BUSINESS PROPERTY/BUILDING INSURANCE

Do you own commercial property, equipment or a building? If so, you need a business property/building insurance policy. This policy can protect your practice’s physical assets from fire, burst pipes, storms, explosions, theft, and vandalism. These assets include the following:

• Computers used to run your practice
• Furniture, such as desks, chairs, and tables
• Accounts receivable and other valuable documents
• Exterior signs

If you have any questions or would like to obtain a quote, please complete the following form, give us a call at 800.347.1109, or email us at tda@assoc-admin.com.

Business Property/Building Insurance Quote Request - Step 1 of 4

Practice:

Contact:

Location Address:

City:

State:

Zip Code:

County:

Phone:

Email:

Business Structure:Select OneIndividualPartnershipCorporationOther

Do you have multiple locations?Select OneYesNo

Business Structure (if you selected other):

Multiple Location Details:

Number of Full-Time Employees:

Number of Part-Time Employees:

Next

Current Carrier:

Policy Number:

Expiration Date:

Years in Business:

Years at this Location:

Claims in past 5 years:Select OneYesNo

Claim(s) Details:

Do you own the building?Select OneYesNo

Value of Office Contents*:

Value of Building:

*Replacement cost of furniture, computers, equipment, etc.

of Address: Layout

PreviousNext

Year Roof Updated:

Year Plumbing Updated:

Year Electrical Updated:

Year HVAC Updated:

Burglar Alarm:Select OneYesNo

Sprinkler System:Select OneYesNo

Basement:Select OneYesNo

Flood Insurance Required:Select OneYesNo

Age of Building (year built):

Square Footage You Occupy:

Total Square Footage:

Number of Stories:

Non-Owned/Hired Auto Liability:Select OneYesNo

Pension or Profit Sharing Plan:Select OneYesNo

Deductible Requested:

• $250
• $500
• $1,000
• $2,500

PreviousNext

Please complete the following for any commercial or commercially-owned vehicles that you wish to insure along with your property coverage.

Vehicle Year:

Vehicle Make:

Vehicle Model:

Vehicle VIN:

Add Vehicle Remove Vehicle

Please complete the following for each driver if adding any commercial or commercially-owned vehicles.

Driver's Name:

Driver's Age:

Accidents/Violations:

Add Driver Remove Driver

Additional Information:

Previous

Submit