Business Owners  Package (BOP)  Insurance Quote We would like to provide you with a free, no-obligation insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only. General Information Name of Insured: Address: City:   State:   Zip: Business Phone:   Fax Number: Email Address: Location Address  (type "same" if same as above): City:   State:   Zip:   Property Questions Age of building /Year Built: Type of building construction: Number of stories: Other occupancies: Square feet you occupy: --Select One-- FrameStuccoMasonry/Brick Fire ResistiveOther sq. ft. If the building is over 25 years old, please answer the following: Year Electricity was updated: Is it on circuit breakers?: Yes   No Year Plumbing was updated: Copper or Galvanized plumbing?: Copper   Galvanized   Other: Year Building was last re-roofed: Type of roofing material: Type of heating system in the building:   Protective Devices Burglar Alarm: Central Station or local alarm?: Name of alarm company: Is the building sprinklered?: Are there smoke detectors?: Y   N  Central Station  Local Alarm Y   N Y   N   Liability Questions Please provide information on previous insurance carrier: Previous Ins. Carrier: Policy number: Prior premium: Policy renewal date: $ Please provide information about your business: Years in business: Projected Gross annual receipts: Projected annual payroll: $ $     Describe your business, product or service:   Coverage Limits Building: Contents (equipment, inventory, supplies, etc.): Deductible: Loss of Income: $ $ --Select One-- $100$250$500 $1,000 $ Money and Securities: Glass or signs: General Liability Limit: Non-owned and Hired Automobile Liability: Is liquor liability needed? $ $ --Select One-- $500,000$1,000,000 $2,000,000 $ Yes   No     If Glass Coverage is needed, please provide dimensions:     Please list other coverages you may need:   Miscellaneous Information Name of Additional Insured (Landlord or vendor): Mailing Address: City:   State:   Zip:   Additional Comments Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough fields above, please enter them here. Please click on the "Submit Quote" button to send your quote request. One of our representatives will respond to your submission as soon as possible.