Commercial Fast App

Commercial Fast App
Name of Business*
Website*
How did you find us?*

ReferralGoogleSocial MediaOther
Referred By*

First NameLast Name
Referral Source*
First Point of Contact*

First NameLast Name
Office Number*
First Point of Contact Format: (000) 000-0000.
Email*
First Point of Contact
Mobile Number*
First Point of Contact Format: (000) 000-0000.
Do you want to receive notification through SMS?*

SMS Opt-inSMS Opt-out
How Many Owners?*
Desired Effective Date*

MonthDayYear
Date
- Name*
  
  First NameLast Name
- Percentage of Ownership*
- Email*
  example@example.com
- Name*
  
  First NameLast Name
- Percentage of Ownership*
- Email*
  example@example.com
- Name*
  
  First NameLast Name
- Percentage of Ownership*
- Email*
  example@example.com
- Name*
  
  First NameLast Name
- Percentage of Ownership*
- Email*
  example@example.com
- Name*
  
  First NameLast Name
- Percentage of Ownership*
- Email*
  example@example.com
- FEIN
- SSN (If no FEIN)
- Mailing Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Is your physical address the same as your mailing address?*
  
  YesNo
- Physical Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Entity Type:*
  
  CORPLLCLPSOLE PROPOther
- Other Entity*
- Any Subsidiaries?*
  
  YesNo
- Description of Operations*
- Years of Experience (Owner)
- Years in Business
- Current Insurance Company
- Expiration Date
  
  MonthDayYear
  Date
- Reason for Shopping Insurance*
- Projected Annual Gross Receipts*
- Projected Annual Payroll*
- Number of Full Time Employees*
- Number of Part Time Employees*
- Do you have any contract (insurance) requirements?*
  
  YesNo
- Insurance Requirements Uploads*
  
  Cancelof
- Any losses in the last 5 years?*
  
  YesNo
- Date, Description, and Estimated Loss*
- Do you have a business continuation plan?*
  
  YesNo
- Is it funded?*
  
  YesNo
- Would you like to discuss/review funding plans?*
  
  YesNo
- Would you like to learn more about this subject?*
  
  YesNo
- Coverage Requested
- Select all that applies*
  
  General LiabilityPropertyAutoWorkers CompensationErrors and OmissionsCyberDirectors and OfficersInland MarineCrimeUmbrellaGroup HealthBuilders RiskCargoBondExecutive Board PlansOther
- Other Coverage Details*
- Commercial General Liability
- Square footage you occupy or own*
- Liability Limits Requested*
  
  1MM/2MM2MM/4MM
- Do you own or lease your property?*
  
  OwnLeaseBoth
- Are you a contractor or general contractor?*
  
  ContractorGeneral ContractorNeither
- Do you use subcontractors?*
  
  YesNo
- Insured Sub Costs*
- Uninsured Sub Costs*
- Type of Work Subcontracted out to Insured Subcontractors*
- Type of Work Subcontracted out to Uninsured Subcontractors*
- % Residential Work*
- % Commercial Work*
- Any Waivers of Subrogation?*
  
  YesNo
- Description of Work*
  Performed as Contractor or General Contractor
- Do employees use their own vehicles in the business?*
  
  YesNo
- Any Additional Insureds?*
  
  YesNo
- Number of Additional Insured*
- General Liability Additional Notes
- Commercial Property
- How many locations do you own or lease?*
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Is this a Condo?*
  
  YesNo
- Occupancy*
  
  OwnerTenant
- Monitored Alarm*
  
  LocalMonitoredNone
- Sprinklered*
  
  YesNo
- Building Value*
- Tenant Improvements and Betterments*
- Business Personal Property*
- Square Feet*
- How many stories?*
- Year Built*
- Construction Type/Material*
- Type a question*
- For the questions below, please enter the estimated year that each of them was updated
- Year Roof Updated*
- Year Electric Updated*
- Year Plumbing Updated*
- Year HVAC Updated*
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Is this a Condo?*
  
  YesNo
- Occupancy*
  
  OwnerTenant
- Monitored Alarm*
  
  LocalMonitoredNone
- Sprinklered*
  
  YesNo
- Building Value*
- Tenant Improvements and Betterments*
- Business Personal Property*
- Square Feet*
- How many stories?*
- Year Built*
- Construction Type/Material*
- Roof Type*
- For the questions below, please enter the estimated year that each of them was updated
- Year Roof Updated*
- Year Electric Updated*
- Year Plumbing Updated*
- Year HVAC Updated*
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Is this a Condo?*
  
