INSURED SECTION

DESCRIBE YOUR BUSINESS

Legal Entity:

PROPERTY AND COVERAGE INFORMATION

Is the location address the same as the company address?
If No, please enter the building address:
If older than 20 years, please enter the year any updates were made to the building:
Are there other businesses in the same building?
If Yes, please provide a complete description of the other businesses:
Please check the type of building construction (check only one):
Is your building 100% sprinklered?

COVERAGE REQUESTED

General Liability Limits:
For this building, are you the:
Deductible: (check only one)

Upload Loss Runs/Loss History

For a fast Turnaround Time on your quote please upload the files below.

  • DRIVERS LICENSE
  • REGISTRATION
  • CURRENT CERTIFICATE OF INSURANCE.
  • IFTA REPORTS
  • LOSS RUNS