 12 months	Loss History (last 3 years)
Builder/Contractor Information

Project Information*

	Total Completed Value (excluding cost of land)	Description of Construction/Installation Project	Type of Construction Materials	Any Additional Interested Parties
Project Information

Property Information*

	Address, including County	Type of Property	Square Footage	Number of Stories	Effective Date Needed
Property Information

Mailing Address (if different from Physical Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Information, Requests for Coverages, or Questions*
(if none, Type NONE)

Renters Insurance
Address of Rental*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from Physical Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Current Insurance Information*

	I have none	Company Name (not Agency)	Policy Expiration Date	Premium Amount	Amount Insured For	List Claims (last 3 years)
Current Insurance Information

Dwelling Information*

	Living Square Feet	Number of Units in Your Building	What Floor are you on?	Year Built	Smoke Detectors?	Fire Extinguisher	Deadbolt Locks all exterior doors?	Central Station Fire	Central Station Burglar	Fire Sprinklers in Unit?
Dwelling Information

Desired Coverages*

	Deductible	Liability Limit	Value of Your Contents	Other Coverages Desired
Desired Coverages

Additional information, request for coverages, or questions*
(if none, Type NONE)

Commercial Auto

Small (1-5 units), Fleets (6+ units, please call our office at 305-451-4788)
Name of Business / In Business Since?
Please describe the business operations
Address of the Business

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Driver Information*

	Driver #1	Driver #2	Driver #3	Driver #4	Driver #5
Full Name
DOB
# Years U.S. Licensed
Occupation
Primarily drives vehicle #?
License #
State Licensed

Autos/Trucks owned by the Business*

	Year	Make (ex: Ford)	Model (ex: F150)	Vehicle Type (ex: Trailer, P/U, Van, SUV)	Vehicle Identification Number (VIN)	Owned, Bank Financed, or Leased?	Primary Use: Business or Personal, or Both	Gross Vehicle Weight	Radius of Operation	Jobsites per Day	Garaging Zip	Stated Value of Vehicle
Vehicle #1
Vehicle #2
Vehicle #3
Vehicle #4
Vehicle #5

Prior Coverage Information*

	Continuous Coverage	Prior Insurance Company (not Agency)	Prior BI Coverage	Prior Expiration Date
Prior Coverage Information

Additional information, request for coverages, or questions*
if none, Type NONE

Commercial Property
Legal Name of the Property*
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address of the Owner*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please describe the occupancy(s) of the building*

Prior Coverage Information*

	Continuous Coverage	Prior Insurance Company (not Agency)	Prior BI Coverage	Prior Expiration Date
Prior Coverage Information

Property Information*

	County	Total Square Feet	Construction Type	Year Built	# of Stories	Update Year Roof	Update Year Plumbing	Update Year Electrical	Update Year HVAC	Percent Occupied
Property Information

Building Coverage $$$*
Estimated
Contents Coverage $$$*
Estimated
Leinholder, or other Interested Party*
Type NONE, if none
Additional information, request for coverages, or questions*
If none, please Type NONE

Artisan Contractors / Commercial Liability / Business Owners Policy (BOP)
Legal Name of Business*
Include Entity Type: S Corp, C Corp, LLC, Individual
Full Names of All Owners*
Address of Business*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please fully describe the business operations*
Date Your Business Began*

MonthDayYear
Date
Website*
Number of Employees*
Estimated Gross Sales Receipts $$$*

Prior Coverage Information (if none, type NONE)*

	Prior Insurance Company (not Agency)	Prior Liability Coverage Limit	Prior Expiration Date
Prior Coverage Information

Location Information*

	County	Total Square Feet	Percent Occupied	Construction Type	Year Built	# of Stories	Update Year Roof	Update Year Plumbing	Update Year Electrical	Update Year HVAC
Property Information

Do you need Building Coverage (or Build Out Coverage, if leasing)? How much?*
Estimated Value $$$
Do you need Contents Coverage? How much?*
Estimated Value $$$
Do you need Tools Covered? How much?*
Estimated Value $$$
Additional information, request for coverages, or questions*
if none, please Type NONE

Jet Ski Insurance
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mooring Zip / Facility Name*

Prior Coverage Information*

	Prior Insurance Company (not Agency)	Prior BI Coverage	Prior Expiration Date	No Prior Boat Insurance
Prior Coverage Information

Drivers*

	Driver 1	Driver 2	Driver 3	Driver 4
Name
Date of Birth
Drivers License # / State

Jetski*

	Jetski #1	Jetski #2	Jetski #3
Year
Length
Make
Model
Hull ID
Horsepower
Max Speed
Include Trailer for Rating?
Boater Safety Course (please list)
Comprehensive and Collision Deductible
Liability Limit Desired
Stated Value

Additional information, request for coverages, or questions*
if none, please Type NONE

Motorcycle Insurance
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Prior Coverage Information*

	Prior Insurance Company (not Agency)	Prior BI Coverage	Prior Expiration Date	No Prior Motorcycle Insurance
Prior Coverage Information

