Home
  Larkin Insurance Group, Inc.

Commercial Insurance Proposal Request

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.

Fields marked * are required

Personal Information

Name *
Business Name *
Address *
City *
State *
Zip Code *
Phone Number
Business Phone Number *
Fax Number
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 square footage of the 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 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 1500 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
Are 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 was the plumbing updated?
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 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?

Best Time to Contact You

Please let us know the best time to call and discuss your quote. Morning
Afternoon
Evening

Home | Company | Property & Casualty | Larkin Wealth Mgmt. | Benefits

Larkin Agency of Traverse City | 310 W Front St Ste 101 | Traverse City, MI 49684 | Phone: 231.947.8800 | E-mail: admin@larkininsgroup.com
© Copyright 2008 Larkin Insurance Group, Inc. All rights reserved. Webdesign by leelanau.com