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ARG & Associates will provide you with a free, no-obligation Home and Earthquake Insurance quote. The information below is kept confidential. Please answer as many questions as possible, so we can provide you with the most accurate quote.


Commercial Property and Earthquake Insurance

Company Information
 
Company Name:                    Date: 
Contact:             
Address:            
City:                  
State:                
Zip:                   
Phone:                                Best time to call:   am    pm
Fax:                  
E-mail:              


Insurance Information
 
Currently Insured with: 
Policy Number:            Policy Expiration Date:  
Premium Amount: $       Insured Amount: $
Term of Insurance:  6 months    1 year    other: 
What other types of insurance coverage do you have relating to your business? (Please list below):
          Insurance Type                              Premium paid per Year                      Expiration Date
 Business Liability                         $                     
 Business Auto                             $                     
 Business Umbrella                       $                     
 Workers' Compensation                $                     
 Professional Liability                     $                     
 Liability for Corporate Executives   $                     
 Group Health                               $                     
 Group Life                                   $                     
 Group Retirement/401k/etc.          $                     
 Surety Bonds                              $                     
 Other:           $                     


Company Financial Information
 
What was your past years Annual Income: $    Projected Current Year: $ 
Cash: $           Securities: $    Other income: $ 
Amount of inventory:  $ 
Amount of Supplies:  $ 
Amount of Equipment: $ 
Amount of other Assets: $ 
What was your past years Annual Payroll: $   Projected Current Year: $ 
How many years has the company been in business? 
How many Full Time employees do you employ?  
How many Part Time employees do you employ? 
Do you have any contract labor?  Yes    No, if yes, how many contractors do you have? 
Please describe your business below:


Building Information
 
How long has the company been at this address? 
Year the building was built:  
How many square feet?  sq. ft.
How many claims in the past 3 years? 


Building Structure
Number of Story: 
Structure:  Metal Frame    Wood Frame    Concrete Tilt-up    Veneer    Masonry    other: 
Roof:  Asphalt    Asphalt Shingle    Tar and Gravel    Wood Shingle    Tile or Slate    other: 
How old is the roof? 
Type of foundation:  Slab    Concrete Footing    Pier    Basement    other: 
Parking Garage:  Yes    No, if yes, how many levels: 
Parking Lot:  Yes    No, if yes, how many parking spaces: 
Building water is plumbed in:  Copper    PVC    Galvanized    Other: 
Does the building have a Sprinkler System for fire?  Yes    No, if yes, is it monitored  Yes    No
Does the building have a Burglar Alarm?  Yes    No, if yes, is it monitored  Yes    No
What size Electrical Service does the building have? Amps
Is all electrical wiring plumbed in conduit?  Yes    No, if no, please explain below:


Additional Details
Please list below any additional details in the space provided below:


When you click "Submit Quote" button, your application will be emailed to one of our representatives, who will contact you shortly.


      



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