Drivers*

	Driver 1	Driver 2	Driver 3	Driver 4
Name
Date of Birth
Drivers License # / State

Motorcycle Info*

	Motorcycle #1	Motorcycle #2	Motorcycle #3
Year
Make
Model
CC's / Horsepower
Include Trailer for Rating?
Cycling Course? (please list)
Comprehensive and Collision Deductible
Liability Limit Desired

Additional information, request for coverages, or questions*
if none, please Type NONE

Golf Cart Insurance

Off Road and Street Legal
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Drivers*

	Driver 1	Driver 2	Driver 3	Driver 4
Name
Date of Birth
Drivers License # / State

Prior Coverage Information*

	Prior Insurance Company (not Agency)	Prior BI Coverage	Prior Expiration Date	No Prior Golf Cart Insurance
Prior Coverage Information

Golf Cart Info*

	Golfcart #1	Golfcart #2
Year
Make
Model
CC's / Horsepower
Include Trailer for Rating?
Drivers Course? (please list)
Comprehensive and Collision Deductible
Liability Limit Desired

Additional information, request for coverages, or questions*
if none, please Type NONE

Life Insurance

Term, Universal, Whole Life, and Annuities. We work with our large brokerage partner to find you the right coverage at the best price.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Life Insurance Info*

	Insured #1	Insured #2
Amount of Coverage Desired
Type of Coverage Desired (Term, Universal, Whole Life)

Additional information, request for coverages, or questions*
if none, please Type NONE

Flood Insurance

Through NFIP or Private Markets
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*

Risk Information (most of the structure information we will attain via the County Appraisers website)*

	Occupancy?	Primary Residence?	Vacation Home?	Rented to Others?	Required for Closing?	Flood Elevation Certificate
Property #1

Attach Flood Elevation Certificate here

Cancelof
Contact Information for Lender (Lender Name, Processor Name, Tel #, Email)*
Type NONE, if none.
Additional information, request for coverages, or questions*
if none, please Type NONE

If your choice was not listed, please let us know what insurance type you are looking for. Otherwise, please select Submit below.
Thank you!
Please verify that you are human*
Should be Empty:

	Name of Company? (if none, Type NONE)	How long have you had this policy? (years/months)	Policy Number?	Next Expiration Date?	Prior Liability Limit? (ex: 100/300/100)
CURRENT POLICY
Prior Policy (if less than one year)

	$250k/$500k	$100k/$300k	$50k/$100k	$25k/$50k	$10k/$20k	Do Not Want Cov'g
UM Unstacked
UM Stacked

	No Deductible	$250 Ded	$500 Ded	$1,000 Ded
PIP $10,000
PIP w/o Lost Wages (if retired or unemployed)

	$1,000	$500	$250	Do Not Want Cov'g
Coll Ded Veh #1
Coll Ded Veh #2
Coll Ded Veh #3
Coll Ded Veh #4
Coll Ded Veh #5
Coll Ded Veh #6

	$1,000	$500	$250	$100	Do Not Want Cov'g
Comp Ded Veh #1
Comp Ded Veh #2
Comp Ded Veh #3
Comp Ded Veh #4
Comp Ded Veh #5
Comp Ded Veh #6

formerly Morgan Insurance Group

Type of Insurance You Need Quoted Today?

Auto Insurance

Home Insurance

Home Insurance (Rented to Others)

Condominium Owners Insurance

Umbrella Liability Insurance

Mobile Home Insurance

Builders Risk

Renters Insurance

Commercial Auto

Commercial Property

Artisan Contractors / Commercial Liability / Business Owners Policy (BOP)

Boat Insurance

Jet Ski Insurance

Motorcycle Insurance

Golf Cart Insurance

Life Insurance

Flood Insurance

	$30/day (max $900)	$40/day (max $1,200)	$50/day (max $1,500)	Do Not Want Cov'g
Rental Veh #1
Rental Veh #2
Rental Veh #3
Rental Veh #4
Rental Veh #5
Rental Veh #6

	I HAVE THIS!	I have ordered this!	Don't have this and have not ordered
A signed Mitigation Report from a certified engineer within the last 3 years.
A 4-point inspection (usually completed for older homes that have been renovated).
A roof certification report (gives a remaining useful life for the roof)

	Boat #1	Boat #2	Boat #3
Boat Type (Ex: Center Console)
Year
Length (ft)
Make (Ex:Contender)
Model (Ex: 25 Bay)
Hull ID #
Name of Boat/Yacht
State of Registration
Registration #
Vessel Flag
Date Purchased
Purchase Price
Type (Power, Multihull, Sail, or Houseboat)
Construction (Fiberglass, Wood, Aluminum, Kevlar/Carbon Fiber, Steel, Other)
Engine Manufacturer/Model
Year Built
Serial #
Fuel (Gas/Diesel/Electric)
Propulsion (Inboard, Outboard, I/O, Jetdrive, Pod Drive)
Engine(s): Single, Twin, Triples, Quad
Horsepower - Each
Max Speed
Fuel Tanks (Metal, Fiberglass, Plastic)
Auxiliary Generator: Diesel or Gas?
Current Survey? (drydock or afloat)
Date of Survey
# of Fire Extinguishers
Total Years Boating Experience

	Make/Model	Size	Waters Navigated	Dates
Previous #1
Previous #2
Previous #3