Business Owners (bop) Quote

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Business Owners (BOP) Quote Form

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Business Owners (BOP) Quote Questionnaire

Please complete the information below. IMPORTANT: This form is not an insurance policy – it is general information necessary to prepare a quotation. Note that many carriers require a complete signed carrier application specific to their product offerings.

General Information

Applicant Name:(Required)

First Last

Business Name:(Required)

DBA (If Applicable):

Legal Entity (Choose one):

Applicant Mailing Address:(Required)

Street Address City State ZIP Code

Applicant Primary phone number:(Required)

"By submitting my phone number, I hereby authorize Cornerstone Agency Services, LLC to communicate with me through text messaging."

Applicant Alternate phone number:(Required)

"By submitting my phone number, I hereby authorize Cornerstone Agency Services, LLC to communicate with me through text messaging."

Applicant Email:(Required)

Business Location Address (Leave blank if same as mailing address)

Street Address City State / Province / Region ZIP / Postal Code

(Leave blank if same as mailing address)

Principal Contact Name (Leave blank if same as Applicant Name)

First Last

(Leave blank if same as Applicant Name)

Principal Contact Phone Number (Leave blank if same as Applicant Name)

(Leave blank if same as Applicant Name)

Principal Contact Email (Leave blank if same as Applicant Name)

(Leave blank if same as Applicant Name)

Date Business Established

FEIN:(Required)

SIC Code:

https://www.sec.gov/corpfin/division-of-corporation-finance-standard-industrial-classification-sic-code-list

Years in Operation:(Required)

Years of Owner Experience in Industry:(Required)

Number of FULL TIME Employees(Required)

Definition of Full-Time Employee For purposes of the employer shared responsibility provisions, a full-time employee is, for a calendar month, an employee employed on average at least 30 hours of service per week, or 130 hours of service per month. https://www.irs.gov/affordable-care-act/employers/identifying-full-time-employees

Number of PART TIME Employees(Required)

Definition of Part-Time Employee For purposes of the employer shared responsibility provisions, a part-time employee is, for a calendar month, an employee employed on average at less than 30 hours of service per week, or less than 130 hours of service per month.

Description of Operations (Min. 10 Words):(Required)

Min. 10 Words):

Gross Annual Payroll(Required)

Gross payroll is the total amount of money designated for a particular employee or for all employees in the business, depending on how the term is being used. The goal is to provide a maximum figure that can be easily examined by managers, payroll employees and analysts.

Gross Annual Revenue(Required)

Annual revenue is gross revenue. That's all of a business's income generated from the sale of products or services, assets, and capital over 12 months before expenses are subtracted.

Insurance Coverage Requested (Check all that apply):(Required)

Business Owners Policy (BOP)

General Liability

Professional Liability

Commercial Auto

Workers’ Comp

Other

(Check all that apply):

Current Insurance Carrier (If no insurance, enter “NONE”):(Required)

Current Insurance Carrier

Drop files here or

Max. file size: 5 MB.

Please upload Current Carrier documents here.

Current Policy Expiration Date:(Required)

The expiration date refers to the day your insurance coverage ends, after which your policy is no longer in force, and you are no longer protected against potential risks or financial losses.

Current Policy Retroactive Date:(Required)

Your retroactive date is the date on which your coverage begins. It is usually the same as your inception date or the date since which you've held continuous insurance coverage.

Current Limits:(Required)

In insurance, policy limits are the maximum dollar amount that an insurer will pay for covered damages or losses under an insurance policy.

Desired Effective Date for New Policy:(Required)

You want your new policy to start the moment your old one expires, so your new policy needs an effective date that starts the day after the old policy's expiration date.

Desired Limits:(Required)

In insurance, policy limits are the maximum dollar amount that an insurer will pay for covered damages or losses under an insurance policy.

Desired Deductible:(Required)

A deductible is your share of an insurance claim, which you must pay before your insurer provides financial coverage.

Complete our form and we’ll get back to you with your insurance quote.

Apply Today

Business Owners (BOP) Quote Questionnaire

General Information

PROPERTY DETAILS

BUILDING INFORMATION

BUILDING SECURITY

PROPERTY VALUES & BUSINESS INCOME

GENERAL LIABILITY - GL

PROFESSIONAL LIABILITY (E&O)

Personal Insurance

Commercial Insurance

Life Insurance