Florida Business Owners Insurance Quote

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


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

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

Please Quote: (check as many boxes as desired)
Owners Insurance
Complete Business Insurance Package

Florida Property Information

Contents (including inventory): $
Square footage you occupy:
Building Limit (if you own the building) $

Type of Construction: Required - Please Select One Frame (Wood walls & Floors/Roof) Joisted Masonry (Masonry Walls & Wood Floors/Roof) Non-Combustible Masonry (Masonry Walls, Non-combustible material floors) Fire Resistive (Masonry/Concrete Walls, Concrete or Steel Floors/Roof) Other

Electrical Type:             Electrical Renovation Year: 
Amps: 
Plumbing Renovation: Select One None Partial Complete     Plumbing Renovation Year:
Heating Type:               Heating Renovation Year:   
Roofing Renovation:   Select One Partial Complete     Roof Age (years):  
Sprinkler system in your building? Select One Yes NO
Burglar Alarm: Select One Yes NO        Central Station Alarm: Select One Yes NO

Total Annual Sales: $
Is your store located within 5 miles of any coastline? Select One Yes NO

Florida Liability Information

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

General Aggregate Limit (other than products completed):    Select One $300,000/$300,000 $300,000/$600,000 $500,000/$1 million $1 million/$2 million Other Amount
Products/Completed Operations Aggregate Limit:                 Select One $300,000/$300,000 $300,000/$600,000 $500,000/$1 million $1 million/$2 million Other Amount


   Florida Workers Compensation Information
Class                         Code           Total Payroll
          $
          $
          $

Experience Mod (if any, per policy)
Federal Employer's ID #

Umbrella Insurance Amount Desired: Select One None $1 million $2 million $5 million

Additional Information



Click on the "Submit Quote Information" button below to send your
Florida Business Owners Insurance quote request.**

**Information received from this Florida Business Owners 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 owners insurance policy 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 Owners Insurance policy. We are licensed in Florida and will not provide business owners insurance quotes for other states.

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Florida Business Information:

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