Florida Business Liability Insurance Quote

Business Name:    
Premises Address:
City:
Florida
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 
Federal Employer's ID #:
Description of Operations or SIC code:


Number of Employees:              
Payroll (not including owners): $
Estimated Gross Receipts:       $

Select all that apply to your Florida business:
Operate or lease aircraft/watercraft     Work Underground
Work above 15 feet                           Require out of state travel
Use Subcontractors                            Delivery Service
Pre-employment physicals                   Offer safety incentive programs
Store, treat, dispose, or transport hazardour waste
Work on vessels, docks, or bridges over water
Other

Recent Insurance Information:

Current Insurance Company: 
Policy #: Expiration Date: (mm/dd/yyyy)

What types of coverages do you currently have:
Benefit Liability               Business Liability
Commercial Umbrella     Directors & Officers Liability
Discrimination                 Errors & Omissions
Product Liability              Professional Liability
Other

Other Insurance Company Used In Last 3 Years: 
Policy #:
Losses past 3 years: Select One Yes NO     Amount paid for each loss: $
Description of losses or loss runs:


Choose Florida Business Liability Insurance Limits:

General Aggregate Limit (other than products completed)    Select One None $300,000/$300,000 $300,000/$600,000 $500,000/$500,000 $500,000/$1 million $1 million/$1 million $1 million/$2 million
Products/Completed Operations Aggregate Limit                 Select One None $250,000/$500,000 $500,000/$500,000 $500,000/$1 million $1 million/$1 million $1 million/$2 million
Umbrella Amount: Select One None $1 million $2 million $3 million $5 million

If you've already filled out information on your buildings or facilities
in another insurance quote form then skip the section below.

Building 1
Building Value: $   Contents Value: $
Total Building Area:        Year Built:
Construction Type:  Select One Wood Frame Steel Reinforced Mill Concrete Block Concrete Tilt Up         Sprinklers: Select One Yes NO
Electrical Type:                             Amps:
Electrical Renovation Year: 
Plumbing Renovation: Select One None Partial Complete     Plumbing Renovation Year:
Heating Type:               Heating Renovation Year:   
Roofing Renovation:   Select One Partial Complete     Roof Age (years):  
Central Alarm: Select One Yes NO

List Neighboring Businesses:
To the right:   Distance:
To the left:     Distance:
To the rear:    Distance:

Additional Information or Comments



Click on the "Submit Quote Request" button below to send your
Florida Business Liability Insurance quote request.

**Information received from this Florida Business Liability Insurance quote request form sent to "YOUR AGENCY NAME" will be for our use only and will not be sold, given to or distributed to any other parties. A quote will be based on the Florida business liaiblity insurance information provided and does not guarantee acceptance of the risk by us. The precise coverage afforded is subject to meeting underwriting guidelines, and the terms, conditions and exclusions of the policy as issued. By submitting this request you acknowledge that this is neither an offer to insure nor a guarantee of insurance. Completion of this form does not entitle your business to a Florida Business Liability Insurance policy. We are licensed in Florida and will not provide business liability insurance quotes for other states.

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