CIC - Commercial Insurance Center

Quick Quote

Full Name:
Telephone:
Email:
Type of Insurance:	Personal Business
Insurance Needed

Additional Comments:

General Liability Quote

Business general liability insurance is your businesses protection against devastating claims for things over which you may have
minimal control. Choose Texas business liability insurance for products, directors & officers, errors & omissions, discrimination, benefit liability, and other professional liability policies.

We offer professional liability insurance services to Manufacturers, Wholesale, Retail, Services, Transportation, Construction, Commercial Real Estate, small Contractors, and other businesses throughout Texas.

Texas Business Information

Business Name:
Premises Address:
City:
State:
Zip Code:
Contact Name:
Phone:	.Cel.: .Fax:
Years in Business:
Email Address: (Required)
Federal Employer's ID #:
Description of Operations or SIC code:
Estimated Annual Payroll:	$
Gross Sales:	$
Do you need a bond?	Yes No

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General Information:

Is the applicant a subsidiary of another entity?	Yes No
Does the applicant have any subsidiaries?	Yes No
Is a formal safety program in operation?	Yes No
Any exposure to flammables explosives chemicals?	Yes No
Any catastrophe exposure?	Yes No
Any other insurance with this company or being submitted?	Yes No
Any policy or coverange declined, cancelled ot non-renewed during the prior 3 year?	Yes No
Any past losses or claims relating to sexual abuse or molestation allegations, discrimination or negliget hiring?	Yes No
During the last five year (ten in ri). Has any applicant been convicted of any decgree of the crime of arson? (In Ri, this question must be answered by any applicant for property insuarance. Failure to disclose the existence of an arson conviction is a misdemeanor punishable by a sentence of up to one year of imprisonment)	Yes No
Any unicorrected fire code violations?	Yes No
Any bankruptcies, tax or credit liens against the applicant in the past 5 years?	Yes No
Has business been placed in a trust? If yes, name of trust	Yes No
Any parking facilities owned/rented?	Yes No
Is a fee charged for parking?	Yes No

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Recent Insurance Information:

Current Insurance Company:
Policy #:
Expiration Date:	(mm/dd/yyyy)

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What types of coverages do you currently have:

Benefit Liability	Business Liability
Commercial Umbrella	Directors & Officers Liability
Discrimination	Errors & Omissions
Product Liability	Professional Liability
Other

Other Insurance Company Used Within Past 3 Years:
Policy #:
Losses past 3 years:
Amount paid for each loss:	$
Description of losses or loss runs:

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Choose Texas Business Liability Insurance Limits:

General Aggregate Limit (other than products completed)
Products/Completed Operations Aggregate Limit
Umbrella Amount:

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If you do not own or rent a building - Skip this Box

Building 1
Building Value:	$	Contents Value:	$
Total Building Area:		Year Built:
Construction Type:		Sprinklers:
Electrical Type:		Alarm:
Electrical Renovation Year:

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List Neighboring Businesses:

To the right:		Distance:
To the left:		Distance:
To the rear:		Distance:


Additional Information or Comments:

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Click on the "Submit Quote Information" button below to send
your Texas Business Liability Insurance quote request.

“Information received from this Texas Business Liability Insurance quote request form sent to our company, will be for our use only and will not be sold, given to or distributed to any other parties.”