Commercial Insurance Quote Form (Updated)

Doherty Insurance Group Commercial Application

Fill the fields below to the best of your knowledge and we will reach out to our carriers and find the most competitive rate for you.
The Basics
Name *

First Name Last Name
Company Name *
Company Name
Please Choose Entity Type *

Corporation Individual Joint Venture LLC Not For Profit Partnership Trust
Business Phone Number *

Area Code Phone Number
E-Mail *
Email
Website
EIN#
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Location Square Footage
Number of Full Time Employees *
Number of Part Time Employees *
Annual Revenue (estimate if in business for less than one year) *
Application Questions
Date Entity Started *

Month Day Year
Date
Please provide us with a brief explanation of your business. *
Do you have any other subsidiaries?

Yes No
If Yes, please provide subsidiary company name, relationship description, and percent ownership below.
Are you a subsidiary of another entity?

Yes No
If Yes, please provide parent company name, relationship description, and percent ownership below.
Does any named insured sell to other named insureds?

Yes No
Do you install, service, or demonstrate products? Check all that apply.

Install Demonstrate Service
Do you use guarantees, warranties, or hold harmless agreements? Check all that apply.

Guarantees Warranties Hold Harmless Agreements
Have you sold, acquired, or discontinued a business in the last five years?

Yes No
Do you have any products that were recalled, discontinued, or changed?

Yes No
Do you use products of others that are sold or re-packaged under your company name?

Yes No
Is Vendor's Coverage Required? (Do you have distributors for your product?)

Yes No
Do you rent or loan equipment to others?

Yes No
Is there a formal, written safety and security policy in effect? (Safety manual, safety position, monthly meetings, OSHA)

Yes No
Any exposure to flammables, explosives, or chemicals?

Yes No
Have you had any claims in the last five years?

Yes No
Do you use drones in your business?

Yes No
Drones are:

Owned/Leased/Operate Contracted Out
Do you want any property coverage INSIDE the premises?

Yes No
Amount of insurance needed for equipment or business property
Description of property wanting to be covered
Any spoilage coverage needed?

Yes No
Any inventory need to be covered?

Yes No
Construction Type of building property (Frame, Stucco, Metal, Masonry, Concrete, etc.)
Year building property was built
Should be Empty:

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Doherty Insurance Group Commercial Application

The Basics

Application Questions