  YesNo
- Occupancy*
  
  OwnerTenant
- Monitored Alarm*
  
  LocalMonitoredNone
- Sprinklered*
  
  YesNo
- Building Value*
- Tenant Improvements and Betterments*
- Business Personal Property*
- Square Feet*
- How many stories?*
- Year Built*
- Construction Type/Material*
- Roof Type*
- For the questions below, please enter the estimated year that each of them was updated
- Year Roof Updated*
- Year Electric Updated*
- Year Plumbing Updated*
- Year HVAC Updated*
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Is this a Condo?*
  
  YesNo
- Occupancy*
  
  OwnerTenant
- Monitored Alarm*
  
  LocalMonitoredNone
- Sprinklered*
  
  YesNo
- Building Value*
- Tenant Improvements and Betterments*
- Business Personal Property*
- Square Feet*
- How many stories?*
- Year Built*
- Construction Type/Material*
- Roof Type*
- For the questions below, please enter the estimated year that each of them was updated
- Year Roof Updated*
- Year Electric Updated*
- Year Plumbing Updated*
- Year HVAC Updated*
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Is this a Condo?*
  
  YesNo
- Occupancy*
  
  OwnerTenant
- Monitored Alarm*
  
  LocalMonitoredNone
- Sprinklered*
  
  YesNo
- Building Value*
- Tenant Improvements and Betterments*
- Business Personal Property*
- Square Feet*
- How many stories?*
- Year Built*
- Construction Type/Material*
- Roof Type*
- For the questions below, please enter the estimated year that each of them was updated
- Year Roof Updated*
- Year Electric Updated*
- Year Plumbing Updated*
- Year HVAC Updated*
- Commercial Property Additional Notes
- Commercial Auto
- Driver Details
- Do you have a Driver List file available for upload?*
  
  YesNo
- Driver List*
  
  Cancelof
- How many drivers do you have?*
- Name*
  
  First NameLast Name
- Date of Birth*
  
  MonthDayYear
  Date
- License Number*
- Licensed State*
- CDL?*
  
  YesNo
- Name*
  
  First NameLast Name
- Date of Birth*
  
  MonthDayYear
  Date
- License Number*
- Licensed State*
- CDL?*
  
  YesNo
- Name*
  
  First NameLast Name
- Date of Birth*
  
  MonthDayYear
  Date
- License Number*
- Licensed State*
- CDL?*
  
  YesNo
- Name*
  
  First NameLast Name
- Date of Birth*
  
  MonthDayYear
  Date
- License Number*
- Licensed State*
- CDL?*
  
  YesNo
- Name*
  
  First NameLast Name
- Date of Birth*
  
  MonthDayYear
  Date
- License Number*
- Licensed State*
- CDL?*
  
  YesNo
- Vehicle Details
- Desired Liability Coverage*
- Uninsured Motorist*
- Personal Injury Protection*
- Collision & Comp Deductibles*
- Hired/Non-owned Liability*
  
  YesNo
- Rental Reimbursement*
  
  YesNo
- Roadside*
  
  YesNo
- Do any vehicles require "filings"?*
  
  YesNo
- Are all vehicles titled in the name of your business?*
  
  YesNo
- Title Variations*
  Identify the vehicles titled outside of the business and who is on the title for each
- Do you have a Vehicle List file available to upload?*
  
  YesNo
- Vehicle List*
  
  Cancelof
- How many vehicles do you have?*
- Year*
- Make*
- Model*
- VIN Number*
- Radius*
- Trailer Length (If Applicable)
- Garaging Zip Code of Vehicle*
- Value of Vehicle*
- Permanently Attached Equipment Value (If Any)
- Year*
- Make*
- Model*
- VIN Number*
- Radius*
- Trailer Length (If Applicable)
- Garaging Zip Code of Vehicle*
- Value of Vehicle*
- Permanently Attached Equipment Value (If Any)
- Year*
- Make*
- Model*
- VIN Number*
- Radius*
- Trailer Length (If Applicable)
- Garaging Zip Code of Vehicle*
- Value of Vehicle*
- Permanently Attached Equipment Value (If Any)
- Year*
- Make*
- Model*
- VIN Number*
- Radius*
- Trailer Length (If Applicable)
- Garaging Zip Code of Vehicle*
- Value of Vehicle*
- Permanently Attached Equipment Value (If Any)
- Year*
- Make*
- Model*
- VIN Number*
- Radius*
- Trailer Length (If Applicable)
- Garaging Zip Code of Vehicle*
- Value of Vehicle*
- Permanently Attached Equipment Value (If Any)
- Commercial Auto Additional Notes
- Workers Compensation
- Owner Details
- Number of Owners*
- Name*
  
  First NameLast Name
- Date of Birth*
  
  MonthDayYear
  Date
- Title*
- *Note: If you choose to exclude the owner from Worker's Comp benefits, they must be at least 25% owner
- Duties*
- Ownership Percentage*
- Exclude?*
  
