Commercial Insurance Quote Request

* Name of Business

* Type of Business Entity

* Business Description

* Location Street Address

* City

* State

* Zip Code

* Contact Person

* Contact Phone Number

* Email Address

Property

	check all that apply
Building
Contents
Computers/EDP
Contractor's Equipment
Vehicles

Property Coverage Limit

	enter amount
Bldg
Value
Value
Value
# Vehicles

Additional Property Coverage Information

Liability

Liability Coverage Type

	check all that apply
General Liability
Professional Liability
Umbrella Liability

Liability Coverage Limit

	enter amount
G/L Limit
Prof. Limit
Umbrella Limit

Additional Liability Coverage Information

Workers Compensation

Payroll Classifications(list owners or officers payroll on separate line(s)

	Class Code or Job Description	No. Employees	Annual Payroll for the Classif.	Owner/Officer ? (Y/N)
1
2
3
4
5
6

* Owners / Officers Payroll

	Exclude Owner/Officer Coverage ?
Please select

Cape Ann Insurance Agency offers insurance to Massachusetts residents only. Our quotes are estimates based on information you have provided and may change depending on information not collected for this quote. For a more accurate quote please contact us directly and one of our Staff will personally assist you.

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Cape Ann Insurance Agency, 23 Dale Ave, Gloucester MA

Cape Ann Insurance Agency, Inc. www.capeanninsurance.com

Commercial Insurance Quote Request

Property

Liability

Workers Compensation