Commercial Insurance | Brentwood CA | (925) 634-1240

Commercial Insurance Quotes

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General Business Information

Business Legal Name*

Does your business operate under a DBA?*

Yes

DBA Name:

Name of Primary Contact*

First Last

Preferred Email*

Preferred Phone Number*

Can we text this phone number?*

Yes

Organization Type*

Business Website Address

FEIN

DO NOT enter SSN. If no FEIN, enter 123456789.

Primary Location Address*

Street Address City State ZIP Code

Mailing address:*

Same

Different

Mailing Address*

Street Address City State ZIP Code

Please briefly describe the business operations:*

Which types coverage can we help you with?*

General Liability

Property Coverage

Commercial Auto

Worker's Comp

Professional Liability

Excess Liability / Umbrella

Check all that apply

Does the business perform work as an artisan contractor?

Yes

Artisan Contractor Questions

Contractor Type*

Please select the contractor type that best fits your business. On the next page, you can describe in more detail.

Do you have an active contractor's license?*

Yes

Type of license:*

License Number:*

Commercial Work %*

Please enter a number less than or equal to 100.

Residential Work %*

Please enter a number less than or equal to 100.

New Construction %*

Please enter a number less than or equal to 100.

Remodel %*

Please enter a number less than or equal to 100.

Any work above 15ft or below 1ft surface?*

Yes - Work above 15ft

Yes - Work below 1ft underground

How often do you use a written contract with your customers?*

Always

Sometimes

Never

Additional Business Information

Year Business Started*

Years of Industry Experience*

Number of Owners*

Number of staffed locations:*

Occupied Sq ft:

Annual Sales/Revenue*

Number of Employees*

Estimated Annual Payroll*

Include owners/officers in WC coverage?*

Yes

List all NAICS/SIC codes for any type of work your employees do for you

Class Code (or Type of Work)

Percentage of Payroll

If you don't know the NAICS/SIC codes, please describe as best you can the type of work your employees do you. Please also breakdown the percentage of your payroll for each class/code.

Are subcontractors used?*

Yes

Subcontractor Questions

Does your subcontractor agreement include a hold harmless clause?*

Yes

Do you require subcontractors to maintain General Liability Insurance matching your limits of liability?*

Yes

Do you generally use the same subcontractors?*

Yes

Est. annual cost of subcontractors (incl. materials & labor)*

Auto Limits Requested

Please list the type of cargo being carried and percentage:

Example: "Raw Construction Materials / 30%" Use the "+" to add more lines as needed.

Requested Commercial Auto Liability Limit:

Uninsured/Under-insured Motorist Coverage*

Do Not Include

Include

Limit Requested

Personal Injury Protection*

Do Not Include

Include

Limit Requested

Filings Required*

Yes

Filing Type

Hired/Non-owned Auto Required*

Do Not Include

Include

Limit Requested

Cargo Coverage Requested*

Do Not Include

Include

Limit Requested

Trailer Interchange Required*

Do Not Include

Include

# of Trailers

Roadside Assistance*

Do Not Include

Include

Current GL/BOP policy in force:*

Do Not Include

Include

Interested in Telematics Discount*

Yes

How would you like to provide the driver list?*

Enter driver info manually

Upload a list of drivers

Please upload your driver list here:*

Max. file size: 39 MB.

How would you like to provide the vehicle list?*

Enter vehicle info manually

Upload a list of vehicles

Please upload your vehicle list here:*

Max. file size: 39 MB.

Drivers Information

Please enter driver info below. Click + to add more drivers.*

Name

DOB

Marital Status

Hire Date

DL#

Vehicle/Trailer Information

Please enter vehicle info below. Click + to add more vehicles.*

Year

Make

Model

VIN

Value

Radius Driven

Current Insurance

Does the business currently have insurance?*

Yes

Have you had any claims or judgments filed against you in the last 5 years?*

Yes

Current Insurance Company:*

Expiration Date:*

Current Premium:

Please upload a copy of your current insurance declarations:

Drop files here or

Max. file size: 39 MB.

Why are you shopping for insurance?

Please check all the apply

New Venture

Price

Poor Customer Service

How did you hear about us?

I'm a current Zeigler Insurance client

Referred by someone

Google / Online Search

Social Media

I was contacted by Zeigler Insurance

Other

Do you have a DOT# / MC# or plan to get one in the next 6 months?

Yes

Loss Run Reports

Do you agree to help us obtain a copy of your current loss run history report showing any losses/claims for the last 5 years?

Yes

DOT #

If unavailable or not applicable, enter: "N/A"

MC #

If unavailable or not applicable, enter: "N/A"

Please provide any additional details that may help us find the best coverage for your business:

Fast Turnaround

Bringing efficiency to everything we do to get you covered quickly.

Proactive Service

Our account managers are here to help you whenever you need it.

Carrier Selection

Our wide range of business insurance carriers ensures great pricing.

We wouldn't trust our business to anyone else...

"Several years back we had a fairly significant claim on our business insurance. It wasn't until then that we realized how much we neglected our insurance through the years. Zeigler Insurance stepped in when others couldn't help, and they've been a tremendous asset to our business ever since. If you need someone you can count on, they are incredible, and we highly recommend them! "

Commercial Client Since 2012