  YesNo
- Name*
  
  First NameLast Name
- Date of Birth*
  
  MonthDayYear
  Date
- Title*
- *Note: If you choose to exclude the owner from Worker's Comp benefits, they must be at least 25% owner
- Duties*
- Ownership Percentage*
- Exclude?*
  
  YesNo
- Name*
  
  First NameLast Name
- Date of Birth*
  
  MonthDayYear
  Date
- Title*
- *Note: If you choose to exclude the owner from Worker's Comp benefits, they must be at least 25% owner
- Duties*
- Ownership Percentage*
- Exclude?*
  
  YesNo
- Name*
  
  First NameLast Name
- Date of Birth*
  
  MonthDayYear
  Date
- Title*
- *Note: If you choose to exclude the owner from Worker's Comp benefits, they must be at least 25% owner
- Duties*
- Ownership Percentage*
- Exclude?*
  
  YesNo
- Name*
  
  First NameLast Name
- Date of Birth*
  
  MonthDayYear
  Date
- Title*
- *Note: If you choose to exclude the owner from Worker's Comp benefits, they must be at least 25% owner
- Duties*
- Ownership Percentage*
- Exclude?*
  
  YesNo
- Does your business have a documented Safety Program?*
  
  YesNo
- Safety Program Documents*
  
  Cancelof
- Employee/Payroll Details
  
  *Note: Employee Category Examples: Clerical, Driver, Technician, Retail, Electricians, HVAC, Plumbers, Artisan Contractor
- List the Employee Category, Number of Employees, and Payroll Category Total*
  One category per line
- Workers Compensation Additional Notes
- Errors and Omissions
- Limits of Liability*
- Errors and Omissions Additional Notes
- Cyber
- Limits of Liability*
- Cyber Additional Notes
- Directors and Officers
- Limits of Liability*
- Directors and Officers Additional Notes
- Inland Marine
- Inland Marine Schedule - Mobile
- Do you have an equipment list to upload?*
  
  YesNo
- Equipment List*
  
  Cancelof
- List Item Description, Serial Number, Make/Model, and Item Value*
  One item per line. Schedule any item values at $500 or more
- Total Estimate Value of Misc. Tools/Equipment under $500*
- Inland Marine Additional Notes
- Crime
- Limits of Liability*
- Crime Additional Notes
- Umbrella
- Limits of Liability*
- Deductible*
- Umbrella Additional Notes
- Group Health
- Company Desired Coverrages*
  
  Major MedicalDentalVisionLifeShort Term DisabilityLong Term DisabilityOther Ancillary Coverages
- Other Ancillary Coverages Types*
- 1. Download a copy of the Group Health Census Form.
  
  2. Fill it up with the necessary details
  
  3. Once completed, upload it below
- Group Health Census Form Upload*
  
  Cancelof
- Group Health Additional Notes
- Owner Name*
  
  First NameLast Name
- Builder Name*
  
  First NameLast Name
- Are you the owner or contractor?*
  
  OwnerContractor
- Property Location Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- How many buildings are at this location?*
- Cost of Labor*
- Cost of Materials*
- Construction Type*
- Roof Type*
- Number of Stories*
- Square Feet*
- Cost of Labor*
- Cost of Materials*
- Construction Type*
- Roof Type*
- Number of Stories*
- Square Feet*
- Cost of Labor*
- Cost of Materials*
- Construction Type*
- Roof Type*
- Number of Stories*
- Square Feet*
- Cost of Labor*
- Cost of Materials*
- Construction Type*
- Roof Type*
- Number of Stories*
- Square Feet*
- Cost of Labor*
- Cost of Materials*
- Construction Type*
- Roof Type*
- Number of Stories*
- Square Feet*
- Inside City Limits?*
  
  YesNo
- Distance to Fire Hydrant*
- Distance to Fire Station*
- Remodeled or New Construction?*
  
  RemodeledNew Construction
- Pre-Construction Value*
- Year of Original Construction*
- Description of Renovations*
- Has Construction Begun?*
  
  YesNo
- Construction Start Date*
  
  MonthDayYear
  Date
- Expected Completion Date*
  
  MonthDayYear
  Date
- Flood Needed?*
  
  YesNo
- Mortgage Company
- Builders Risk Additional Notes
- Limits of Liability*
- Cargo Additional Notes
- Type of Bond*
- Bond Amount*
- Bond Additional Notes
- Upon clicking Submit, you will be directed to a page where you can upload a copy of your current insurance policies to our agency.
- Should be Empty:

Commercial Fast App

Coverage Requested

Commercial General Liability

Commercial Property

Commercial Auto

Workers Compensation

Errors and Omissions

Cyber

Directors and Officers

Inland Marine

Crime

Umbrella

Group Health