Business Insurance Quote


Business Insurance Quote or Commercial Insurance
Name 
Email 
Phone 
Website Adress (if any) 
Business Information
Business Name 
Sole Proprietor /Partnership/Corporation 
Mailing Address Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Business Address (If different from Mailing Address) Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Building Construction Details & Protection Details
Exterior Walls : 
Roof : 
Floor : 
Type of Heating : 
Type of Electrical System : 
Total Area of Building (including Basement) in Sq Ft or Sq Meters 
Area Occupied by Insured in Sq Ft or Sq Meters 
Number of Storeys (Excluding Basement): 
Does Building have Basement? YesNo
Which Year Was Building Built? 
If over 20 years old have updates been carried out YesNo
Year Roof updated 
Year Heating updated 
Year Electrical updated 
Year Plumbing updated 
Distance to hydrant (in feets/meters) 
Distance to Fire Hall (in Kms/in miles) 
Building Type : Industrial MallResidentialApartment Building
Fire Alarm System MonitoredLocalNone
Burglary Alarm System MonitoredLocalNone
Neighbouring Exposure To Left Hand Side : type of building/business -Adjoing or how many feets away 
To Right Hand Side : type of building/business -Adjoing or how many feets away 
Years in Business: 
Please provide a brief description on the nature of your business activities : 
Annual Gross Receipts (Income): or Gross Annual Revenue : 
Number of Active Owners: 
Insurance Information
Previous insurance cancelled, declined or non-renewed in the last 3 years? YesNo
Are you insured previously? YesNo
If yes, please specify the name of the company and number of years insured 
Any Prior Claims: 
Coverage Information :
Building Amount : 
Contents Amount : 
Liability Amount 
Deductible : 
Business Interruption 
Other : 
Annual Payroll (including owners) 
No of full time employess and number of part time Employess(including owners) 
Are all employee’s covered by worker’s compensation? If no, please provide details of class of employees not covered 
Do you subcontract work ? YesNo
If yes, what percentage of your work is subbed, and what kind of work? 
If yes, then you are required to obtain Certificates of Insurance obtained from all sub-contractors How much limit accepting from sub contractors 1 million or 2 million 
Do you have written contracts with sub-contractors? YesNo
Comments/Remarks (if any) : 
The completion of this form is for quote purpose and does not provide any insurance coverage. We may require more information in order to provide a quote. This quote request contains some information about coverage offered but it does not contain all.
 
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