Pretige Commercial Lines

Commercial Insurance Quote
Name*

First NameLast Name
DBA (if applicable):
Principal Contact (if different)

First NameLast Name
Primary Phone*

Area CodePhone Number
Email*
example@example.com
Business Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tax ID:
Legal Entity (check One):

CorporationLLCPartnershipIndividualNot-For-ProfitOther
Description of Operations*
Year Business was Established:*
eg. 1995
Years of Owner’s Experience in Industry:
eg. 5 years
Estimated Gross Annual Revenue: *
Estimated Gross Annual Payroll: *
Full Time Employees
Part Time Employees
Subcontractors

YesNo
Name of Current Liability Insurance Carrier:
Policy Expiration Date:
Retroactive Date: (if any):
Current Liability Limits:
Name of Current Property Insurance Carrier:
Policy Expiration Date:
Current Property Limits:
INSURANCE COVERAGE REQUESTED (Check All that Apply):

Business IncomeEmployers Practices LiabilityBondWindstormFloodBusiness Owners Policy (BOP)Product LiabilityCommercial General LiabilityCyber LiabilityProfessional LiabilityCrimeCommercial AutomobileData Breach LiabilityDirectors & Officers LiabilityOther
Additional Insured (s) Required:

YESNO
Liability Limits Desired

$1,000,000/$1,000,000$1,000,000/$2,000,000$2,000,000/$4,000,000Other
Waiver of Subrogation?

YESNONot Sure
Hired & Non-owned Auto?

YESNONot Sure
PROPERTY DETAILS:
Are you the Owner of Building?

YESNO
If yes, please state total Square Feet of Building:
If you are a Tenant, please state Total Square Feet of your leased space:
PROPERTY COVERAGE & LIMITS DESIRED
Building Limit:
Business Personal Property (BPP) Limit:
Business Income Limit:
Ordinance or Law Coverage:
AOP Deductible:
Premises Location & Building Information:
Location 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Building Construction Type:
Number of Stories:
% Sprinklered
Sprinklers

Entire BuildingCommon areas onlyNo sprinklersOther
Year Built:
If building owned - State Year of All Building Updates:

Year Renovated (Mandatory if building is greater than 10 years old):
Roof
Electrical
Plumbing
Heating/AC
Select all that apply

Central Station Fire AlarmCentral Station Burglar AlarmNone
SmokeDetectors:

YESNOBatteryHardwired
Should be Empty:

Commercial Insurance Quote