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

Quick Quote - EPLI

  • Applicant
  • General Information
  • Current EPLI Coverage
  • Miscellaneous
  • Finish

Applicant

Can you tell us about yourself?

First Name *
Last Name *
Email *
Phone *

Please fill all the mandatory questions.

General Information

Business Name

Business Address

Address *
City *
State *
Zipcode *
Nature of Business
Year Established
Annual Revenues

Total number of employees

( including Partners, Directors and Officers, at all locations)

Full Time Employee
Part Time Employee
Temp/​Leased Employee
Seasonal Employee
Contract Employee

Terminations / Layoffs

Number of Involuntary Terminations in past 12 months, if any:
Any anticipated/​pending layoffs, or any layoffs within the last 12 months?

Please fill all the mandatory questions.

Current EPLI Coverage

EPLI Coverage
Current policy expiration date:
What are the limits?
What are the deductible?
What are the premium?
P&P/​Continuity dates if prior coverage:

Please fill all the mandatory questions.

Miscellaneous

Please fill all the mandatory questions.



Your details has been submitted successfully.