Abel Insurance Group ~ Prospect Commercial Quote Forms

We do things a little different, our goal is to help protect you against everyday risks...

We ae going to ask you a few question to make sure we not only provide you with the correct coverage but that you also receive the best rate
Business Legal Name
Dba Name
Type of entity
Fein # / Tax ID #
Number of years in business
Brief description of business activity
Contacts Name

First NameLast Name
Contacts Title
Business Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contacts Phone #

Area CodePhone Number
Contacts Email
example@example.com
Business Website?
How were you referred to our agency?
What lines of business are we quoting?

Other

General Liability Info ~ 🏤
Contacts Name

First NameLast Name
Mailing Address?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Detailed Business Description?
(include date and summary of claim)
Is there current insurance in place?
Prior Liability Carrier?
Prior Liability premium?
Any losses in past 5 years?
Description of losses?
Gross Sales/Receipts?
(Estimate if new business)
Total Estimated annual payroll?
(Direct employees only)
Number of Employees?
Are subcontractors / independent used?
Do you request certificates of insurance from them?
Total cost / payroll for subcontractors
Are there additional insureds that need listed on the policy?
Additional Insureds info?
(name, address, as it should appear on Certificate of Insurance)

Inland Marine ~ 🚂
Type of coverage needed?
Brief Description of Items to be covered?
(mobile tools, equipment, machinery)
Value of unscheduled items?
# of items to be scheduled
(if more than 4 ask for a spreadsheet listing items, year, make, model, serial #, value)
Item #1

YearMakeModelSerial #Value
Item #2

YearMakeModelSerial #Value
Item #3

YearMakeModelSerial #Value
Item #4

YearMakeModelSerial #Value

Notes:

This document will become a permanent record in this client's file. Underwriting and coverage decisions by our sales, service team, and carriers will rely on this information to be accurate. B initialing below, you acknowledge that all the information included with this document is accurate and was provided to you by the client.
Initials:
Additional Notes:
Should be Empty:

We do things a little different, our goal is to help protect you against everyday risks...