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                B
usiness Insurance Quote:

 

   

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                                                                      Company Information     
                              

Business
Name
  Contact
  Name
    
Type of Business                          
DBA   Position
  

Suite#    
Business 
Address      
  City   Zip
Code
 
County   Work
  Phone
Business
Entity
   
Cell
Phone
  Fax
  Number
E-mail    

      Underwriting Information
        (Please Explain all Yes Answers)
    
  

 
 Is the Applicant a subsidiary of another entity or does the Applicant have any subsidiaries?    
 Is there any Exposure to flammables, explosives, or chemicals?    
 Does the Applicant draw plans, designs or specifications?    
 Does the Applicant lease equipment with or without operators?    
 Does the Applicant currently have General Liability coverage?    
 Does the Applicant hold a General Contractors or Builders License?    
 Does the Applicant ever act in the capacity of a General contractor or Builder?    
 Does the Applicant eve do any exterior work on buildings over 3 stories?    
 Does the Applicant perform work on boats/ships or engage in
 boating or shipping operations?
   
 Does the Applicant manufacture or sell products "under his name"?    

 Does the Applicant sponsor sporting or social events?    
 Does the Applicant ever do asbestos removal?    
 Has the Applicant had any policy or coverage declined, cancelled or non-renewed?    
 Has the Applicant ever had any construction defects, product liability
 or other claims?   (Last 5 Years)
       
   
 Has the Applicant ever been named in a lawsuit alleging construction defects?    
 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)
 
   
 

 Does the Applicant's Gross Receipts exceed $1,000,000.?    
 Anticipated Gross Receipts? $ *    

 Does the Applicant's Annual Payroll exceed $300,000.?

   
 Anticipated Annual Payroll? $    
 Are subcontractors used?                                
 If yes, what is the annual cost of subcontractors?   $    
 

  Please Explain any Yes Answers                 

 


 
                                                                         Just a few more questions
       

 

Years in Business ?

# of Full Time Employees?      

 

Years Experience ?

# of Part Time Employees?    

Percent of work Preformed
(Must Equal 100%)
       

             Please Describe Your Daily Business Operations *
  
                                        (What do you do in detail?)

  

% Commercial  

 

% Residential 

 
Contractors license

 
  
      
      If yes, what is your
      Contractor Number *
 
 If you do not have
 a contractors license
 Please write None
                              

 

 

                               List the last 3 jobs including the cost of those jobs.
 

               Location       

               Type of Job         Job Receipts    
Location 1            
Location 2            
Location 3            
 
  Current Insurance Co.          Policy Expires
       (
Month / Date)

         
  Please enter All Claims or
  Losses for the last 5 years
 

 
  Do you need a Workers
  Comp Quote?
  Policy Expires
  (
Month / Date)
 
  Can I offer a Business
  Auto Quote?
          
  Policy Expires
  (
Month / Date)
 
  Can I offer a Life Insurance
  Quote?
  Policy Type
  Whole, UL, Term
 
  Present Business Auto
  Insurance Co.
  Policy Expires
  (
Month / Date)
 
    
  Liability Limits *
  (Coverage Desired)
  Non Owned
  Auto Coverage
*
 
  Do you have a web site * Web Site Name      
 

  How were you
  referred to our site?
*
                                

                                      
  Comments / Request  
 
 
     

  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.
 


                                                                     This is not a binder or proof of Insurance.
 
 


  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
      

                                                          
 


    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
  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) 562-8585

  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.