BOP insurance quote | Small Business Insurance California

First Name *

Last Name *

Phone Number *

Personal Number

Legal Entity *

Number of Members and Managers:

Please Specify

GL Code (Optional)

SIC (Optional)

NAICS (Optional)

FEIN (Optional)

Business Address: *

Tell me about the building:

Number of Stories *

Are you the:

How big is the building:

The percentage of the occupied building

Square footage of your premises

Year Built

Is your operation habitational? (Habitational Only: Apartments, Condos, Hotels, and Motels)*

Number of Units *

Number of Swimming Pool(s): *

Has the building been renovated?

Electrical

Percentage of Renovation

Year Renovated

Plumbing

Percentage of Renovation

Year Renovated

Heating

Percentage of Renovation

Year Renovated

Roof

Percentage of Renovation

Year Renovated

Construction Type

Please Specify:

Type of Alarm

Does your building have a Fire Sprinkler?

Please choose the percentage of the building protected by fire sprinkler:

Any Area Leased to Others?

Square footage leased to other?

Add information About the Area(s) Leased to Others if needed:

Select your Primary Business Category below: *

Please Specify

Business Type: *

Please Specify

Number of Full Time Employees *

Number of Part Time Employees *

Annual Sales *

Annual Payroll *

Date Business Started

Installation, Service, OR Repair Work Percentage:

Describe Your Business

Do you have any subsidiaries?

Yes

Subsidiary Company Name:

Percentage Owned:

Relationship Description:

Is a formal safety program in operation?

Yes

Select all that apply:

Safety Manual

Safety Position

Monthly Meetings

OSHA

Any exposure to flammables, explosives, and chemicals?

Yes

Any policy or coverage declined, canceled, or non-renewed during the last three years for any premises or operations?

Yes

Select that apply:

Describe:

Any past losses or claims relating to sexual abuse or molestation allegations, discrimination, or negligent hiring?

Yes

During the last five years, has any applicant ever been indicted for OR convicted of any degree of the crime of fraud, bribery, arson, or any other arson-related crime in connection with this or any other property?

Yes

Have you had a foreclosure, repossession, bankruptcy, or filed for bankruptcy during the last five years?

Yes

Occur Date:

Resolve Date:

Explanation:

Has business been placed in a trust?

Yes

Name of Trust:

Any foreign operations, foreign products disturbed in the USA, or US Products Sold/Distributed in foreign countries?

Yes

Do you have other business ventures for which coverage is not requested?

Yes

Do you own/lease/operate any drones?

Yes

Please describe:

Do you hire others to operate drones?

Yes

Please describe:

Number of years you have been insured

Name of Prior Carrier *

Please Specify *

Have you had any losses in the last three years?

Yes

Loss #1

Date of Loss

Type of Loss

Please specify

Amount Paid

Subrogation

Claim Open

Add another loss history

Loss #2

Date of Loss

Type of Loss

Please specify

Amount Paid

Subrogation

Claim Open

Add another loss history

Loss #3

Date of Loss

Type of Loss

Please specify

Amount Paid

Subrogation

Claim Open

Building Limit (Sq ft.*Cost per Sq ft.)

Deductible

Please Specify

Business Personal Property:

Annual Loss of Income:

Personal Property of Others (if any):

Earthquake

Yes

Flood

Yes

Equipment Breakdown

Yes

Building Ordinance

Yes

Building Ordinance

Occurrence/Aggregate

Product Liability (Same as Aggregate Limit)

Liquor Liability (If Applicable)

Annual Liquor Sales: *

Classification: *

Hired/Non-Owned Auto

Yes

Garage Keepers (Applicable for Auto Related Businesses)

Workers’ Compensation

Yes

Professional Liability / E&O

Yes

Employment Practice Liability (EPLI)

Yes

Employee Benefits Liability

Yes

Deductible Per Claim:

Number of Employees Covered by Employee Benefits Plan

Retroactive Date

Directors & Officers Liability

Yes

Commercial Umbrella

Yes

Amount

Please specify

Businessowners Policy Quote

If you know

Tell me about the building:

Loss #1

Loss #2

Loss #3

Property Coverage

Liability Coverage

Additional Policies