Commercial BOP Insurance Quote
1
Applicant Info
2
Premises Info
3
Nature of Business Info
4
General Info
5
Prior Carrier Info
6
Coverage Info
First Name
*
Last Name
*
Phone Number
*
Personal Number
Email Address
*
Mailing Address
*
Website Address
*
Legal Entity
*
Corporation
Individual
Joint Venture
LLC
Non-Profit Organization
Partnership
Subchapter Corporation
Trust
Other
Please Specify
Number of Members and Managers:
If you know
GL Code (Optional)
SIC (Optional)
NAICS (Optional)
FEIN (Optional)
1
Applicant Info
2
Premises Info
3
Nature of Business Info
4
General Info
5
Prior Carrier Info
6
Coverage Info
Business Address:
*
State
*
City
*
Zip Code
*
Building Type of Occupancy:
Number of Stories
*
Are you the:
Owner
Tenant
How big is the building:
Total Building Occupancy
less than 5 Percent
10 Percent
25 Percent
50 Percent
75 Percent
100 Percent
Square footage of your premises
Year Built
Is your operation habitational? (Habitational Only: Apartments, Condos, Hotels, and Motels)
*
No
Yes
Number of Units
*
Number of Swimming Pool(s):
*
Select all that apply
Approved Fence (Auto Lock)
Limited Access
Diving Board
Slide
Above Ground
In-Ground
Life Guard
Has the building been renovated?
No
Yes
Electrical
Percentage of Renovation
Year Renovated
Plumbing
Percentage of Renovation
Year Renovated
Heating
Percentage of Renovation
Year Renovated
Roof
Percentage of Renovation
Year Renovated
Construction Type
Frame Stucco
Joisted Masonry
Masonry
Other
Type of Alarm
Local Burglary
Local Burglary and Fire
Central Burglary
Central Burglary and Fire
None
Is your building fully sprinklered?
No
Yes
Please choose the percentage of the building protected by fire sprinkler:
10 Percent
30 Percent
50 Percent
70 Percent
100 Percent
Any Area Leased to Others?
No
Yes
Square footage leased to other?
Type of occupancy:
Retail
Restaurant
1
Applicant Info
2
Premises Info
3
Nature of Business Info
4
General Info
5
Prior Carrier Info
6
Coverage Info
Select your Primary Business Category below:
*
Apartment Building
Building Owner other than Habitational
Condominium Association
Hotel or Motel
Contractor
Institutional
Manufacturing
Office
Restaurant
Retail
Service
Wholesale
Other
Number of Full Time Employees
*
Number of Part Time Employees
*
Annual Sales
*
Annual Payroll
*
Year Business Started
Installation, Service, OR Repair Work Percentage:
Describe Your Business
1
Applicant Info
2
Premises Info
3
Nature of Business Info
4
General Info
5
Prior Carrier Info
6
Coverage Info
Do you have any subsidiaries?
*
Yes
No
Subsidiary Company Name:
*
Percentage Owned:
*
Relationship Description:
*
Is a formal safety program in operation?
*
Yes
No
Select all that apply:
Safety Manual
Safety Position
Monthly Meetings
OSHA
Any exposure to flammables, explosives, and chemicals?
*
Yes
No
Any policy or coverage declined, canceled, or non-renewed during the last three years for any premises or operations?
*
Yes
No
Select that apply:
Non Payment
Non Renewal
Agent No Longer Represents Carrier
Underwriting
Condition Correcte
Describe:
Any past losses or claims relating to sexual abuse or molestation allegations, discrimination, or negligent hiring?
*
Yes
No
During the last five years, has any applicant ever been indicted for OR convicted of any degree of the crime of fraud, bribery, arson, or any other arson-related crime in connection with this or any other property?
*
Yes
No
Have you had a foreclosure, repossession, bankruptcy, or filed for bankruptcy during the last five years?
*
Yes
No
Occur Date:
*
Resolve Date:
*
Explanation:
*
Has business been placed in a trust?
*
Yes
No
Name of Trust:
*
Any foreign operations, foreign products disturbed in the USA, or US Products Sold/Distributed in foreign countries?
*
Yes
No
Is the product under your label:
*
Yes
No
Do you have other business ventures for which coverage is not requested?
*
Yes
No
Do you own/lease/operate any drones?
*
Yes
No
Please describe:
*
Do you hire others to operate drones?
*
Yes
No
Please describe:
*
1
Applicant Info
2
Premises Info
3
Nature of Business Info
4
General Info
5
Prior Carrier Info
6
Coverage Info
Number of years you have been insured
0
1
2
more than 3
Name of Prior Carrier
*
Travelers
Hartford
Farmers
State Farm
All State
Chubb Corp
CNA
Firemans Fund
Gaurd
AIG
CIG
Allied Nationwide Insurance
ACE
Lloyds
Other
Please Specify
*
Have you had any losses in the last three years?
*
Yes
No
Loss #1
Date of Loss
Type of Loss
Travelers
Fire
Liability
State Farm
Water
Vandalism
Theft
Other
If Other, Please specify
Amount Paid
Subrogation
Yes
No
Claim Open
Yes
No
Add Another Loss
1
Applicant Info
2
Premises Info
3
Nature of Business Info
4
General Info
5
Prior Carrier Info
6
Coverage Info
Property Coverage
Building Limit (Sq ft.*Cost per Sq ft.)
Deductible
$500
$1,000
$2,500
$5,000
$10,000
Other
Please Specify
Business Personal Property:
Actual Loss Sustained:
12 months
24 months
Other
Please Specify
Annual Loss Building Ordinance
10 Percent
20 Percent
50 Percent
100 Percent
Personal Property of Others (if any):
Earthquake
*
Yes
No
Flood
*
Yes
No
Equipment Breakdown
*
Yes
No
Building Ordinance
*
Yes
No
Building Ordinance Coverage
10 Percent
20 Percent
50 Percent
100 Percent
Liability Coverage
Occurrence/Aggregate
$1 million to $2 million
$2 million to $4 million
Product Liability (Same as Aggregate Limit)
$1 million
$2 million
$4 million
Liquor Liability (If Applicable)
No
Yes
Annual Liquor Sales:
*
Classification:
*
Beer and Wine
Full
Hired/Non-Owned Auto
*
Yes
No
Garage Keepers Liability (Applicable for Auto Related Businesses)
Are you interested in other additional policies?
Workers’ Compensation
*
Yes
No
Professional Liability / E&O
*
Yes
No
Employment Practice Liability (EPLI)
*
Yes
No
Employee Benefits Liability
*
Yes
No
Deductible Per Claim:
Number of Employees Covered by Employee Benefits Plan
Retroactive Date
Directors & Officers Liability
*
Yes
No
Numbers of Directors & Officers
Commercial Umbrella
*
Yes
No
Amount
$1 million
$2 million
$5 million
Other
Please specify
Earthquake
*
Yes
No
Commercial Auto
*
Yes
No
Data Breaches
*
Yes
No
I agree to the
Privacy Policy
,
Terms and Conditions
Submit
Previous
Next