Business Insurance Quote Form

Please fill out the form below to request a Business Insurance Quote. If you wish, you may also download the form by clicking here.
All fields marked with ( * ) are required.


Business Name*:
Premises Address*:
City*:
State*:
Zip Code*:
Contact Name*:
Phone #*:
Ext #:
Fax*:
Years in Business*:
Email Address*:
Federal Employer's ID #*:
Description of Operations or SIC code*:
Number of Employees*:
Payroll (not including owners)*:
Estimated Gross Receipts*:

   
Select all that apply to your Florida business:
  
Work above 15 feet
Work Underground
Use Subcontractors
Require out of state travel
Delivery Service
Work on vessels, docks, or bridges over water
Offer safety incentive programs
Other
     
Recent Insurance Information:
  
Current Insurance Company:
Policy #:
Expiration Date:
 (mm/dd/yyyy)
   
What types of coverages do you currently have:
General Liability
Worker’s Compensation
Property
Business Auto
Equipment Floater
Directors + Officer’s
Crime
Professional Liability (E + O)
Benefit Liability
Pension Trust Bond
Other
 
   
Other Insurance Company Used Within Past 5 Years:
Policy #:
Losses past 3 years:
Amount paid for each loss:
Description of losses or loss runs:
Choose Florida Business Liability Insurance Limits:
  
General Aggregate Limit (other than products completed)
Products/Completed Operations Aggregate Limit   
Umbrella Amount:
   
If you've already filled out information on your buildings or facilities
in another insurance quote form then skip the section below.
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:
Additional Information or Comments





Please Enter the letters or numbers you see in the box.
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Click on the "Submit Quote Information" button below to send your
Florida Business Liability Insurance quote request.

**Information received from this Florida Business Liability Insurance quote request form sent to Innovative Insurance Agency will be for our use only and will not be sold, given to or distributed to any other parties. A quote will be based on the Florida business liaiblity insurance information provided and does not guarantee acceptance of the risk by us. The precise coverage afforded is subject to meeting underwriting guidelines, and the terms, conditions and exclusions of the policy as issued. By submitting this request you acknowledge that this is neither an offer to insure nor a guarantee of insurance. Completion of this form does not entitle your business to a Florida Business Liability Insurance policy. We are licensed in Florida and will not provide quotes for other states.



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Innovative insurance offers the following Business/Commercial Insurance products: General Liability Insurance, Workers Comp Insurance, Construction Insurance, Business Insurance, and Commercial Auto. For Personal Insurance, we offer: Auto and Homeowners Insurance. From our office in Coral Springs, Florida, we serve Ft. Lauderdale and all surrounding cities, Palm Beach County, and the rest of South Florida. Our address is 5461 N. University Drive, Suite#103 Coral Springs, FL 33067. Our phone number is (954) 340-9551.