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FREE, NO OBLIGATION BUSINESS LIABILITY QUOTE

COMMERCIAL INSURANCE TERMS  |  COMMERCIAL INSURANCE COVERAGE  |  FREE APARTMENT BUILDING INSURANCE QUOTE  |  FREE ARTISAN CONTRACTOR'S INSURANCE QUOTE  |  FREE BUSINESS OWNER'S PACKAGE INSURANCE QUOTE

GENERAL INFORMATION
1. First Name:   Last Name:
Name of Legal Entity, if other
2. Phone:
3. Email:
4. Business Name:
5. Mailing Address:

City:

State:

   Zip Code:
6. Ownership type:
7. Years in Business: years
8. Currently insured?
9. If yes, Number of years continuously insured: years
10. Name of Current Insurance Company:
10a. Policy No:
11. Losses-claims in the last 5 years:
12. If any Losses, provide date, amount paid and reserves, description, and steps taken to avoid future losses:
13. Has your insurance ever been canceled or non-renewed?
14. If yes for what reason?
15. Nature of Business/Description of Operations by Premises(s), Special Conditions or Circumstances:
16. Gross annual sales or receipts:
17. Number of owners or officers: 18. Annual payroll for all owners or officers:
19. Number of full time employees: 20. Annual payroll for all full time employees:
21. Number of part time employees: 22. Annual payroll for all part time employees:

BUSINESS LOCATION(S)

Number of business locations:

LOCATION #1

23. Address:

City:

State:

   Zip Code:
24. Location is used for: (Factory, Warehouse, Office, etc.)
25. Total Area: sq/feet
26. Customer Area: sq/feet
27. Parking Area: sq/feet
28. Common Parking?
29. Year of Construction:
30. Number of units, if apartment building:

If there are no other location(s) go to question # 31

LOCATION #2
23a. Address:

City:

State:

  Zip Code:

24a. Location is used for: (Factory, Warehouse, Office, etc.)
25a. Total Area: sq/feet
26a. Customer area: sq/feet
27a. Parking area: sq/feet
28a. Common Parking?
29a. Year of Construction:
30a. Number of units, if apartment building:

LOCATION #3
23b. Address:

City:

State:

  Zip Code:

24b. Location is used for: (Factory, Warehouse, Office, etc.)
25b. Total Area: sq/feet
26b. Customer area: sq/feet
27b. Parking area: sq/feet
28b. Common Parking?
29b. Year of Construction:
30b. Number of units, if apartment building:
31. Additional Location Information:

COVERAGE
32. General Liability Coverage:
33. Products/Completed Operations Coverage:
34. Personal/Advertising Injury Coverage:
35. Liability General Aggregate Limit: 
36. Fire Legal Liability Coverage: 
37. Professional Liability Coverage: 
38. Deductible: 
39. Number of additional Insureds:
40. Your business relationship with each additional insured: (Landlord, Job Owner, Contractor, etc.)
41. Other required coverage: (please provide coverage type and amount required) 


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Licensed in State of California.

LICENSE #:  0787078

Phone: (800) 316-3002
Fax:    (818) 500-1855

Email: info@firsteagle.com