Commercial Property Insurance
Please complete the intake form below to the best of your ability. We'll shop our markets and present the best option based on the data you provide us. If you are a start-up and/or new business venture, start with this form as well. Thank you, Nick Ramirez / CA License #0K79987
When do you need coverage to start?
*
-
Month
-
Day
Year
Date
Business Contact Information
Legal Name
*
First Name
Last Name
Date of Birth
*
Cell Phone #
*
-
Area Code
Phone Number
Email
*
example@example.com
Describe your relation to the property:
*
I am the owner
I am the manager
Other
Entity Name To Be Insured (HOA, LLC, INC, etc)
*
Example, LLC or Movement, Inc.
Business MAILING Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Address To Insure
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What Year Was The Building Built?
*
Number of Units
*
Square Feet of Building
*
Does the Building Have Sprinklers Inside the Units?
Yes, building(s) do have sprinklers
No, no sprinklers in the building
Updates / Maintenance
How Old Is The Roof?
*
Please Select
Brand New - Less than 1 Year Old
Less than 5 Years Old
About 10 Years Old
No Idea - But it's Older than 10 Years
How Old Is The Plumbing?
*
Please Select
Brand New - Less than 1 Year Old
Less than 5 Years Old
About 10 Years Old
No Idea - But it's Older than 10 Years
Is your business currently insured with an active policy?
*
Yes
No
No - New Business Venture
Name of Current Carrier
Have you filed ANY business insurance claims in the last 5 years?
*
Yes (if selected, please upload your LOSS RUN document below)
No
Do you have any W2 employees?
*
Yes
No
What is your F-EIN number?
Annual Rent Roll or Income
*
If you're a start up, please PROJECT the annual revenue instead.
Do you have any cars that are registered to the business?
*
YES
NO
Upload LOSS RUNS, Prior Dec Page, etc.
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