Commercial Quote

Your Name (required)

Your Email (required)

Proposed Insured

Address

Type of Business

Tax ID

Year business started

Type of work (description)

Number of full time employees

Number of part time employees

Total Yearly Payroll

Yearly Revenue

Gas Sales in Gallons

Inside Sales in $

No. of pumps

Liability coverage

Property Information:

Year Built

Property located in strip center/stand alone building

No. of story

Construction Type

Roof type

Any updates:Roof(Year),HVAC (Year),Plumbing(Year)

Occupied Area in sq. feet

Total area of the building in sq. feet

Coverage Value for the building

Pumps

Canopy

Loss of business income

Equipment break down

Business Property value

Theft coverage

Wind coverage

Note: If it is apartment complex, please provide the following:

Total number of buildings

Total number of units in each building

Area of each unit

Any Play ground: Yes/No (Area in sq. ft if Yes)

No. of swimming pools

Fenced

Area in sq. ft of each swimming pool

Claim History – last 5 years

Date

Type of claim (property or liability)

Amount paid

Status