Business Earthquake Quote

Business Earthquake Quote Request

Your Information

Last Name*

First Name*

Email Address*

Street Address*

City*

State*

Zip Code*

Phone Number*

Alternate Phone

Business Information

Company Name

Company Street Address

City

State

Zip Code

What is the nature of your business? (Bar/Restaurant, Manufacturing, Retail, etc.) (250 chars left)

Is the business a corporation, partnership, or sole proprietorship? Corporation
Partnership
Sole Proprietorship

Number of owners

Payroll of Owners

Payroll of Employees

Total annual gross receipts

Business License Number

License Type

Years of experience

Years operated under current name

Other business names

Is this business open 24 hours a day? Yes No

Any deep frying (food)? Yes No

Is there any manufacturing, mixing, re-labeling or repackaging of products? Yes No

Is there filling of propane tanks? Yes No

Please describe the nature of your business and ANY unusual exposures: (500 chars left)

Building & Property Information

Occupancy Type

Building Type

Year Built

Total square footage of the building your business is in

What date was the property purchased?

Total square footage of the customer area only

Garage Description

How many stories is it?

If two stories, what is the ground floor square footage?

What is the construction type?

What is the foundation type?

What is the nature of sub-soil?

What is the topography?

Is there any erosion in the area?

What type of roof covering?

Was the roof updated? Yes No

If yes, what year?

What is the distance to fire protection?

Is the business in a brush area? Yes No

If yes, has the brush been cleared by 250 feet from all around the building? Yes No

Is there any below ground parking? Yes No

Is there any soft first story or tuck under parking? Yes No

Are there smoke detectors at this location? Yes No

Is there a fire extinguisher? Yes No

Is the electrical updated? Yes No

Are there circuit breakers? Yes No

Is the heating / air conditioning thermostatically controlled? Yes No

Is the heating/ air conditioning central?

Has the plumbing been updated? Yes No

If yes, what year was the plumbing updated?

Does the building have interior automatic fire sprinklers? Yes No

Claim & Coverage Information

Claim Information

Were there any losses or claims in the last 5 years? Yes
No

If yes, what is the date, amount paid and description of each loss or claim? (500 chars left)

Coverage Information

Current Insurance Company

How much are you paying now?

What is the liability limit requested?

What is the building limit requested?

What is the building deductible requested?

What is the business personal property (contents) limit requested?

What is the earthquake deductible?

What is the loss of income requested?

Please let us know the best time to call and discuss your quote. Morning
Afternoon
Evening
Anytime

Questions or Comments (1000 chars left)

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