Commercial Insurance Quote Request

Commercial Insurance Quote Request

Please provide the following information to receive a commercial insurance quote tailored to your business needs.
1. Applicant Information:
Legal Business Name:*
Operating/Trade Name:
Address:*

Street Address

Street Address Line 2

CityProvince

Postal Code
Website:

2. Business Details:
Type of Business Entity*
Description of Operations:
Number of Years in Business:*
Annual Gross Revenue:
Number of Employees:

3. Coverage Information:
Requested Effective Date:

MonthDayYear
Date
Limit of Liability Required ($ in Millions)*
Any prior CGL Insurance?
Name of Insurer:
Policy Number:
Any claims in the past 5 years?
Provide details:

4. Risk Management:
Are written contracts used with clients/subcontractors?
Do you obtain certificates of insurance from subcontractors?
Describe any safety or training programs in place:

5. Additional Information:
List any additional insureds required:
Any special exposures (e.g., working at heights, hazardous materials)?
Any Additional information material to the risk.
Property/Tenant Insurance Required?

YesNo

Commercial Property Insurance Questionnaire
1. Property Details:
Description of Operations at this Location:
Year Building was Constructed:
Building Construction Type
Number of Stories:
Type of Occupancy:

Percentage Occupied by Applicant:

	Percentage
Owner
Tenant

2. Coverage Information:
Requested Effective Date:

MonthDayYear
Date
Building Coverage Amount Requested:
$
Contents/Stock Coverage Amount:
$
Business Interruption Coverage:
Any Prior Property Insurance?
Name of Insurer:
Policy Number:
Any losses or claims in the past 5 years?
Details:

4. Additional Information:
Any Tenants?
List type of businesses:
Any special hazards (flammables, manufacturing, etc.):
Is there a mortgage?

YesNo

Signature and Date:
Signature:

Powered by Jotform SignClear
Date:

MonthDayYear
Date
Should be Empty: