Click these for
a quick quote:

• Business
• Workers' Comp.

• Homeowners
• Automobile

• Special Event
• Special Event
  Liquor Liability

Business Insurance Quotation

Welcome to our Business Insurance quotation page.

For a free quote, fill out the secure form below and click submit. Please fill in as much of the information as possible to assist us in getting to you the most accurate quote. All information is held in the strictest confidence.

Use your keyboard TAB button to move through the form. Use the keyboard ENTER button to submit your completed form, or click on the CLICK HERE TO SEND button at the end of the form.

Insured's Information

Your Name Business Name DBA

Is the applicant:

[ select one ] Individual Partnership Corporation Joint Venture other if other, please describe:

Please describe your business Number of years in business or business experience Number of years in business at this location Business Street Address Business Street Address (continued) Business City Business State Business Zip Code Business Email Business Phone Home Phone Mobile Phone Current Business Insurance Carrier Current Policy Expiration Date

Any losses within the last 5 years?

yes no if yes, please describe:

Total Gross Annual Receipts

Coverage

Commercial Liability Aggregate

[ select one ] 500,000 1,000,000 2,000,000 other if other, please describe:

Medical

[ select one ] 1,000 5,000 other if other, please describe:

Business Personal Property

[ select one ] 10,000 20,000 30,000 40,000 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 other if other, please describe:

Property Deductible

[ select one ] 500 1,000 2,500 5,000 other if other, please describe:

Building Information

Year built Total Square Feet Customer Area

Number of stories

[ select one ] 1 1.5 2 3 split level other if other, please describe:

What floor do you occupy?

Does the building occupy any residential or hotel type living situation?

yes no

Construction type

[ select one ] Frame Masonry Brick other if other, please describe:

Roof type

[ select one ] Tile Shingles Composition Tar & Gravel Wood Shake Concrete other if other, please describe:

Age of roof

Burglar Alarm

[ select one ] central station local alarm other none if other, please describe:

Fire Alarm

[ select one ] central station local alarm other no if other, please describe:

Is the building Sprinklered? [ select one ] 0% 25% 50% 75% 100%

Plumbing Updated

[ select one ] Completely Partially None if done, what year:

Wiring Updated

[ select one ] Completely Partially None if done, what year:

Heating Updated

[ select one ] Completely Partially None if done, what year:

Do you need liquor liability?

yes no

Do you need a Commercial Auto quote?

yes no

We also offer Workers' Compensation quotes. Click on link above.

Can we help you with any other insurance need? How Did You Hear About Us? [ select one ]Internet Friend/Colleague Mailer Other

click here to send click here to clear the form return to top of form

Northern California

Toll free: 800-722-6606

1045 N. Fourth Street
San Jose, CA 95112
Tel: 408-298-9882
Fax: 408-298-9886

P.O. Box 837
Bodega Bay, CA 94923

Southern California

Toll free: 800-722-6606

P.O. Box 99593
San Diego, CA 92169

Toll free: 800-722-6606

info@communityinsuranceonline.com