Venture Pacific Insurance Services, Inc. specializes in commercial insurance Commercial Insurance Quote

General Liability Insurance Quote
 

Online Quote

  Applicant Information
 
First Name
Last Name
Title
Company Name
Address
City
State
Zip
Operations in Other States Yes No
Telephone (ex. 310-555-5555)
Fax (ex. 310-555-5555)
E-mail Address
Website Address
Policy Effective Date (ex. 01/01/01)
Renewal Date (ex. 01/01/01)
Gross Annual Salary $
Current G/L Carrier
Limits of Liability
General Aggregate $
Products and Completed Operations $
Personal Advertising Injury $
Fire Damage $
Medical Expense $
Do You Subcontract Any Work? Yes No
Deductible Amount
Code Number on Policy
Estimated Payroll 1.

2.

3.
Description of Operations
Premium $
  General Questions
Any medical facilities provided or medical professionals employed or contracted?
 Yes No
Any operations sold, acquired, or discontinued in last 5 years?
 Yes No
Machinery or equipment loaned or rented to others?
 Yes No
Any watercraft, docks, floats owned, hired, or leased?
 Yes No
Any parking facilities owned/rented?
 Yes No
Is a fee charged for parking?
 Yes No
Recreation facilities provided?
 Yes No
Is there a swimming pool on the premises?
 Yes No
Sporting or social events sponsored?
 Yes No
Any structural alterations contemplated?
 Yes No
Any demolition exposure contemplated?
 Yes No
Has applicant been active in or is currently active in joint ventures?
 Yes No
Do you lease employees to or from other employers?
 Yes No
Is there a labor interchange with any other business or subsidiaries?
 Yes No
Are day care facilities operated or controlled?
 Yes No
Have any crimes occurred or been attempted on your premises within the last three years?
 Yes No
Is there a formal, written safety and security policy in effect?
 Yes No
Does the businesses' promotional literature make any representations about the safety or security of the premises?
 Yes No
Additional Coverage

Property Inland Marine Umbrella

Notice to applicants: This application must be completed in full as the quote will be based solely on the information provided. Any person who knowingly and with intent to defraud any insurance company or other person, files an application for insurance containing any false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime. By clicking "Submit", the applicant warrants that to their best knowledge all information given is true and accurate.