Business Owners Quote - Monteleone Insurance

service@monteleoneins.com | 631-544-4000

About
Insurance By Policy
Insurance By Industry
Resources
Contact Us
Client Portal
Get A Quote
Search
Menu Menu

Business Owners Policy – Monteleone Insurance

In efforts to find you the best value and coverage From ALL our carriers, kindly fill out the following questions to the best of your ability.

If you do not know the answer, please leave blank or reach out to our team for guidance.

Thank you!

Questions or Requests: broeder@monteleoneins.com or 631-544-4000.

Current Policy Information

Upload Existing BOP Policy (This is efficient to compare current coverages, endorsements and pricing)

Drag & Drop Files, Choose Files to Upload

Upload Existing UMBRELLA Policy (This is efficient to compare current coverages, endorsements and pricing)

Drag & Drop Files, Choose Files to Upload

How Many Years Have You Been With The Same Carrier(s)?

Kindly Best Describe If Any Claims Were Made or Settled In The Past 5 Years (Claim Cause, Payment, Open or Closed):

Business Information

Legal Name Of The Entity:

Doing Business As (DBA Name If Applicable):

Tax ID Number/FEIN:

Main Contact Name:

Main Contact Email *

Office Phone Number

Mobile Phone Number:

Fax Number:

Business Physical Address and Mailing Address:

How Many Years Of Industry Experience? What Date/Year Was The Business Formally Started?

Please Describe Your Business (what do you do? wholesale? retail? manufacture?):

What Are Your Estimated Annual Sales/Revenue?:

Building/Property Information

Location 1

Location #1 Address

What Type Of Property (stand alone building, shopping center, office building)? Are You The Sole Occupant or Are Other Businesses At Same Location?

Do You Own The Building Under Same Entity or Different Entity? Tenant Only?

What Is Your Estimated Business Personal Property Value (Inventory, Rented Equipment, Furniture, Computers, All Other Property In Store/Office, and Improvements Made):

Sales Volume At This Location:

Square Footage Of Your Business Location? Is 100% Of The Business Location Open To The Public?

# Of Stories:

Roof Material:

Last Year Roof Updated:

Circuit Breakers?:

Last Year Electric Updated?

Last Year Plumbing Updated?

Heat Type?

Last Year Heat Updated

Does Building Have Sprinklers?

Yes - Full
Yes - Partial
No

Burglar Alarm?

Yes - Central Station
Yes - Local
No

Fire Alarm?

Yes - Central Station
Yes - Local
No

Security Cameras?

Yes
No

Add 2nd Location

Add 2nd Location

Location 2

Location #2 Address

What Type Of Property (stand alone building, shopping center, office building)? Are You The Sole Occupant or Are Other Businesses At Same Location?

Do You Own The Building Under Same Entity or Different Entity? Tenant Only?

What Is Your Estimated Business Personal Property Value (Inventory, Rented Equipment, Furniture, Computers, All Other Property In Store/Office, and Improvements Made):

Sales Volume At This Location:

Square Footage Of Your Business Location? Is 100% Of The Business Location Open To The Public?

# Of Stories:

Roof Material:

Last Year Roof Updated:

Circuit Breakers?:

Last Year Electric Updated?

Last Year Plumbing Updated?

Heat Type?

Last Year Heat Updated

Does Building Have Sprinklers?

Yes - Full
Yes - Partial
No

Burglar Alarm?

Yes - Central Station
Yes - Local
No

Fire Alarm?

Yes - Central Station
Yes - Local
No

Security Cameras?

Yes
No

Add 3rd Location

Add 3rd Location

Location 3

Location #3 Address

What Type Of Property (stand alone building, shopping center, office building)? Are You The Sole Occupant or Are Other Businesses At Same Location?

Do You Own The Building Under Same Entity or Different Entity? Tenant Only?

What Is Your Estimated Business Personal Property Value (Inventory, Rented Equipment, Furniture, Computers, All Other Property In Store/Office, and Improvements Made):

Sales Volume At This Location:

Square Footage Of Your Business Location? Is 100% Of The Business Location Open To The Public?

# Of Stories:

Roof Material:

Last Year Roof Updated:

Circuit Breakers?:

Last Year Electric Updated?

Last Year Plumbing Updated?

Heat Type?

Last Year Heat Updated

Does Building Have Sprinklers?

Yes - Full
Yes - Partial
No

Burglar Alarm?

Yes - Central Station
Yes - Local
No

Fire Alarm?

Yes - Central Station
Yes - Local
No

Security Cameras?

Yes
No

Add 4th Location

Add 4th Location

Location 4

Location #4 Address

What Type Of Property (stand alone building, shopping center, office building)? Are You The Sole Occupant or Are Other Businesses At Same Location?

Do You Own The Building Under Same Entity or Different Entity? Tenant Only?

What Is Your Estimated Business Personal Property Value (Inventory, Rented Equipment, Furniture, Computers, All Other Property In Store/Office, and Improvements Made):

Sales Volume At This Location:

Square Footage Of Your Business Location? Is 100% Of The Business Location Open To The Public?

# Of Stories:

Roof Material:

Last Year Roof Updated:

Circuit Breakers?:

Last Year Electric Updated?

Last Year Plumbing Updated?

Heat Type?

Last Year Heat Updated

Does Building Have Sprinklers?

Yes - Full
Yes - Partial
No

Burglar Alarm?

Yes - Central Station
Yes - Local
No

Fire Alarm?

Yes - Central Station
Yes - Local
No

Security Cameras?

Yes
No

Add 5th Location

Add 5th Location

Location 5

Location #5 Address

What Type Of Property (stand alone building, shopping center, office building)? Are You The Sole Occupant or Are Other Businesses At Same Location?

Do You Own The Building Under Same Entity or Different Entity? Tenant Only?

What Is Your Estimated Business Personal Property Value (Inventory, Rented Equipment, Furniture, Computers, All Other Property In Store/Office, and Improvements Made):

Sales Volume At This Location:

Square Footage Of Your Business Location? Is 100% Of The Business Location Open To The Public?

# Of Stories:

Roof Material:

Last Year Roof Updated:

Circuit Breakers?:

Last Year Electric Updated?

Last Year Plumbing Updated?

Heat Type?

Last Year Heat Updated

Does Building Have Sprinklers?

Yes - Full
Yes - Partial
No

Burglar Alarm?

Yes - Central Station
Yes - Local
No

Fire Alarm?

Yes - Central Station
Yes - Local
No

Security Cameras?

Yes
No

Workers Comp, Paid Family Leave, & Disability

# Of FT Employees

#Of PT Employees

# Of Male Employees

#Of Female Employees

What Are Your Estimated Total Annual Payroll and Break It Down By Job Position?

Please Let Us Know Any Questions, Concerns or Important Information:

PRINT THIS FORM

Contact Our Office

Monteleone Insurance

Hauppauge, NY

service@monteleoneins.com

Mo,Tu,We,Th,Fr 8:00 am – 5:00 pm

Claims & Payments

Contact Our Office

Monteleone Insurance

Hauppauge, NY

service@monteleoneins.com

Mo,Tu,We,Th,Fr 8:00 am – 5:00 pm
Sat & Sun by call or Appointment

Popular Pages

Home
About
Our Carriers
Get A Quote
Make A Payment

© Copyright - Monteleone Insurance
Website Design by Tosten Marketing

Link to Facebook