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 NameLast Name
Company Name*
Company Name
Please Choose Entity Type*

CorporationIndividualJoint VentureLLCNot For ProfitPartnershipTrust
Business Phone Number*

Area CodePhone Number
E-Mail*
Email
Website
EIN#
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
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*

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

YesNo
If Yes, please provide subsidiary company name, relationship description, and percent ownership below.
Are you a subsidiary of another entity?

YesNo
If Yes, please provide parent company name, relationship description, and percent ownership below.
Does any named insured sell to other named insureds?

YesNo
Do you install, service, or demonstrate products? Check all that apply.

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

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

YesNo
Do you have any products that were recalled, discontinued, or changed?

YesNo
Do you use products of others that are sold or re-packaged under your company name?

YesNo
Is Vendor's Coverage Required? (Do you have distributors for your product?)

YesNo
Do you rent or loan equipment to others?

YesNo
Is there a formal, written safety and security policy in effect? (Safety manual, safety position, monthly meetings, OSHA)

YesNo
Any exposure to flammables, explosives, or chemicals?

YesNo
Have you had any claims in the last five years?

YesNo
Do you use drones in your business?

YesNo
Drones are:

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

YesNo
Amount of insurance needed for equipment or business property
Description of property wanting to be covered
Any spoilage coverage needed?

YesNo
Any inventory need to be covered?

YesNo
Construction Type of building property (Frame, Stucco, Metal, Masonry, Concrete, etc.)
Year building property was built
Should be Empty:

Doherty Insurance Group Commercial Application

The Basics

Application Questions