| 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 Converage 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 |
|
