Agent Info:
Name : Jen K
License ID : 9793086
Phone : (949) 258-9835
Email : [email protected]
Address : 2072 Orchard Drive, Newport Beach, California, 92660

Automotive

  • Applicant
  • Business
  • Business Location
  • Policy
  • Losses
  • Coverage
  • Miscellaneous
  • Finish

Applicant

First Name *
Last Name *

Where should we send your quote?

Email *
Phone *

Please fill all the mandatory questions.

Business

Business Info

Business /​ Company Name *
Years in Business
DBA (If Applicable)
FEIN # (If Applicable)
Organization Type

Internal

Type of Business *
Specify Business *
Number of Full Time Employees
Number of Part Time Employees
Annual Payroll *
Estimate Annual Sales *
Description of Business
Number of Vehicles stored overnight?
What is the average value of each car?
What would be the maximum value of all cars stored at night in your custody ?

Please fill all the mandatory questions.

Business Location

Building Info

Business Address
Address *
City *
State *
Zip Code *
Construction Type
Roof Type
Total Square Feet
Year Built
Number of Stories
Number of Basement
Specify the Business

Building Renovations

Year Wiring was renovated
Year Heating was renovated
Year Plumbing was renovated
Year Roofing was renovated

Security

Burglar Alarm Type
Percent of Protection that are sprinklers
Type of Safety Program *

Please fill all the mandatory questions.

Policy

History

Reason for Cancellation
Please describe how or why are you using drones? *

Prior Carrier

Name of Carrier *
Policy Number *
Expiration Date of Policy

Please fill all the mandatory questions.

Losses

loss 1

Loss Details

Type of Loss *
Date of Loss
Amount of Loss
Details of Loss

Please fill all the mandatory questions.

Coverage

Property Coverage

Building Limit *

(Sq ft. * Cost per Sq ft.)

Deductible *
Business Personal Property
Personal Property of Other (If Any)
Actual Loss of Income /​ Rent
Specify loss income/rent *

Additional Property Coverage

Building Ordinance Coverage *

Liability Coverage

Occurrence /​ Aggregate
Product Liability

(Same as Aggregate Limit)

Liquor Classification *
Annual Liquor Sales *

Additional Policies

Umbrella Limit

Please fill all the mandatory questions.

Miscellaneous

Do any of the following apply to your business?

Please fill all the mandatory questions.



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