Let's Gather Some of the Information that will Help Me Determine Your Quote. Leave Blank Contact Name Email Phone Number Business Name Knowing about your business helps me understand your liabilities, with additional information I can provide a more accurate estimate. Complete this form, or request a phone call. Request a Phone Call Get a Quote Where is Your Primary Business Located? Street Address Zip Code City State Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Back to Previous Continue to Next About Your Business Location: Hours of Operation (daily) Square Feet Fire Code Max Occupancy Years in Business Ownership Details: Building Owner Tenant Insure Building? Desired Building Limit Desired Tenant Improvements Limit Desired Personal Property Limit Cooking on Premise? Oven Only? Wet Suppression System? Self Contained Fryer? Grease Latent Cooking without a Wet Suppression Hood? Back to Previous Continue to Next Details of Safety Operations: Which of these Safety Features are Active? Security Alarm Local Alarm Monitored Alarm Fire Alarm Fire Sprinker Security Video Cameras Security Staff? Contracted? Employees? Back to Previous Continue to Next About Your Business Performance: Annual Gross Food & N/A Beverage Sales Annual Gross Alcohol Sales Annual Cover Charges Misc Receipts Net Gambling Receipts Gambling Machines (#) Servers certified in alcohol training? Incident Logs Maintained? Special Drink Promotions? Late Night Happy Hour 2 for 1 Drinks All You Can Drink Specials Ladies Night Free Alcoholic Drinks Claims in the Last 5 Years? Back to Previous Continue to Next Entertainment: Does Your Business Offer Entertainment? Live Bands? Live DJ? Karaoke? Pool Tables? Dart Board? Dance Floor? Elevated? Less than 200 Sq Ft? More than 200 Sq Ft? Stage? Elevated? Less than 200 Sq Ft? More than 200 Sq Ft? Back to Previous Continue to Next Liability Coverage Exposures: Desired General Liability Limit Select $300,000/$300,000 $300,000/$600,000 $600,000/$600,000 $1M/$1M $1M/$2M Desired Liquor Liability Limit Select $300,000/$300,000 $300,000/$600,000 $600,000/$600,000 $1M/$1M $1M/$2M Desired Assault & Battery Sub-Limit Select $25k $50k $100k $300k $500k $1M Back to Previous Continue to Next Optional Policy Coverages: Employment Practices Liability # Full Time Employees # Part Time Employees Excess Liability Coverage $1 Million $2 Million $3 Million $4 Million Earthquake Flood Current Insurance Provider Policy Expiration Date Annual Policy Premium Back to Previous Continue to Next Policy Review: Optional: Attach your current policy declarations (PDF) for review. Select File, Or Drag & Drop Back to Previous