Request Commercial Quote | Larkin Group

Request Commercial Quote

Complete the following information if you would like to start the process for a commercial proposal. Once received we will contact you by phone. Please understand this is not an application for insurance nor does it bind any coverage. An application will be sent to you if coverage is desired.

All of the information provided is confidential and will be used solely for the purpose of developing a proposal for you.

Personal Information (required)
What is your name?	First Middle Last
What is your business name?
What is your address?	Street City State ZIP
What is your telephone number?	Home Business
What is your fax number?
What is your email address?

Underwriting Information
What is the nature of your business?
Is the business a corporation, partnership or sole proprietorship?	Corporation Partnership Sole Proprietorship
How many owners?
How many employees?
What is the payroll amount of the owners?
What is the payroll amount of the employees?
What is the total annual gross?
What is the business license number?
What is the license type?
Years of experience in this business?
How many years have you operated under your current business name?
Have you used any other business names during the past 5 years?	Yes No
Is this business open 24 hours a day?	Yes No
Any deep frying? (food)	Yes No
Is there any manufacturing, mixing, re-labeling or repackaging of products?	Yes No
Is there filling of propane tanks?	Yes No
Please describe the nature of your business and ANY unusual exposures

Building & Property Information
What is the total square footage of the building your business is in?
What is the total square footage of your business only?
What is the total square footage of customer area only?
How many stories is it?
If it’s two stories, what is the ground floor square footage?
What is the construction type?
What type of roof covering?
Was the roof updated?	Yes No
If yes, what year?
What is the distance of fire protection?
Is the business in a brush area?	Yes No
Do you have a storage area more than 1,500 sq. ft.?	Yes No
Are there smoke detectors at this location?	Yes No
Are there fire extinguishers?	Yes No
Are there deadbolts on all doors?	Yes No
Are there circuit breakers?	Yes No
Is the electrical updated?	Yes No
Is the heating/air-conditioning thermostatically controlled?	Yes No
Is the heating/air-conditioning central?	Yes No
Has the plumbing been updated?	Yes No
If yes, what year?
Does the building have interior automatic fire sprinklers?	Yes No
Is there a theft alarm?	Yes No
Is there a fire alarm?	Yes No
Are there any restaurants in your building?	Yes No
Are there any restaurants in your building?	Yes No
Are there any restaurants in the building next to your business?	Yes No

Claims Information
Where there any losses or claims in the last 5 years?	Yes No
If yes, what is the date, amount paid and description of each loss or claim?

Coverage Information
What is the current insurance company?
How much are you paying now?
What is the liability limit requested?
What is the building limit requested?
What is the building deductible requested?
What is the business personal property (contents) limit requested?
What is the contents deductible requested?
What is the loss of income requested?
Are there any questions, comments or additional coverage required?
Are there any questions, comments or additional coverage required?

Best Time to Contact You
Please let us know the best time to call and discuss your quote	Morning Afternoon Evening Anytime
Or, please specify another time

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Larkin Agency of Traverse City | 3963 W Royal Dr | Traverse City, MI 49684 | Phone: (231) 947-8800 | Email: admin@larkingrp.com

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