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Company Information
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Business
Name |
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Contact
Name
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Type of Business |
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DBA |
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Position
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Suite# |
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Business
Address |
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City |
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Zip
Code |
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Cell
Phone |
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Work
Phone |
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Business
Entity |
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Home
Phone |
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Fax
Number |
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E-mail |
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Underwriting Information
(Please Explain all Yes
Answers)
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Is the Applicant a subsidiary of another entity or
does the Applicant have any subsidiaries? |
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Is there any Exposure to
flammables, explosives, or chemicals? |
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Does the Applicant draw plans,
designs or specifications? |
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Does the Applicant lease
equipment with or without operators? |
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Does
the Applicant currently have
General Liability coverage? |
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Does the Applicant hold a
General Contractors or Builders License? |
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Does the Applicant ever act in
the capacity of a General contractor or Builder? |
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Does the Applicant eve do any
exterior work on buildings over 3 stories? |
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Does the Applicant perform work
on boats/ships or engage in
boating or shipping operations? |
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Does the Applicant manufacture
or sell products "under his name"? |
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Does the Applicant sponsor
sporting or social events? |
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Does the Applicant ever do
asbestos removal? |
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Has the Applicant had any
policy or coverage declined, cancelled or non-renewed? |
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Has the Applicant ever had any construction defects, product
liability
or other claims?
(Last 5 Years)
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Has the Applicant ever been named in a lawsuit alleging
construction defects? |
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Are you
involved (present or future) in new residential construction and/or development?
(This
would include dwellings, townhouses or condo units located in a
single development)
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Does the Applicant's Gross Receipts
exceed $1,000,000.? |
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Anticipated Gross Receipts? |
$ |
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Does the
Applicant's Annual Payroll exceed $300,000.? |
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Anticipated Annual Payroll? |
$ |
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Are subcontractors used?
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If yes, what is the annual cost
of subcontractors?
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$ |
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Please Explain any Yes Answers |
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Just a few more questions
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Years in Business ? |
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# of Full Time Employees? |
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Years Experience ? |
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# of Part Time Employees? |
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Percent of work Preformed
(Must Equal 100%)
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Please Describe Your Daily Business Operations
(What do you do?) |
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% Commercial |
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% Residential |
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Contractors license |
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If yes, what
is your
Contractor Number
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If you do not have
a contractors license
Please write None |
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List the last 3 jobs including the cost of those jobs.
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Location |
Type of Job |
Job Receipts |
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Location 1
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Location 2
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Location 3
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Present Business
Insurance Co.
If None Please Type "None" |
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Policy Expires
(Month
/ Date) |
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Please enter All Claims or
Losses for the last 5 years |
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Can I offer a Workers
Comp Quote? |
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Policy Expires
(Month / Date) |
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Can I offer a Business
Auto Quote?
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Policy Expires
(Month / Date) |
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Can I offer a Life Insurance
Quote? |
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Policy Type
Whole, UL, Term |
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Present Business Auto
Insurance Co. |
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Policy Expires
(Month / Date) |
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Liability Limits
(Coverage
Desired) |
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Non Owned
Auto Coverage |
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How were you
referred to our site?
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Comments / Request |
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Submission of this application
in no way constitutes a receipt of a quotation or approval for
binding, All requirements must
be received in our office. a rate will be based on information provided on
this application and is subject to change. |
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By
clicking the Submit button I have Reviewed the
Privacy Statement
and the Auto Insurance Disclosure Statement and
Understand that this is
only
a quote for the State of California, any
information and does
not constitute a binder of coverage or proof of Insurance in any form, or does
it guarantee
insurance. All Coverage's are subject to the
terms and conditions contained in the policy
and endorsements. I agree the above
information is true and factual. Insurance will not begin until I sign a contract and make a down payment.
Please Read
Auto
Insurance Disclosure Statement below
This is not a binder or proof of Insurance.
Business
Insurance Disclosure Statement
Please Read Below
Thank you for the opportunity to discuss your Business insurance needs.
I look
Forward to
offering you the service and value that is
the standard of Ronn Hall Insurance. I am sure
you will see
hat this quote can affordable enhance your insurance program.
Please Note:
An Insured which refuses to Provide coverage to an applicant who is
a
“Good Driver” Must provide the applicant with a written
statement of the reasons it denied
coverage. In general, under
California law a “good driver” is a person who, during the last
three years, Has been continually licensed and has not had more than
one violation point or
more than One at-fault
accident resulting in only property damage.
As part of the
application process, Our Insurance Companies may collect personal information
from
Persons other than you or other individuals proposed for
coverage, including credit reports,
loss information reports,
CLUE,
and motor vehicle reports.
This information, as well as other personal
or privileged
information subsequently collected by us, may in certain circumstances be
disclosed to third parties without your authorization.
You have a right of access and correction
with respect
to al personal information we collect. If you would like more detailed
information
in writing about our information collection
practices, please let us know
All coverage’s are subject to the Terms and conditions
contained in the policy and
endorsements.
The Business Auto premiums shown are for a 12-month policy period.
If you have any questions please call me at the
Telephone number listed below.
Ronn Hall Insurance & Notary Services
(619) 449-8585
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All material on this site is
intended for educational purposes only. Any proposals are not
contracts
or binders, No coverage will be afforded until an application is
completed, signed, underwritten, and
monies are exchanged. All Coverage's are subject to the terms and
conditions contained in the policy
and endorsements. If you have any questions Please call us @ (619)
660-8585
The publishers are not responsible or liable for misinformation,
misprints, or typographical errors.
All information provided is deemed reliable
but is not guaranteed and should be independently
verified. We are not responsible
for advertisers listed on this site, please research your data prior to
making a purchase.
Some links are
"Paid Ads" and will transfer you to various web sites, others are
links
including Virginia Hall Coldwell Banker, Santee Real
Estate , Mortgage companies, insurance
companies, Sporting sites, San Diego County,
government sites,
including School
Districts, and other web
sites.
All information provided is deemed reliable
but is not guaranteed and should be independently
verified. We are not responsible
for advertisers listed on this site, please research your data prior to
making a purchase.
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