Business Owners Package (BOP) Insurance Quote

We would like to provide you with a free, no-obligation insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

General Information
Name of Insured:
Address:
City:	State: Zip:
Business Phone:	Fax Number:
Email Address:
Location Address (type "same" if same as above):
City:	State: Zip:

Property Questions
Age of building /Year Built:	Type of building construction:	Number of stories:	Other occupancies:	Square feet you occupy:
				sq. ft.
If the building is over 25 years old, please answer the following:
Year Electricity was updated: Is it on circuit breakers?:		Yes No
Year Plumbing was updated: Copper or Galvanized plumbing?:		Copper Galvanized Other:
Year Building was last re-roofed: Type of roofing material:
Type of heating system in the building:

Protective Devices
Burglar Alarm:	Central Station or local alarm?:	Name of alarm company:	Is the building sprinklered?:	Are there smoke detectors?:
Y N	Central Station Local Alarm		Y N	Y N

Liability Questions
Please provide information on previous insurance carrier:
Previous Ins. Carrier:	Policy number:	Prior premium:	Policy renewal date:
		$
Please provide information about your business:
Years in business:	Projected Gross annual receipts:		Projected annual payroll:
	$		$
Describe your business, product or service:

Coverage Limits
Building:	Contents (equipment, inventory, supplies, etc.):		Deductible:	Loss of Income:
$	$			$
Money and Securities:	Glass or signs:	General Liability Limit:	Non-owned and Hired Automobile Liability:	Is liquor liability needed?
$	$		$	Yes No
If Glass Coverage is needed, please provide dimensions:
Please list other coverages you may need:

Miscellaneous Information
Name of Additional Insured (Landlord or vendor):
Mailing Address:
City:	State: Zip:

Additional Comments

Please give any additional comments you feel appropriate for this quotation. If you have
additional information where there was not enough fields above, please enter them here.

Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

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Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.

Community Insurance Group

139 Harristown Road, Suite 202
Glen Rock, New Jersey 07452

Phone:
Toll Free:
Fax:
Fax (NJ only):

201-444-4426
855-344-4426
201-444-0731
800-440-2267