https://businessinsurancelosangeles.com/wp-content/plugins/nex-formsfalsemessageThank you for connecting with us. We will respond to you shortly.1https://businessinsurancelosangeles.com/wp-admin/admin-ajax.phphttps://businessinsurancelosangeles.com/business-owners-policy-quoteno Name of Your CompanyContactMailing AddressProperty Address(if different than mailing address)FEIN # (9 numbers)Website address:Phone NumberEmailWhat is your business entity--- Select ---Sole ProprietorLLCPartnershipCorporationTrustOtherNature of Business:Please explain your type of business--- Select ---RetailersWholesalerHabitational (Apartment or Condo building)ContractorsManufacturersOfficeTechnology ServicesBuilding other than residentialHealth careAuto Repair, Body ShopCommercial TrucksBrief description of your business:NextWhen does your policy ExpireWho is the present carrier? --- Select ---The HartfordHiscoxNextTravelersChubbNationwideFarmers InsuranceLiberty MutualCNAThe HanoverAmTrustAllstateState FarmProgressive CommercialPhiladelphia Insurance CompaniesOthersHave you had any losses in the past 3 Years?--- Select ---YesNoType Of Loss--- Select ---Water DamageFireTheftVandalismBodily injuryProperty DamageOtherAmount of LossDate Of LossOthers. Please specifyWhat is your estimated annual sales?How many Employees do you have?What is your estimated annual payroll? Estimate Annual Liquor sales if any?Only applicable for Liquore stores, Grocery Stores and RestaurantsNextBusiness personal PropertySeparate StructureLoss of Income Business personal Property of othersBuilding Ordinance or LawElectronic Data ProcessingEquipment BreakdownCargo Or TransportationExtended Replacement cost--- Select ---100%125%150% NextPlease let us know about your propertyBuilding Structure--- Select ---Frame StuccoJoisted Masonry (1 or2 stories concrete block with wood frame)Fire resistive, (Concrete with multiple stories)Masonry (Brick, Stone)OtherYear BuiltTotal Building Square feetThe Building Square feet you are occupyingDo you Own the Building--- Select ---YesNoTenant OccupiedNumber of storiesNumber of unitsDo you have a swimming pool?--- Select ---N/A12345Number of swimming pools?--- Select ---Option 1Option 2Option 3 Is it fenced and locked?--- Select ---YesNoHas the building been renovated--- Select ---YesNoBuilding upgrades and year Please show the items below were replaced and whenElectricalPlumbingHeatingRoofWhat was updated? --Select----Select-- CloudyCloudy Partly CloudyPartly Cloudy SunnySunny SunnySunnyWhen was the update? --Select----Select-- CloudyCloudy Partly CloudyPartly Cloudy SunnySunny SunnySunnyDo you carry worker's compensation?--- Select ---Option 1Option 2Option 3 Do you carry Group Health Insurance?--- Select ---YesNoIs Building Sprinklered?--- None---10%30%50%100%Do you have an Alarm?--- None---Local BurglaryLocal Burglary and FireCentral BurglaryCentral Burglary and FirePlumbingElectricalRoofHeatingWhat percentage of total building is vacant?--- Select ---10%-30% Vacant30% - 50% Vacant50%- 70% Vacant70% - 100% VacantNextLiability Limit Occurrence / Aggregate--- Select ---1,000,000 / 2,000,0002,000,000/ $4,000,000Product and completed operation--- Select ---1 M2 M4 MUmbrella LimitWould you like to add umbrella coverage?--- Select ---1,000,0002,000,0003,000,0004,000,000Commercial General LiabilityThe first limit is Occurrence and the 2nd limit is aggregate (Maximum limit per year)--- Select ---500,000 / 1,000,0001,000,000 / 2,000,0002,000,000 / 4,000,000Liquor Liability--- Select ---N/A5000001000000Deductible--- Select ---5001,0002,5005,000Building Limit:SCost Per Square Foot (X) Total Square Footage of The Buildingub labelBusiness Personal Property:How much it would cost to replace all your fixtures equipment stocks, etc?Loss of Income and Extra Expenses:Annual Loss of Income which includes temporary cost of location and operationNon Owned Auto--- Select ---YesNoHired Auto--- Select ---YesNoOptional CoveragesProfessional Liability E&O--- Select ---1 M2 M5 MN/ADirector and officers Liability--- Select ---1 M2 M5 MN/AEmployment Practice Liability Insurance--- Select ---1 M2 M5 MN/ACyber Liability--- Select ---$10,000$50,000$100,000$500,000$1,000,000N/AFrequently Selected Coverage OptionsPlease select all options you would like to have (Click all that apply)Building Ordinance or LawBackup of Sewers & DrainsComputer Fraud (Data Breach)EarthquakeEarthquake Sprinkler LeakageTransportation/CargoGaragekeepersEmployment Practice Liability (EPLI)Commercial VehiclePersonal Property of OthersBailee (customer's goods in your care custody and control)Equipment BreakdownAccount Receivable / Valuable PaperProfessional LiabilityLiquor LiabilityNon-Owned, Hired AutoDirectories and OfficesOtherSubmit
