Commercial Insurance Quote

Some types of commerical insurance policies are highly specialized to the particular industry of the business. This quote request form only obtains some basic necessary information about your business, but a separate application specific to your particular business may also be required. Please complete our online questionnaire below (or a PDF verison can be found here), and we will contact you with any additional questions or applications necessary to obtain a quote for your business.

The information that you provide in this questionnaire will be used to determine your premiums and eligibility for insurance, and you are responsible for the accuracy of the answers you provide. If you falsely describe or fraudulently omit any fact that is material to the insurance company in order for it to be able to judge the risk, your insurance policy may be void. Please ensure that you fully understand the answers that you are providing when completing this questionnaire; if you are unsure of some of these details, we strongly recommend that you obtain professional advice. You are welcome to contact our office with any questions you have about this questionnaire.

Please note, email is not a secure method of transmitting sensitive personal information and by using this service you accept this risk. If you are concerned, you may use an alternative method.

This request form will take 5-10 minutes to complete and includes two sections.

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– Step 1 of 2

ABOUT YOUR BUSINESS

Name of Person Applying *

First

Last

Business name (if applicable)

Email address *

Email

Confirm Email

Phone number *

Business LOCATION address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountry

Is the business MAILING address different from the LOCATION address?

• No
• Yes

Business mailing address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountry

How is this business structured? *

• Individual/Proprietorship
• Partnership
• Corporation/Limited Liability Company

What type of business? *— Select Choice —RetailOfficeCommercial Building OwnershipPersonal Services (salon/spa)Professional servicesFood/BeverageContractorFarmManufacturerGarage OperationWholesale OperationOther

Please describe your business operations in detail (what products or services you offer): *

What are the gross annual receipts? *— Select Choice —Up to $10,000$10,000 to $25,000$26,000 to $50,000$51,000 to $100,000$101,000 to $200,000$201,000 to $300,000$301,000 to $500,000$501,000 to $1,000,000Over $1,000,000

Gross receipts means total income BEFORE expenses are deducted. If this is a new venture, please indicate your estimate for the next 12 months

How many years in the business?New startup1 – 2 years3 – 5 years> 5 years

How many years of experience do you have in this line of work? *

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ABOUT THE BUSINESS PREMISES & INSURANCE REQUESTED

Has insurance ever been denied or cancelled? *

• Yes
• No

you you in

Have there been any losses or claims in the last 5 years? *

• Yes
• No

Have you had any business insurance in the past? *

• Yes
• No

Expiry date of your current insurance policy: *

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Do you own or rent your location? *

• Owner
• Tenant

Are you the only occupant/tenant of the building? *

• Yes
• No

Age of building: *— Select Choice —< 1 year1 – 20 years20 – 35 years> 35 years

What type of construction is the building?FrameMasonry/Non-combustibleFire Resistive

Type of heat in the building: *— Select Choice —NoneNatural GasElectricPropaneOilWoodOther

How much area do you occupy? *— Select Choice —< 1,000 sq.ft.1,000 – 5,000 sq.ft.5,000 – 10,000 sq.ft.> 10,000 sq.ft.

Is the building sprinklered?

• Yes
• No

Is there a fire hydrant within 500 ft. (150 metres)?

• Yes
• No

Is there a fire hall within 3 miles (5 kms)?

• Yes
• No

Which coverages are you interested in obtaining (indicate all that apply):

• Liability Only (no coverage for physical assets)
• Building Coverage
• Equipment/Tools Coverage
• Coverage for Stock/Goods for Sale
• Office Contents/Computers
• General Liability (Injury/Property Damage to others)
• Professional Liability (Errors & Omissions)
• Business Interruption (Loss of earnings)
• Crime (Loss of Money)
• Equipment Breakdown
• Cyber/Data Coverage
• Cargo Coverage

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