General Business

  • GENERAL INFORMATION

  • * PLEASE ATTACH COPIES OF YOUR CURRENT POLICY DECLARATIONS PAGES FOR MOST ACCURATE QUOTE *
  • LOCATION / BUILDING INFORMATION

  • PROPERTY

    ► 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.
  • CRIME

  • GENERAL LIABILITY

  • WORKERS COMPENSATION | OWNERS | List below all owners/officers of the business, whether active or inactive in operations


  • WORKERS COMPENSATION | Please review your current policy for all classes & codes


  • AUTOMOBILE

  • VEHICLE SCHEDULE | Please complete the below or attach a separate schedule of your own

    ** For vehicles not titled/leased in the business name, please indicate the name of the titled owner or lessee for each vehicle

  • DRIVER SCHEDULE | Please complete the below or attach a separate schedule of your own


  • OTHER COVERAGE TO CONSIDER | Would you like more information or a quotation on any of the following?

  • INSURANCE CARRIER HISTORY

  • Property & General Liability

  • Automobile

  • Workers Compensation

  • Umbrella

  • Other

  • CLAIMS / LOSS INFORMATION

    IF CURRENTLY INSURED: PLEASE CONTACT YOUR CURRENT/PRIOR AGENT(s) OR INSURANCE COMPANY(s) FOR A CURRENTLY-VALUED LISTING OF YOUR CLAIMS HISTORY (“LOSS RUNS”) FOR THE PAST 3 YEARS