Step 1 of 6 16% Where Should We Send Your Quote?Business Name* Please include the type of business (Inc., LLC, Sole Proprietor, etc.) Do you have a Fictitious Name (DBA)* Yes No Fictitious Business Name Insert Fictitious Business Name (DBA) What does your business do?* For Example: Travel Agency, Event Planner, etc..Approximately when did your business begin (i.e. date of formation)?* Month Day Year What date would you like your coverage to begin?* Month Day Year Please select one or more of the coverage types below for which you would like a quote* Business Owner’s Policy (Combines General Liability and other coverages) Cyber Liability Insurance (Privacy, Data, and Networks) General Liability Insurance (Most Common) Professional Liability Insurance (i.e. Errors and Ommissions Insurance) Please note that not all insurance types listed above may be available in your particular area.Name of Contact Person* First Last Email Address to Send Quote* Phone Number* Business LocationBusiness Location* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you have another location you'd like to enter?* Yes No Business Location #2 Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Professional Liability (E&O) QuestionnaireDuring the next 12 months, what percentage of your expected gross sales will you earn from your largest customer?*For the next 12 months, what is the total expected revenue of your business?*Does your business perform any of the following?* Book travel arrangements using travel reward points through a rewards broker Tour operator or transportation (i.e. you physically drive the bus, etc.) None of the above Aggregate Limit*$2,000,000$1,000,000$750,000$500,000$250,000This the total amount the insurance carrier can pay for damages, losses, etc. under your policy subject to your policy provisions.Each Claim Limit*$2,000,000$1,000,000$750,000$500,000$250,000This the total amount the insurance carrier can pay for damages, losses, etc. under your policy resulting from any one occurrence subject to your policy provisions. NOTE: THIS LIMIT CANNOT BE HIGHER THAN THE AGGREGATE LIMIT SELECTED ABOVE.Professional Liability (E&O) Coverage Upgrades (Additional Premium May Apply)Would you like to include Waiver of Subrogation?* Yes No This selection waives a carriers righ to legally pursue a negligent third party that causes a loss subject to your policy provisions. It’s sometimes required by your client as part of a contractual agreement.Would you like to include Contingent Bodily Injury and Property Damage?* Yes No This selection covers bodily injury and property damage cliams that arise out of your professional services subject to your policy provisions.Select your Contingent Bodily Injury and Property Damage limit*$200,000$100,000$50,000 Business Owners Policy (BOP) QuestionnaireDo you or business supply, manufacture, or distribute tangible goods or products?* Yes No For example: Computer hardware, fitness equipment, etc. This would not include items such as tickets, brochures, etc.Does your business perform any design, construction, installation, removal, or physical repair of any property or tangible good?* Yes No Is your business operated out of your home?* Yes No Enter the total number of square feet your business occupies at this location*Does your business own and need coverage for the building?* Yes No Are there multiple occupants in the building?* Yes No Does your building have a professional management team?* Yes No What type of roof is on the building?*Aluminum ShinglesAsbestosAsphaltCedar ShakesCedar ShinglesClay TileCompositionConcrete TileCopperFiberglassFlatMetalOtherPlasticPouredRecycled Roofing ProductsRockRoll RoofingRolled PaperSingle Ply Membrane SystemSlateSteel on Steel JoistSteel/Porcelain ShinglesTar and GravelTileTinWD ShinglesWood Shake/ShinglesDescribe the construction of the building*Fire ResistiveFrameJoisted MasonryMasonry Non-CombustibleModified Fire-ResistiveNon-CombustibleDoes the building have a basement?*NoFinishedUnfinishedHow many stories is this building?*1234 or moreEnter the approximate year the building was built*What is the replacement cost of the building at this location?*The replacement cost amount you select should equal the cost to rebuild the building with materials of like kind and quality. Selecting a limit that is less than 80% of the full replacement cost may limit your ability to recover the full amount of a loss under the policy.General Liability LimitsAggregate General Liability Limit*$2,000,000$1,500,000$1,000,000$600,000This the total amount the insurance carrier can pay for damages, losses, etc. under your policy subject to your policy provisions.General Liability Occurence Limit*$2,000,000$1,500,000$1,000,000$500,000This the total amount the insurance carrier can pay for damages, losses, etc. under your policy resulting from any one occurrence subject to your policy provisions. NOTE: THIS LIMIT CANNOT BE HIGHER THAN THE AGGREGATE LIMIT SELECTED ABOVE.Business Equipment Limits & DeductibleBusiness Personal Property Coverage Limit*$100,000$90,000$80,000$70,000$60,000$50,000$45,000$40,000$35,000$30,000$25,000$20,000$15,000$10,000Please choose a coverage limitBusiness Personal Property Deductible*$10,000$7,500$5,000$2,500$1,000$500Coverage Upgrades (Additional Premium May Apply)Would you like to include coverage for Terrorism?* Yes No This covers losses arising out of certified acts of terrorism as defined by the Terrorism Risk Insurance Act.Would you like to include coverage for Hired Auto and Non-Owned Auto?