| LEAD TYPE: Commercial Property & Casualty | |||
| Recipient: | Thomas Agent | APPLICATION ID: | 123456 |
| From: | NetQuote | LEAD ID: | 1234567 |
| Date: | 11/01/07 | Time: | 12:25PM (MST) |
| BUSINESS TYPE: | |||
| Business Name: | Joe's Grocery | ||
| Business SIC Code: | 5411 | SIC Description: | Grocery Store |
| Brief Business Description: | We specialize in organic foods | Desired Effective Date: | 12/15/07 |
| INSURANCE COVERAGE REQUESTED: | |||
| General Liability: | Yes | Business Owners Policy: | Yes |
| Commercial Auto: | Yes | ||
| BUSINESS CONTACT INFORMATION: | |||
| Contact First Name: | Joe | Business Street Address: | 1980 Grocery Ln. |
| Contact Last Name: | Gallegos | Suite or Unit #: | |
| Contact Phone: | 303-555-2525 | City / State / Zip: | Denver, CO 80205 |
| Contact Email: | joe@joesgrocery.com | ||
| CURRENT INSURANCE INFORMATION: | |||
| Replaces an Existing Policy: | Yes | Current Annual Premium: | 4,000 |
| Current Insurance Company: | Hartford | Number of Claims in the Past 3 Years: | 0 |
| Length of Time Insured: | over 10 | Number of Years Continuously Insured: | over 10 |
| BUSINESS DETAILS: | |||
| Number of Full-time Employees: | 15 | Gross Annual Payroll: | $200,001 – $500,000 |
| Number of Part-time Employees: | 0 | Gross Annual Revenue: | $500,000 – $1,000,000 |
| Legal Entity / Status: | Limited Liability Corporation | Years of Owner Experience in Industry: | 15 |
| Number of Years in Business: | Over 10 | ||
| GENERAL LIABILITY DETAILS: | |||
| Desired Amount of General Liability Coverage: | 2,000,000 | ||
| Business Hours: | 08:00 AM – 05:00 PM | ||
| BUSINESS OWNERS POLICY – PROPERTY DETAILS: | |||
| Year Built or Date of Last Updates: | 1980 | Fire Alarm Type: | Central/Monitored |
| Construction Type: | Frame | Desired Deductible Amount: | $1,500 |
| Number of Stories: | 1–2 | Physical Building Coverage Limit: | $500,000 |
| Total Square Footage of Building: | 2,100 | Business Personal Property Amount: | $10,000 |
| Total Square Footage of Space Occupied by Business: |
2,100 | Additional Properties to Insure: | No |
| Burglar Alarm Type: | Central/Monitored | # of Additional Properties to Insure: | 0 |
| COMMERCIAL AUTO DETAILS: | |||
| Garaging Street Address: | 1890 Grocery Ln | Max Distance for Deliveries or Worksite: | 0–50 |
| Garaging Suite or Unit #: | Desired Commercial Auto Liability Limit: | 2,000,000 | |
| Garaging City / State / Zip: | Denver, CO 80205 | Desired Uninsured / Underinsured Motorist Limit: | 2,000,000 |
| Number of Vehicles: | 3–10 | Desired Deductible: | 1,500 |
| Number of Drivers: | 5–10 | ||
| ADDITIONAL COVERAGE INTERESTS: | |||
| Bonds: | No | Business Interruption: | Yes |
| Errors & Omissions: | No | Employment Practices Liability: | Yes |
| Directors & Officers Liability: | No | Rental Reimbursement: | No |
| Non-Owned Auto: | Yes | Medical Coverage: | No |
| Commercial Umbrella: | Yes | ||