Feddersen Insurance Agency, Inc. - Property Liability Quote

Property Liability Quote

Commercial Property Insurance Quote

Contact Information

Name of Business:
Contact Name:
Premises Address:
City:	State: Zip:
Business Phone:	Fax Number:
Contact Email Address:
Years in Business:
Description of Operations or SIC code(s):

Current Insurance Information

Current Insurance Carrier:
Premium: $ Expiration Date:
Annual Sales: $ Payroll: $ Business Income: $
Other Insurance Company Used Within Past 3 Years: Policy #: Losses past 3 years: Amount paid for each loss: $ Description of losses or loss runs:

Coverage's Desired

Liability Limit Desired: Deductible Desired:
Or choose other liability limit amount: $
Umbrella Amount Desired:

Building 1

Building Value: $ Contents Value: $
Total Building Area: Year Built:
Construction Type: Sprinklers:
Electrical Type: Amps:
Electrical Renovation Year:
Plumbing Renovation: Plumbing Renovation Year:
Heating Type: Heating Renovation Year:
Roofing Renovation: Roof Age (years):
Central Alarm:

List Neighboring Businesses:
To the right: Distance:
To the left: Distance:
To the rear: Distance:

Building 2

Additional Comments

Please give any additional comments or questions

No coverage of any kind is bound or implied by submitting information via this online form

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We will not distribute information to other parties other than for insurance underwriting purposes.
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