* Yes No This covers your business for bodily injury and property damage claims by someone outside your organization, which arises out of you or your employee driving a rented or non-owned (i.e. your employee’s personal car) vehicle for business purposes subject to your policy provisions.Hired Auto and Non-Owned Auto Coverage Limit*$1,000,000$500,000$250,000$100,000$50,000Please choose a coverage limitHired Auto and Non-Owned Auto Deductible*$25,000$15,000$10,000$7,500$5,000$2,500$1,000$500$0Would you like to include coverage for Crime Insurance?* Yes No This covers losses of money or damage to covered property caused by theft or dishonest acts by an employee, fradulent computer transfers, or cyber deception, and theft of client’s property by an employee subject to your policy provisions.Crime Insurance Aggregate Limit*$1,000,000$500,000$250,000$100,000$50,000$25,000$10,000Crime Insurance Occurence Limit*$1,000,000$500,000$250,000$100,000$50,000$25,000$10,000Crime Insurance Deductible$10,000$5,000$2,500$1,000$500 General Liability QuestionnaireDo you or business supply, manufacture, or distribute tangible goods or products?* Yes No For example: Computer hardware, fitness equipment, etc. This would not include items such as tickets, brochures, etc.Does your business perform any design, construction, installation, removal, or physical repair of any property or tangible good?* Yes No Is your business operated out of your home?* Yes No Are you contemplating any structural alterations to your premises?* Yes No Enter the total number of square feet your business occupies at this location*Enter the total number of square feet your business occupies at Location #2*For the next 12 months, what is the total expected revenue of your business?*For the next 12 months, what is the total expected payroll of your business?*General Liability – Aggregate Limit*$2,000,000$1,500,000$1,000,000$600,000This the total amount the insurance carrier can pay for damages, losses, etc. under your policy subject to your policy provisions.General Liability – Occurence Limit*$2,000,000$1,500,000$1,000,000$500,000This the total amount the insurance carrier can pay for damages, losses, etc. under your policy resulting from any one occurrence subject to your policy provisions. NOTE: THIS LIMIT CANNOT BE HIGHER THAN THE AGGREGATE LIMIT SELECTED ABOVE.General Liability Coverage Upgrades (Additional Premium May Apply)Would you like to include coverage for Terrorism?* Yes No This covers losses arising out of certified acts of terrorism as defined by the Terrorism Risk Insurance Act.Would you like to include coverage for Business Property & Equipment?* Yes No This covers loss or damage to your business personal property such as computers, printers and furniture subject to your policy provisions. It also includes some coverage for property away from your premises.Business Property & Equipment Coverage Limit*$25,000$20,000$15,000$10,000$5,000Please choose a coverage limitWould you like to include coverage for Hired Auto and Non-Owned Auto?* Yes No This covers your business for bodily injury and property damage claims by someone outside your organization, which arises out of you or your employee driving a rented or non-owned (i.e. your employee’s personal car) vehicle for business purposes subject to your policy provisions.Hired Auto and Non-Owned Auto Coverage Limit*$2,000,000$1,000,000$500,000$300,000Please choose a coverage limitWould you like to include coverage for Waiver of Subrogation?* Yes No This coverage waives the insurer’s right to legally purse a negligent third party that causes a loss subject to your policy provisions. It’s sometimes required by clients as part of a contractual agreement.Would you like to make this coverage Primary and Non-Contributory?* Yes No As part of a contractual agreement, this coverage makes this insurance the primary, meaning the carrier will pay before any other insurance that is available and the carrier will not seek contribution subject to your policy provisions. Cyber Liability QuestionnaireHow many full time, part time, and temporary employees does your business have including all owners?*Do you conduct annual training for employees with respect to privacy matters?* Yes No Privacy matters are considered the failure to protect sensitive information.For the next 12 months, what is the total expected revenue of your business?*Cyber Liability Aggregate Limit*$1,000,000$500,000$250,000This the total amount the insurance carrier can pay for damages, losses, etc. under your policy subject to your policy provisions.Cyber Liability Occurence Limit*$1,000,000$500,000$250,000This the total amount the insurance carrier can pay for damages, losses, etc. under your policy resulting from any one occurrence subject to your policy provisions. NOTE: THIS LIMIT CANNOT BE HIGHER THAN THE AGGREGATE LIMIT SELECTED ABOVE.Cyber Liability Deductible*$25,000$20,000$15,000$10,000$5,000$1,000Cyber Liability Coverage Upgrades (Additional Premium May Apply)Would you like to include coverage for Terrorism?* Yes No This covers losses arising out of certified acts of terrorism as defined by the Terrorism Risk Insurance Act.Would you like to include coverage for Media Liability?* Yes No This covers costs to defend and resolve claims related to online content, such as copyright or trademark infringement, invasion of privacy, defamation, unintentional infliction of emotional distress, and/or unfair practices and negligence in connection with your media activities subject to you policy provisions.Media Liability Limit*Media Liability Deductible*