* All fields below are required, unless marked as optional

Insured Details
General Questions
Submission confirmation

Applicant / Insured Information (Mailing Address)

Business Type

Business Name

Address 1

Address 2 (Optional)

City

State

Zip

County

Business Phone (999-999-9999)

Website Address (Optional)

Insured Contact Information

First Name

Last Name

Contact Title

Phone (999-999-9999)

Policy Proposed Date

Effective Date

Period

Expiration Date

Business Overview

Date Business Started (Note -: The Business start date needs to be before or equal to the policy effective date)

Description of Primary Operations (Max. of 256 characters)

Premises Information

Premise - 1

Street

City

State

County

Zip

# Full time employees (including the owner)

# Part time employees

Select the operations at these premises

Major Classification

Sub Classification

Property Limits

Is the Building Owned by the Business?

Square Footage Occupied at this premise (sf)

Estimated Sales /Receipts for the Next 12 Months at this premise

Enter Building Limit (Optional if Building is not owned)

Enter Business Personal Property Limit (Optional if Building is owned)

Other Business Ventures

Does applicant have other business ventures for which coverage is not requested? (If Yes, Please provide name(s) and description of other business(es))

Policy Level Coverage

Liability & Medical Expenses Limits

Enter Occurrence Limit

Aggregate Limit

Total Building Limit

Total Business Personal Property Limit

CANCEL

General questions about Business Operations

Have you in the past or do you currently sell firearms, ammunitions or weapons of any kind?

Yes No
Are any products sold or services performed by you for any military, law enforcement, or other armed forces or services?

Yes No
Are you required to post motor carrier financial responsibility filings to any federal and or state department of transportation (dot) or other agency?

Yes No
Do you hire non-employee drivers to perform delivery of your products or services?

Yes No
For food delivery, do any of your employees use their owned personal vehicles to make deliveries 10 or more days per month?

Yes No
Do you own or operate any manned or unmanned aviation devices (aircraft, helicopters, drones etc.) in your business?

Yes No
Is more than 5% of your cost of goods sold directly imported by you from a country or territory outside of the United States?

Yes No
Do you have discontinued or ongoing operations involving the manufacturing, blending, repackaging, or re-labeling of components or products made by others?

Yes No
Do you have discontinued or ongoing operations involving the storage, application, transportation, recycling, or disposal of any hazardous materials or substances?

Yes No
Do you have business premises open to the public?

Yes No

If yes, is your business open past 12:00 AM?

Yes No

Loss Information

11. Please indicate the number of loss events to your business, or claims made against you by others, whether covered by insurance or not, regardless of fault within the last three (3) years:

Property loss events or claims

0

1

2

3 or more
General Liability events or claims

0

1

2

3 or more
Professional or Errors & Omissions Claims

0

1

2

3 or more

CANCEL

Success! your quote is ready!

quote number:

BP.xxxxx

named Insured(s):

Bob's bike shop

premium:

$5,146.69 including Terrorism(TRIA) and applicable taxes

Great news! Your proposal is attached for your review. You can view it and bind it by clicking the button below.

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sorry! we have already received a submission for this applicant

Applicant Name:

Bob's bike shop

Status:

blocked submission

We appreciate your submission to InsureThePeople. Unfortunately another applicant has previously submitted an application with same Insured name.

If you have any questions, please contact our team at: Support@InsureThePeople.com

We look forward to working with you on future submissions.

declined submission!

named Insured(s):

Bob's bike shop

This submission has a premises address that requires additional reviews for Coastal Wind exposure.

Your submission was decline, probably due to answering a question that our computer did not like. You can either go back and do a new quote and see if you can get the answer right, or you can contact us direct, please.

Please Email: Support@InsureThePeople.com
Or Call Us: +1 833-246-1988

BUSINESSOWNER APPLICATION FRAUD WARNINGS

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION OR CONCEALS, FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS SUCH PERSON TO CRIMINAL AND CIVIL PENALTIES. (Not applicable in AL, AR, CO, DC, FL, KS, KY, LA, MD, ME, NJ, NM, NY, OH, OK, OR, RI, TN, VA, VT, WA or WV – see Additional Fraud Notices for these States below).

ADDITIONAL FRAUD NOTICES

NOTICE TO ALABAMA, ARKANSAS, LOUISIANA, NEW MEXICO, RHODE ISLAND, AND WEST VIRGINIA APPLICANTS: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

NOTICE TO COLORADO APPLICANTS: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.

NOTICE TO DISTRICT OF COLUMBIA APPLICANTS: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant.

NOTICE TO FLORIDA APPLICANTS: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.

NOTICE TO KANSAS APPLICANTS: Any person who, knowingly and with intent to defraud, presents, causes to be presented or prepares with knowledge or belief that it will be presented to or by an insurer, purported insurer, broker or any agent thereof, any written, electronic, electronic impulse, facsimile, magnetic, oral, or telephonic communication or statement as part of, or in support of, an application for the issuance of, or the rating of an insurance policy for personal or commercial insurance, or a claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance which such person knows to contain materially false information concerning any fact material thereto; or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act.

NOTICE TO KENTUCKY APPLICANTS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.

NOTICE TO MAINE APPLICANTS: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or denial of insurance benefits.

NOTICE TO MARYLAND APPLICANTS: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

ADDITIONAL FRAUD NOTICES (CONT’D)

NOTICE TO NEW JERSEY APPLICANTS: Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties.

NOTICE TO NEW YORK APPLICANTS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

NOTICE TO OHIO APPLICANTS: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

NOTICE TO OKLAHOMA APPLICANTS: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.

NOTICE TO OREGON APPLICANTS: Any person who knowingly and with intent to defraud or solicit another to defraud the insurer by submitting an application containing a false statement as to any material fact may be violating state law.

NOTICE TO TENNESSEE, VIRGINIA AND WASHINGTON APPLICANTS: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits.

NOTICE TO VERMONT APPLICANTS: Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense and subject to penalties under state law.

The undersigned declares that to the best of his or her knowledge and belief the statements and representations made herein and in any attachments appended hereto and/or incorporated herein by reference are true and complete and that no material facts have been misstated, misrepresented, suppressed or concealed. The signing of this application does not bind the undersigned to purchase insurance, nor does review of the application bind any insurer to issue a policy. It is agreed, however, that this application shall be the basis of the contract should a policy be issued. If there is any material change in the answers to the questions provided herein or in any of the attachments appended hereto and/or incorporated herein by reference prior to the effective date of the insurance policy, the applicant must immediately notify the insurer in writing and the insurer reserves the right in such instance to modify or withdraw any quotation or binder that may have been issued. The undersigned also represents that he or she is authorized on behalf of the applicant to complete and sign this application on its behalf.