business owners policy

General Liability and Property Insurance

 
Name *
Name
Business Address *
Business Address
Phone *
Phone
Do you desire Commercial General Liability coverage? *
Desired Limits (Per Occurrence/Annual Aggregate) *
Do you Own, Rent or Lease premises from others? *
Do you Rent or Lease equipment from others? *
Are you required to name and Additional Insured? *
Name of Additional Insured
Name of Additional Insured

Please be advised that if you do not purchase tail coverage (an extended reporting endorsement) from your current insurer where you are insured for Commercial General Liability under a Claims-Made policy, this will result in an uninsured exposure for any claims which may arise as a result from an event while insured by your current insurer’s policy. If you do not purchase tail coverage from your current insurer, understand that the policy for which you are applying, if offered, will not provide prior acts Commercial General Liability coverage. 

 
 
 
 

MANDATORY: ALL DISTRICT OF COLUMBIA APPLICANTS must read the following:

WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant.

 

MANDATORY: ALL FLORIDA APPLICANTS must read the following:

Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.

 

MANDATORY: ALL MAINE APPLICANTS must read the following:

It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits.