Commercial insurance Is this a quote for: * Commercial Property and Liability Workers Compensation Commercial Auto Inland Marine Bond Cyber When would you like the policy to go in effect? * Business Owner * First Name Last Name Business Phone * (###) ### #### Personal Phone * (###) ### #### Business Email * Business Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Business Owner Date of Birth * MM DD YYYY DBA * LLC Sole Proprietor Corporation Business Name * Business Operations * Please provide an in-depth description. FEIN Number * Year Established * Is garaging address the same as the address above? * Yes No If No, what is the garaging address? Number of employees * Annual Salary (if any) Annual Gross Sales Prior Insurance? Any claims against you or your business? PROPERTY INSURANCE Do you own or rent the property? How much personal property coverage do you need? Square feet? Does the location have sprinklers? (Y/N) Yes No COMMERCIAL AUTO/TRUCKING Does the insured already have a Progressive or Cover Whale quote or policy? Yes No Does the customer currently have insurance (Personal Auto counts) Yes No If yes, which carrier? If yes, is it continuous coverage for 1 year? Expiration date? Bodily Injury Limit? Is the insured being non-renewed by current carrier? Yes No If yes, please explain Does the vehicle have anti-lock brakes? Yes No Does the vehicle have an anti-theft device? Yes No Does the vehicle have driver side airbags? Yes No Does the vehicle require a hazardous materials placard? Yes No Are any vehicles used to remove debris for a fee? Yes No Have the drivers had any accidents/violations in the past 5 years? Yes No If yes, what was the date and type of accident/violation? Farthest one-way distance this vehicle typically travels (90% or more of the time) Does the business haul for hire? Yes No If yes, enter all commodities (please list) Does the business have a USDOT number? Yes No If yes, enter it here Are filings required? (Federal, State, MCS90) Yes No If yes, enter all required types (Federal, State, MCS90) Is the insured subject to the Electronic Logging Device (ELD) mandate? Yes No If yes, enter the ELD vendor Is there a fleet management system? Yes No Would you like the Snapshot ProView* or Smart Haul* discount? Yes No Vin Number(s) Make year and model Is this all the commercially owned and operated vehicles? Yes No (PLEASE SEND ANY OTHER DOCUMENTS TO pgins1094@gmail.com) Additional Details Important - Terms of Service Please confirm the terms of service for online communications and servicing Please confirm consent for online communications, servicing and transfer of information. * I agree to the terms of service Thank you!