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Business Insurance QUOTE

Centerpoint Insurance Group will work closely with you to understand your business and determine your insurance needs. We offer comprehensive programs with coverage enhancements and pricing that separates us from many of our competitors.

BUSINESS INSURANCE QUOTE REQUEST FORM

General Information
Name of Insured:
Address:
City:
State:    Zip:  
Business Phone:   Fax Number:
Email Address:
Location Address 
(type "same" if same as above):
City:
State:   Zip:

Property Questions

Age of building
/Year Built:		 Type of building
construction:		 Number of
stories:		 Other
occupancies:		 Square feet
you occupy:

sf.
   
Year Electricity was updated:
Is it on circuit breakers?: Yes   No
Year Plumbing was updated:
Copper or Galvanized plumbing?: Copper   Galvanized
  Other 
Year Building was last re-roofed:
Type of roofing material:
Type of heating system in the building:

Protective Devices

Fire Alarm?: Burglar Alarm?: Is the building
sprinklered?:		 Are there
smoke detectors?:
Y   N Y   N

Liability Questions


Please provide information on previous insurance carrier:
Previous Ins. Carrier: Policy number: Prior premium: Policy renewal date:
$

Please provide information about your business:
Years in business: Projected Gross annual receipts: Projected annual payroll:
$ $
    Describe your business, product or service:

Coverage Limits

Building: Contents (equipment,
inventory, supplies, etc.):		 Deductible: Loss of Income:
$ $ $
Money and Securities: Glass or signs: General Liability Limit: Non-owned and Hired
Automobile Liability:		 Is liquor liability needed?
$ $ $ Yes   No
    If Glass Coverage is needed, please provide dimensions:
    Please list other coverages you may need:

Miscellaneous Information

Name of Additional Insured
(Landlord or vendor):
Mailing Address:
City:
State:   Zip:  

Additional Comments

Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough fields above, please enter them here.


Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

   
 
3900 E. Mexico Avenue, Suite 850 • Denver, CO 80210 • 888-933-0375 • 303-333-1391 Fax • Info@cptins.com