Our Experts Are Available to Help You
Interested In
Areas of Specialization
Business Insurance
Personal Insurance
Employee Benefits
Security Verification
+
=
Submit
Search for
Search
Toggle navigation
MENU
ABOUT US
Who We Are
Testimonials
Careers
Contact Us
CLIENT CENTRAL
HRnet
Claims
Business Clients
Add/Delete A Driver
Add/Delete A Vehicle
Add/Change Location
Personal Clients
Add/Delete A Driver
Add/Delete Vehicle
Insurance Companies/Specialty Markets
REQUEST A QUOTE
Associations and Not-For-Profit
Biotech, Medtech and Life Sciences
Cleaning and Restoration Services
Cyber Liabiity
Directors and Officers Liability
Employment Practices Liability
General Business
General Quick Quote Request
Group Health Employee Census
Group Life & Disability Employee Census
Homeowners
Information Technology
International and Defense Base Act
International Medical and Travel Products
Investment Property
Kidnap & Ransom
Personal Automobile
Professional Cleaning Services Program
Residential Cleaning Services
Blog
(855) 868-0170
Toggle navigation
MENU
AREAS OF SPECIALIZATION
Retail Industry
Non-Profit Organizations and Associations
Professional/Commercial Cleaning Services Program
Technology Industry Professionals
International and Defense Base Act
Management & Professional Liability
Biotech & Life Sciences
Cleaning and Restoration Services
Professional Services – Medical, Legal, Architects, Accountants
Manufacturers, Wholesalers, and Distributors
Contractors – Small, Medium, and Large
Personal High Net Worth Individuals and Families
International Medical and Travel Products
BUSINESS INSURANCE
Overview
Commercial Property & Liability
Business Automobile
Cyber Liability Insurance
Workers’ Compensation
Umbrella Liability
Management & Professional Liability
Business Travel Accident
Surety Bonding
PERSONAL INSURANCE
Overview
Homeowners
Personal Automobile
Personal Umbrella Liability
Valuable Items
Flood Insurance
Watercraft
Motorcycle
Motorhome
Investment Property
Renters Insurance
Individual Life & Disability Insurance
EMPLOYEE BENEFITS
Overview
Group Life Insurance
Group Health Insurance
Group Disability Insurance
Group Dental Insurance
Supplemental Insurance
Group Life Census Worksheet
Group Health Census Worksheet
Add/Change Location
GENERAL INFORMATION
Business Name (incl Corp and T/A names)
Date
Date Format: MM slash DD slash YYYY
Requestor Name & Contact Information (phone / email)
Delete Current Location?
Yes
No
Effective Date of Deletion
Address of Location to Delete
Effective date to Add Location
Use New Location for Mailing?
Yes
No
New Location Address
LOCATION / BUILDING INFORMATION
Type of building (office, retail strip mall, industrial, etc.)
Owner or Tenant?
Sq Ftg You Occupy
Stories
Approx Year Built
Construction (Frame, Masonry, Noncombustible, Fire Resistive, etc)
% of Bldg Sprinklered
If bldg over 30 yrs old, Year(s) Updated for Wiring, Heating, Plumbing, Roof
Alarm? Burglar or Fire? Local or Central Station?
COVERAGE LIMITS REQUESTED
Building
* Contents Replacement Value
Improvements & Betterments
Business Income & Extra Expense
Computer Hardware
Computer Software (data & media)
Valuable Papers
Accounts Receivable
Exterior Sign?
Building Glass (measurements)
Other Property Used or Stored Off Premises (describe & value)
Total Misc Mobile Tools & Equipment (max $,1000 value per item)
Scheduled Mobile Equipment (for individual items exceeding $1,000 in value)
ATTACH SCHEDULE
Do you rent or loan equipment to others? If Yes, please provide details
Yes
No
* Contents may include, but is not limited to: Leasehold Improvements, Leased Property, Inventory, Furniture/Fixtures, Equipment, Printed Materials, Consumables, and Property of Others in Your Care. Please consult your lease requirements when choosing the coverage and limits for this location.
OTHER
** Issue Certificate of Insurance to Landlord?
Yes
No
** List Landlord as Additional Insured?
Yes
No
Landlord Name and Address:
Comments / Additional Information / Instructions
** Please carefully review your lease for all insurance requirements.
Tweet
Share
Share
0
Shares
