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Business Insurance Lead Sample

Product Type: Business Insurance Lead

Contact Can Be Reached At:
Name: Smith, John Home:(505) 555-1234
Address 1234 Main Street Work: (505) 555-1234
City/St/Zip: Anytown, CO 80206 Fax:
County: Denver Email:customercare@netquote.com
Address 2:  
City/St/Zip: Respond Time: Within 24 Hours
County:  
 
Lead Type: Commercial & Casualty
Recipient: Thomas Agent Applicant ID:123456
From:NetQuote Lead ID :123456
Date:12/31/2009 Date:12:25 PM (MST)
Business Contact Information:
Business Name:Joe's Grocery  
Business SIC Code:5411 SIC Description :Grocery Store
Brief Business Description:We specialize in organic foods
Desired Effective Date :12/31/2009 BOP:Yes
Insurace Coverage Requested:
General Liability:Yes Business Owners Policy:Yes
Commercial Auto:Yes  
Current Insurance Information:
Replaces an Existing Policy :Yes Current Annual Premium:$4,000
Current Insurance Company:Hartford No. of Claims in Past Year :0
Length of Time Insured:over 10 No. of Years Continuously Insured:over 10
Business Details:
No. of Full-Time Employees:15 Gross Annual Payroll:$200,000-$500,000
No. of Part-Time Employees:0 Gross Annual Revenue:$500,000-$1,000,000
Legal Entity/Status:Corporation Years of Owner Experience In Industry:15
No. of Years in Business:Over 10
Business Details:
Desired Amout of General Liabilty Coverage :Over 10
Business Hours:08:00 AM- 05:00 PM
Business Owners Policy - Property Details:
Year Built or Date of Last Update:2000 Fire Alarm Type:Central Monitored
Construction Type :Frame Desired Deductible Amount: $1,500
No. of Stories :1-2 Physical Building Coverage Limit:$500,000
Total Sq. Ft of Building: 2,100 Business Personal Property Amount:$50,000
Total Sq. Ft of Space Occupied by Business:2,100
Additional Property to Insure:No Burglar Alarm Type:Central/Monitored
No. of Additional Property to Insure:0
Commercial Auto Details:
Garaging Street Address:I890 Grocery Lane Max Distance for Deliveries or Worksite:1-50
Garaging Suite or Unit #: Desired Commercial Auto Liability Limit:$2,000,000
Garaging City/State/Zip:Denver, CO 80206  
Desired Uninsured/Underinsured Motorist Limit:$2,000,000
No. of Vehicles: 3-10 Desired Deductible :$1,500
No. of Drivers : 5-10  
Additional Coverage Interests :
Bonds: No Business Interruption:Yes
Errors & Omissions: No Employment Practices Liability:Yes
Directors & Officers Liability: No Rental Reimbursement:No
Non-Owned Auto: Yes Medical Coverage:No
Commercial Umbrella: Yes  


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