GENERAL LIABILITY · FLORIDA & VIRGINIA

Tell us about your business so we can get started on your General Liability quote. The questionnaire has five steps and shows follow-up questions based on your answers. Have your estimated annual revenue and payroll handy; supporting documents are optional.

General Liability Quote Questionnaire

Your business
Operations
Size and people
Coverage and claims
Documents

1. Your business

General Liability quote request for Florida and Virginia. Required fields are marked *. Estimates are welcome; enter 0 for none. This form does not start coverage.

Full legal business name

DBA / trade name (if different)

Business structure

Contact name and title

Phone number

Email address

Mailing address, city, state and ZIP

Primary business address, city, state and ZIP

State where your business is primarily located

Website / business social page (if available)

Date business opened

Owner industry experience (years)

Number of working owners

2. Operations and business type

Tell us about everything the business does. Select all categories that apply; only the related questions will appear.

Describe ALL work, services and products

Main activities and share of total revenue (%)

Who are your customers?

States served and travel radius / service area

Business categories - select all that apply

Contractors and trades

Retail and offices

Restaurants and food businesses

Manufacturing and product sales

Janitorial and other service businesses

Real estate owners and lessors

Events, recreation and fitness

Other business type

Contractors: trades, job types and work height

Retail / offices: products and services

Food businesses: operations and alcohol

Products: manufacturing, imports and sales

Janitorial / service businesses: work and customer property

Property owners / lessors: buildings and tenants

Events / recreation / fitness: activities and participants

Other business type: additional details

3. Business size, premises and outside help

Use actual figures for the last 12 months and estimates for the next 12 months. Gross revenue is revenue before expenses. List subcontractor costs separately from employee payroll.

Gross revenue - last 12 months ($)

Estimated gross revenue - next 12 months ($)

Employee payroll - last 12 months ($)

Estimated employee payroll - next 12 months ($)

Full-time employees

Part-time / seasonal employees

Is working-owner pay included in the payroll figures?

Employee job duties and estimated annual payroll by duty

Primary location type

Space used by your business (square feet)

Do you have additional business locations?

Additional locations: address, use and square footage

Do customers or the public visit any business location?

Do you work at customer locations or other off-site locations?

Do you hire subcontractors, independent contractors or 1099 workers?

Subcontractor / outside labor costs - last 12 months ($)

Estimated subcontractor / outside labor costs - next 12 months ($)

Describe the work you subcontract

Do you collect proof of their General Liability insurance?

Do you use written contracts with these workers?

4. Insurance needs and claims

If you are unsure about limits or contract wording, choose Help me decide and attach any requirements on the next step.

Requested coverage start date

Current General Liability insurance

Current / most recent insurance company

Current / most recent policy expiration date

Annual GL premium ($), if known

Current GL limits, if known

Date coverage ended and reason for the coverage gap

Requested GL limits: each occurrence / general aggregate

Other requested limits

Has business insurance been canceled, nonrenewed or declined?

Cancellation, nonrenewal or decline: reason and date

Any GL claims or incidents during the past 3 years?

Claims / incidents: details for each event

Does a client, landlord or contract require specific insurance terms?

Required limits, additional insureds and special wording

5. Documents and finish

Attach your current declarations page and any contract insurance requirements, if available. You may submit without documents and provide them later. We will request loss runs (insurer claim-history reports) separately if needed.

Current insurance declarations page (optional)

Choose File

Contract insurance requirements (optional)

Choose File

Anything else we should know? (optional)

Your answers will be sent to Hoppy Insurance Agency at agency@hoppyinsurance.com for a General Liability quote review. Privacy policy.

This is a quote request only. Coverage does not begin by completing or submitting this form. Your agent may request additional details or insurer applications.

Confirmation

I confirm these answers are accurate and complete to the best of my knowledge and request that Hoppy Insurance Agency contact me about this quote.

Completed by (name and title)

1. Your business

2. Operations and business type

3. Business size, premises and outside help

4. Insurance needs and claims

5. Documents and finish

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