Commercial Insurance Quote Application

Commercial Insurance Quote Application
Legal name of business:*
DBA:
Type of entity:*
Entity type (for hawksoft):
Non-profit organization?

YesNo
Federal ID# (FEIN/EIN):*
Social Security # of Individual to be Insured:*
Write down SSN of individual to be insured (do not enter in form).
Contact First Name*
Contact Middle Name (or Initial)
Contact Last Name*
Is Contact Name listed above same as Business Owner?*

YesNo
Phone Number*

Area CodePhone Number
E-mail*
How did you hear about us?*
(i.e. Friend/Family, Facebook, TrustedChoice, Google, Yelp, Twitter...etc)
How did you hear about us?*
Which agent are you working with at WPi?
Producer 3 digit name (hawksoft)
Agent's E-mail*

Business Address Information
Website:
Business Street Address
City
State
Zip Code
Do you own or lease this property?

OwnLease
Does the location address differ from the mailing address?*

YesNo
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

What date would you like your coverage to start?:

MonthDayYear
What date did your business begin current ownership?

MonthDayYear
How many years of experience do you have in the industry?
Detailed description of Business Operations:

Types of business insurance needed

Select all that apply
General Liability
General liability insurance is essential for businesses as it provides protection against third-party claims, including bodily injury and property damage caused by business activities. It covers legal defense costs, fulfills contractual requirements, builds trust with clients, safeguards your finances, and ensures compliance with industry regulations. Having this insurance offers peace of mind, helps maintain your business's credibility, and can cover advertising-related liabilities, making it a critical component of risk management and business stability.
Business Auto
Business auto insurance is a specialized insurance policy designed to protect a company's vehicles and drivers. It provides coverage for physical damage to company-owned vehicles, liability protection in case the business vehicle is involved in an accident that causes injury or property damage to others, and often includes coverage for injuries to the employees operating the vehicles. This insurance is crucial for safeguarding a business's assets, mitigating financial risks associated with accidents, ensuring compliance with legal requirements, and helping to maintain the smooth operation of the company's vehicles, which are essential for various business activities like deliveries, transportation, or client visits.
Commercial Property
Commercial property insurance is a vital coverage for businesses, as it safeguards their physical assets, such as buildings, equipment, inventory, and furnishings, from various perils like fire, theft, vandalism, and natural disasters. This insurance provides financial protection by covering the cost of repairing or replacing damaged property, ensuring business continuity and minimizing financial losses in the event of property-related disasters. It's a key risk management tool that helps businesses recover swiftly from unexpected incidents, allowing them to maintain operations and protect their investments in real and personal property.
Workers Compensation
Workers' compensation insurance is a mandatory coverage that provides financial protection for both employees and employers in the event of work-related injuries or illnesses. It offers medical benefits and wage replacement to injured employees, helping them recover and return to work, while also shielding employers from potential lawsuits related to workplace injuries. This insurance is essential for ensuring that injured employees receive necessary care and compensation, promoting workplace safety, and preventing costly legal disputes, making it a vital aspect of responsible business management.
Lessor's Risk
Lessor's risk insurance, also known as landlord insurance, is a type of coverage designed to protect property owners who lease or rent out their buildings or spaces. It typically provides coverage for risks like property damage caused by tenants, loss of rental income due to property damage, liability protection in case someone is injured on the property, and may also cover legal expenses related to disputes with tenants. Lessor's risk insurance is crucial for landlords as it helps mitigate financial losses and legal liabilities associated with property ownership and leasing, ensuring the continued profitability and security of their real estate investments.
Professional Liability
Professional liability insurance, often called errors and omissions (E&O) insurance, is crucial for businesses and professionals who provide specialized services or advice. It protects against claims of negligence, mistakes, or failures in the services provided, helping cover legal costs and potential damages if clients or third parties allege financial losses due to professional errors. This insurance is particularly important for professions like lawyers, doctors, consultants, and architects, providing financial security and defense against professional liability claims that could otherwise threaten a business's reputation and financial stability.
Cyber Liability
Cyber liability insurance is crucial for businesses in the digital age, offering protection against the financial and reputational fallout from data breaches, cyberattacks, and privacy violations. It typically covers expenses related to breach response, such as notifying affected individuals, legal and forensic investigations, and potential regulatory fines. Additionally, it can provide coverage for third-party claims arising from data breaches and cyber incidents, helping businesses recover from financial losses and maintain trust with customers and partners while mitigating the complex risks associated with cyber threats.
Employer Practices Liability
Employment Practices Liability Insurance (EPLI) is crucial for businesses to protect against lawsuits related to employment issues. It covers claims by employees alleging wrongful employment practices such as discrimination, harassment, wrongful termination, or wage disputes. EPLI helps mitigate the financial burden of legal defense costs and potential settlements or judgments, safeguarding a business's reputation, finances, and operations while promoting fair and ethical workplace practices.

Rating Information
Annual Gross Sales (Gross Revenue - can be estimated):*
Annual Rents:
Annual Payroll (sum of all payroll):
Does the company have a restaurant and/or bar?

YesNo
Annual Food Sales:
Annual Liquor Sales:
Annual Gaming Revenue:
Number of Full-Time Employees
Number of Part-Time Employees

Amount of Coverage
Building Amount:
Loss of Business Income:
Please enter desired Loss of Business Income coverage amount:
Contents Amount:
Please enter desired Contents Amount:
Liability:
Enter Liability Limit Desired:
Deductible
Please enter desired Deductible below:

Building Construction & Updates
Please select ALL that apply to the property:

FrameSprinklersJoisted MasonryFire AlarmBurglar Alarm
Square footage of the property:
Number of Stories
Year Built
Building updates:
Year roof last updated
i.e. 2010
Year electrical wiring last updated
i.e. 2010
Year heating last updated
Year plumbing last updated

Additional Underwriting Information
What is your current annual premium?*
If multiple please enter carrier and policy type - premium, separate each by commas (ex. Travelers GL - $1750, Progressive Auto $36,000)
Current Insurance Company*
If your business is new just enter "none yet/startup business"
Have you/your company had any bankruptcies?*

YesNo
Any claims in the past 5 years?*

YesNo
Please describe claims by date and nature of claim below:
Business Owners Legal Name:*

First NameLast Name
Business Owner's Full Legal Name*
If same as primary contact, this is prefilled from prior fields
Business Owner's HOME address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Owner's Date of Birth:*

MonthDayYear
Please list all places where you have a social media presence (Facebook, Instagram, etc.)

Business Auto Questions
Do you have a General Liability Policy currently in place?

YesNo

Drivers Information - if you have more than 6 drivers, please attach document with the following information for all drivers at end of this form OR send to service@wpinsure.com.

	Full Name	DOB	Drivers License Number and State	SSN	Marital Status
Driver 1
Driver 2
Driver 3
Driver 4
Driver 5
Driver 6

Vehicle Information - if you have more than 6 vehicles, please attach document with the following information for all vehicles at end of this form OR send to service@wpinsure.com.

	Year	Make	Model	VIN	Owned? (Y/N)
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Vehicle 5
Vehicle 6

Enter your DOT number*
If you do not have one yet please enter "pending"
Vehicle use (by car if multiple)
(example: F150 - transport employees and materials to and from jobsites, Honda - manager use only)

Please Upload Declarations Pages of Your Current Policies And Drivers/Vehicles List If Applicable:
Notes:
Should be Empty:

Commercial Insurance Quote Application

Business Address Information

Types of business insurance needed

Rating Information

Amount of Coverage

Building Construction & Updates

Additional Underwriting Information

Business Auto Questions