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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, Philip Miles /CA Lic #0K93165, AZ Lic #17963684
When do you need coverage to start?

MonthDayYear
Date
Why are you shopping for a new policy?
Example, cancelled for claims, carrier leaving market, etc
Business Contact Information
Legal Name

First NameLast Name
Date of Birth
Cell Phone #

Area CodePhone Number
Email
example@example.com
Describe your relation to the property:

Other
Entity Name To Be Insured (HOA, LLC, INC, etc)
Example, LLC or Movement, Inc.
Business Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Address To Be Insured

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What Year Was The Building Built?
Number of Units
Square Feet of Building
Please describe how each unit is used if commercial (ie restaurant, bar etc)
If this is a mixed use property Commercial and residential we need to know what commercial tenants are on property.
Does the Building Have Sprinklers Inside the Units?
Updates / Maintenance
Last year update for the roof (estimated)?
Last year update for the plumbing (estimated)?
Last year update for the electrical (estimated)?
Last year update for the heating/cooling (estimated)?
Is your property currently insured with an active policy?
Name of Current Carrier
(put N/A if none)
Have you filed ANY business insurance claims in the last 5 years?
Do you have any W2 employees?
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?
Upload LOSS RUNS, Prior Dec Page, etc.

Cancelof
Should be Empty:

Commercial Property Insurance

Business Contact Information

Updates / Maintenance