ECG Commercial Insurance Quote Questionnaire
Insured Name (Company Name) *
Email *
Insured Address: *
Location Address *
Phone number
Date Business was Established *
MM
/
DD
/
YYYY
Website
FEIN / or SS #: *
Company *
Description of Business: *
Overall Policy Questions:
Renewal Date of Current Policy: *
MM
/
DD
/
YYYY
Carrier *
Current Coverage *
Required
Total Annual Premium (for all coverages):
General Liability
Total Annual Revenue:
% of Liquor Sales?
% of catering sales?
Total Number of Employees: *
Annual Payroll: *
Is it a per claim or per occurrence coverage? *
Property Section
Do you own the building?
If so, what is the building value?
What year was the building built?
MM
/
DD
/
YYYY
Square Footage?
Are there other occupants in building?
Any building updates/improvements (if so, when and what)?
Total value of all contents (kitchen equipment, furniture, etc.)?
Are all kitchen equipment equipped with UL approved chemical extinguishing/cleaning systems?
Are they Wet or Dry?
Do you have an alarm system?
Alarm Company
What is the Property Deductible?
Coinsurance %?
Does your policy currently provide business income and extra expense to protect your revenue if business were to close ?
Business Auto
Please add the year, make, model, VIN number, and Leased or Own.
Auto 1#
Auto 2#
Auto 3#
Auto 4#
Auto 5#
Driver Information
Please add the driver name, Driver license, year first licensed,State, any violations (36 months)and what vehicle.
Driver 1#
Driver 2#
Driver 3#
Driver 4#
Driver 5#
Current Auto Limits:
Current Auto Deductible:
Current Auto Premium:
Current Auto Carrier:
Appointment
Do you need to setup an appointment?
Type of Appointment
ECG Partner or Associate
Comments
Please visit our website at www.consultwithedmond.com.
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