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Commercial – Business Owner’s Application

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Commercial - Business Owner's Application

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Customer Information

If you do not have a company, the name on the policy needs to match the name you are using for your vendors, permit offices or any other contracts that you have.
Mailing Address*
Contact Person*
Email*
Do you have a Web site?*
MM slash DD slash YYYY
Please provide at least the month and year.
Do you have any employees?*
Do you hire any 1099 workers (contractors/subcontractors)?*
Do your contractors/subcontractors name you as additional insured on their General Liability coverage?*
The more detailed you can be here, the better.
Does your business service, install or demonstrate any goods or products?*
Is your company in the business of selling goods/products?*
Will you require Vendor coverage?*
Do you sell goods/products on a retail or wholesale basis?*
Does your company import any products or materials?*
Please include the percentage of materials and\or products that you import as well as the country of origin.
Does your business:*
Is reasearch and development of products conducted or are new products planned?*
Are any products related to the aircraft/space industry?*
Have any products been recalled, discontinued or changed?*
Do you design the products that others manufacture for you?*
Are you authorized to repackage/rebrand these products by the manufacturer?*
Are there guarantees, warranties or hold harmless agreements in place?*
Is your company office based or service based?*
Office based is ONLY office based. If you have business operations outside of your primary business location, please select Service or Both.
Will there be any exposure to radioactive/nuclear material?*
Are there any past. present or discontinued operations involving the storage, treatment, discharging, applying, disposing or transporting of hazardous materials? (e.g. landfills, wastes, fuel tanks, etc.)*
Do you rent or loan equipment to others?*
Any watercraft, docks, or floats that are owned hired or leased?*
Are there any parking facilities owned or rented?*
Is a fee charged for parking?*
Are social events sponsored?*
Are atheltic teams sponsored?*
Are you seeking coverage for an apartment building/complex you own/are buying?*
Are there any:*
Check all that apply to the swimming pools/hot tubs' features:
What kind of parking do tenants have access to:*
Is there gated access?*
Laundry Facilities?*
Are recreational facilities provided? (e.g. playgrounds, business centers, community gyms or clubhouses)*
Are there any other types of lodging operations? (e.g. short term rentals, hotel or motel operations)*
Are any medical facilities provided or medical professionals employed or contracted?*
Have any operations been sold, acquired or discontinued in the last five years?*
Do you own 50% or more of any other business?*
Is(Are) your other business(es) set up as a separate LLC/Corp./Non-Profit, etc.?*
Do any of your other businesses share the same ownership structure as the business you're currently seeking a quote for?*
Do any of the other businesses you own share the same operations as the business you're currently seeking a quote for?*
Do your other businesses have their own insurance coverage?*
Is there a labor interchange with any other business or subsidiary?*
Do you lease employees to or from other employers?*
Is this a home-based business?*
Meaning that the business operations are executed entirely from a home office.
Are day care facilities operated or controlled?*
Have any crimes occurred or been attempted on your premises within the last three years?*
Is there a formal, written safety and security policy in effect?*
Does the business' promotional literature make any representations about the safety or security of the premises?*
Does your business use a written contract or statement of work?*
Do you or the principle of your firm maintain current and valid professional training, certifications, licenses or designations for all services you provide?*
Do your employees/workers use their own vehicles to execute tasks for your business?*
How often do your employees use their own vehicles to execute tasks for the business?*
Does your business ever rent vehicles to execute business operatoins?*

Prior Insurance / Claims

Any prior insurance?*
Any prior claims?*
Do you have loss runs that you can provide?*
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