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Business Information

To process your quote, please provide the following documents (Lease, 5-year Loss Run, Copy of Current Declaration Pages)

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Max. file size: 512 MB.

Business Information

Name of the Business(Required)

Business Description(Required)

Nature of your operation, what does your business do

Address of the Business Location(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mailing address (If different from physical address)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Do You Own or Lease the Location of Operation?

Contact Information

Phone Number(Required)

By submitting your mobile number, you agree to receive periodic text messages from us. Standard messaging rates may apply.

Email Address(Required)

Ownership Information

Name of Owners/Partners/Officers

Date of Birth of Owners/Partners/Officers

Business Details+

Business Details

Federal Employers ID of the Entity (EIN, FEIN #)

Year Business Became Operational

Years of Experience in This Industry

Square Footage of Your Location to Insure

Gross Sales a Year (If New Operation, Indicate Anticipated Sales a Year)

Number of Employees (Besides the Owner)

Subcontractor’s Cost a Year

Subs must have their own general liability insurance to be considered subs

Amount of Business Personal Property in Your Location

Equipment, tools, PCs, desks, chairs, cabinets, materials, etc.

Amount of Tenant Finish Cost Paid by You

Security Measures in Place

Fire extinguisher, smoke detectors

Prior Insurance (if any)

Any Bankruptcies in the Last 5 Years?

Have There Been Any Claims or Losses?

Name of the Additional Insured

Landlord, Who is Requesting Cert of Insurance

Add more

Building/Property Information +

Building/Property Information

Do You Own or Lease?

Do You Own the Commercial Real Estate in a Different Entity?

Entity Type

EIN

Number of Locations for This Business

Number of Buildings at All Locations

Type of Construction of Your Location

Wood frame, concrete, metal

Roof Type

Roof Year

Year Built

Total Square Feet of the Building

Year Updates Were Done to Roof, Electrical, Plumbing, HVAC

Need to know all of these

Tools, Equipment, Inventory?

Tools/Equipment Over $2000?

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Commercial Auto +

Commercial Auto

Number of Vehicles

Year, Make, Model, VIN

Number of Drivers

Drivers' Information

Name, DOB, Driver's License #

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Workers Comp +

Workers Comp

Number of Employees and Job Duties

Total Payroll

Include/Exclude Owner Payroll?

Add more

Commercial Umbrella

Amount Requested

1,000,000-5,000,000

Tim Stuber Insurance Agency, LLC

Tim Stuber
Insurance Agency, LLC

Tim Stuber

tstuber@farmersagent.com

CLIENT INFORMATION

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Upload a pdf of your info

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Please call (303)410-1060 with questions.

Personal Information

Primary Insured Information:

Auto Information:

Additional Drivers:

Vehicle:

Additional Vehicles:

Dwelling Information

*Single Family

-OR- * Townhome/Condo/Renters

Townhouse only

Life Insurance:

Additional:

Business Information

Business Information

Contact Information

Ownership Information

Business Details+

Building/Property Information +

Commercial Auto +

Workers Comp +

Commercial Umbrella