Business Owners Package (BOP) Insurance Quote - Bramhall & Hitchen Insurance

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General Information
* Your Name:
Your Company:
Address:
City:	State: Zip:
Business Phone:	Fax Number:
* E-mail Address:

Current Insurance Information

Company Name:

Policy Exp. Date:

Types of coverage you currently have:

Bonds
Auto
Property & Liability

Workers Comp
Directors & Officers
Group Life & Health

Prof. Liability
Other:

About Your Business
No. of full-time employees:		Years in business:
No. of part-time employees:		No. of locations: Annual sales:
Please give a complete description of your operations:

Property Questions
Age of building or year built:	Type of building construction:	Number of stories:	Other occupancies:	Square feet you occupy:
				sq. ft.
If the building is over 25 years old, please answer the following:
Year electricity was updated:
Is it on circuit breakers?:		Yes No
Year plumbing was updated:
Copper or galvanized plumbing?:		Copper Galvanized Other:
Year building was last re-roofed:
Type of roofing material:

Protective Devices
Burglar Alarm:	Central Station or local alarm?:	Name of alarm company:	Is the building sprinklered?:	Are there smoke detectors?:
Y N	Central Station Local Alarm		Y N	Y N

Liability Questions
Please provide information on previous insurance carrier:
Previous Ins. Carrier:	Policy number:	Prior premium:	Policy renewal date:
		$
Please provide information about your business:
Years in business:	Projected gross annual receipts:		Projected annual payroll:
	$		$

Coverage Limits
Building:	Contents (equipment, inventory, supplies, etc)		Deductible:	Loss of Income:
$	$			$
Money & Securities:	Glass or signs:	General Liability Limit:	Non-owned &Hired Auto Liability:	Is liquor liability needed?
$	$		Y N	Y N
If glass coverage is needed, please provide dimensions:
Please list other coverages you may need:

Miscellaneous Information
Name of Additional Insured (Landlord or vendor):
Mailing Address:
City:	State: Zip:

Comments or Information

Please click the "Submit Quote" button to send your quote request.
No coverage is in effect until bound by an insurance carrier. This is a request for quotation only.