Quote - Property and Casualty

Select Business Type

Apartments/Dwellings

Auto Service/Repair

Bar/Tavern

Beauty/Barber Shop or Personal Services

Builders Risk

Car Wash

Church/House of Worship

Condo/Home Owner Association

Contractor

Day Care Center

Distributor/Wholesaler

Dry Cleaners

Gas Station/C-Store

Lessor's Risk

Manufacturing

Medical Office

Restaurant

Retail Store

Special Event

Supermarket

Tattoo Parlor

Truckers GL

Vacant Land/Building

Washateria/Laundromat

Other

Quick Quote option is not available for this business type, please submit completed Acords and relevant supplemental applications to us at submissions@vintageunderwriters.com. All applications can be found at www.vintageunderwriters.com/applications.html

Select Desired Coverage Type

Property

General Liability

Coverage Type - na

Liquor Liability

Professional Liability

Quick Quote option is not available for Liquor Liability or Professional Liablity, please submit completed Acords and relevant supplemental applications to us at submissions@vintageunderwriters.com. All applications can be found at www.vintageunderwriters.com/applications.html

Please use our Contractor Form by Clicking Here

Insured Information

Submitting Agency *

Agency Contact Name *

Named Insured *

Ownership Status *

Property Owner

Tenant

Mailing Address *

Location Address (if different from Mailing Address)

Entity Type *

Operations *

Detailed description of operations.

Year Business Started *

Experience - Number of Years *

New Venture *

Yes

No

Expiring Carrier *

Expiring Date *

Loss Runs - Has Insured Had Losses? *

Yes

No

Please attach loss runs for the past 5 years. *

Maximum upload size: 5MB

Cooking - Cooking Exposure *

Yes

No

Checkboxes

Insured meets cooking requirements.

If YES, all cooking must be under a UL approved automatic fire suppression system with automatic shut off control, currently tagged and under a semi-annual cleaning contract with a professional firm. Any fryers must be more than 16 inches away from an open flame or have a metal baffle between them.

GL/BOP Type Coverage

General Aggregate *

Prod & Comps *

Personal & Advertising *

Occurence Limit *

Fire, Legal *

Medical Expenses *

Deductibles *

Payroll *

Employees *

# of Employees

Owners *

# of Owners (include officers, partners, etc.

Annual Gross Receipts

2017 - Operation

2017 - Rating Basis Used
(sales, gallons, payroll, etc)

2017 - Exposure

2016 - Operation

2016- Rating Basis Used
(sales, gallons, payroll, etc)

2016 - Exposure

2015 - Operation

2015 - Rating Basis Used
(sales, gallons, payroll, etc)

2015- Exposure

Property Type Coverage

Building Limits ($) *

Building Co-Insurance (%) *

Building Valuation *

ACV

RCV

Contents / BPP Limits ($) *

Contents / BPP Co-Insurance (%) *

Contents / BPP Valuation *

ACV

RCV

Business Income ($)

BI Extra

Add BI Extra

BI Limitation (Monthly Limitation)

3

6

9

12

Pumps Limits ($)

Pumps Co-Insurance (%)

Pumps Valuation

ACV

RCV

Canopy Limits ($)

Canopy Co-Insurance (%)

Canopy Valuation

ACV

RCV

Sign Limits ($)

Sign Co-Insurance (%)

Sign Valuation

ACV

RCV

Coverage Form *

Basic Form

Broad Form

Special Form

Theft Coverage

Add Theft Coverage

Is there a central station alarm?

Yes

No

Building - Year Built *

Building - Total Square Feet *

Building - # of stories *

Building - Construction Type *

ISO 6 Fire Resistive

ISO 5 Modified Fire Resistive

ISO 4 Masonry Non-Combustible

ISO 3 Non-Combustible

ISO 2 Joisted Masonry

ISO 1 Frame/Brick Veneer

Building Age - +20 years?

Building is OVER 20+ years old

Building Update

Roof Update *

Plumbing Update *

Wiring Update *

Heating Update *

Additional Insured?

Yes

Additional Insured

Additional Insured Name

Additional Insured Address

Additional Insured City

Additional Insured State

Additional Insured ZIP

Relationship to Insured

Options

Add Waiver of Subrogation

Add Primary Non-Contributory

Quote – Property and Casualty

Property & Casualty Quote