Quote Request Form Commercial Quote "*" indicates required fields Step 1 of 22 - Insurance Type 0% HiddenPolicy Number HiddenTag 2 Thank you for your interest in receiving a business insurance quote. This form should only take about 5-10 minutes to complete. Don't worry if you don't have everything. You can always click the "Save and continue later" button below. We'll email you a private link to pick up where you left off.Which type of insurance are you looking for?*Check all that apply. General Liability Workers Comp Commercial Auto Garage & Dealers Policy Professional Liability (E&O) Property (Building coverage, contents, etc.) Equipment Floater (Tools coverage, etc.) Cyber Liability Other Other type of insurance* When do you want the policy, or policies, to start?* MM slash DD slash YYYY Personal InformationFull Name* First Last Date of Birth MM slash DD slash YYYY Email* Mobile Phone*Work PhoneConsent* I agreeBy providing my wireless phone number to Rosenthal Insurance Services, Inc., I agree and acknowledge that Rosenthal Insurance Services, Inc. may send text messages to my wireless phone number for any purpose, including marketing purposes.Fax Phone Business InformationBusiness Name* DBA Entity Type*- Select -Sole ProprietorLimited Liability Company (LLC)CorporationPartnershipFEIN Business Website Is this business affiliated with a franchise? No Yes Business Address* Street Address City - Select State -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zipcode Business OwnersNumber of Owners- Select -Just MyselfMultiple Owners VehiclesNumber of VehiclesSelect12345VIN Vehicle 1 Year Vehicle 1 Make Vehicle 1 Model Vehicle 1 Bodily InjuryNo Coverage10/2015/3020/4025/5030/6050/100100/100100/300100/500250/500300/300300/500500/500500/10001000/100075 CSL100 CSL200 CSL250 CSL300 CSL500 CSL1000 CSLProperty DamageNo Coverage5000100001500020000250003000040000500001000002500003000005000001000000UM-BINo Coverage10/2015/3020/4025/5030/6050/100100/100100/300100/500250/500300/300300/500500/500500/10001000/100075 CSL100 CSL200 CSL250 CSL300 CSL500 CSL1000 CSLUIM-BINo Coverage10/2015/3020/4025/5030/6050/100100/100100/300100/500250/500300/300300/500500/500500/10001000/100075 CSL100 CSL200 CSL250 CSL300 CSL500 CSL1000 CSLUMPDNo Coverage100001500020000250003000040000500001000002500003000005000001000000Medical PaymentsNo Coverage500100020002500500010000250005000075000100000Comprehensive Vehicle 1No CoverageZero Deductible10020025030050010005000Collision Vehicle 1No CoverageZero Deductible10020025030050010005000RentalNo Coverage15203035405060TowingNo CoverageYes255075100250Full GlassYesNoVIN Vehicle 2 Year Vehicle 2 Make Vehicle 2 Model Vehicle 2 Collision Vehicle 2No CoverageZero Deductible10020025030050010005000Comprehensive Vehicle 2No CoverageZero Deductible10020025030050010005000VIN Vehicle 3 Year Vehicle 3 Make Vehicle 3 Model Vehicle 3 Comprehensive Vehicle 3No CoverageZero Deductible10020025030050010005000Collision Vehicle 3No CoverageZero Deductible10020025030050010005000VIN Vehicle 4 Year Vehicle 4 Make Vehicle 4 Model Vehicle 4 Collision Vehicle 4No CoverageZero Deductible10020025030050010005000Comprehensive Vehicle 5No CoverageZero Deductible10020025030050010005000VIN Vehicle 5 Year Vehicle 5 Make Vehicle 5 Model Vehicle 5 Comprehensive Vehicle 5No CoverageZero Deductible10020025030050010005000Collision Vehicle 5No CoverageZero Deductible10020025030050010005000Are all vehicles titled in the name of the business?* Yes No DriversNumber of DriversSelect1234567Driver Name 1 First Last Driver DOB 1 MM slash DD slash YYYY Driver DL 1 Driver Name 2 First Last Driver DOB 2 MM slash DD slash YYYY Driver DL 2 Driver Name 3 First Last Driver DOB 3 MM slash DD slash YYYY Driver DL 3 Driver Name 4 First Last Driver DOB 4 MM slash DD slash YYYY Driver DL 4 Driver Name 5 First Last Driver DOB 5 MM slash DD slash YYYY Driver DL 5 Driver Name 6 First Last Driver DOB 6 MM slash DD slash YYYY Driver DL 6 Driver Name 7 First Last Driver DOB 7 MM slash DD slash YYYY Driver DL 7 Do any of your drivers take the vehicle(s) home at night?* No Yes Do all drivers have a clean driving record?* Yes No What is on each driver's record?Include each driver's name and date of violation if possible. Business Information ContinuedDo you have employee(s)?* Yes No Do you lease your employees?* No Yes Estimated annual payroll* Do you use any subcontractors? (1099s)* Yes No How many subcontractors?* Subcontractor annual payroll* What type of work do your subs perform?* Do you have a written contract with your subs requiring them to name your business as Additional Insured and show proof every year?* Yes No Not yet What year did the business start?* Years of experience operating this business?* Years of experience in this field?* Building and Property InformationMy business location is* A business property or office My home Address* Same as previous Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code This location is* Leased Owned You may upload a copy of your lease hereAccepted file types: pdf, Max. file size: 50 MB.PDF file type only.Do you need coverage for the building? Yes No Have you made any tenant improvements? Yes No In the future How much tenant improvement coverage do you need? Number of Full Time Employees* Number of Part Time Employees* What is your total annual gross sales / business income?* Occupied Percentage Occupied Area Square footage of your business Open to Public ANY AREA LEASED TO OTHERSYesNoOCCUPANCY DESCRIPTION City LimitSelectInsideOutsideInterestSelectOwnerTenantYear Built*- Select -2020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Number of stories of the building ConstructionSelectNon-CombustibleMasonry Non-CombustibleModified Fire ResistiveSuperior Non-CombustibleSuperior Masonry Non-CombustiblePoured ConcreteConcrete Tile-upAsbestos & StuccoConcrete BlockSteelEarth ShelterFrameAdobeHeavy Timbered Joisted MasonryPlastic/Vinyl SidingJoisted MasonryLogMasonryMetal/Aluminum SidingOtherPre-FabricatedFire Resistive/SuperiorMetal/Plastic SidingTrailer (Mobile Home)Masonry VeneerRoof TypeSelectCompositionAsbestos ShakesCopperCedar ShakesSteel/PorcelainPlasticRecycled Roofing ProductsRoll RoofingSingle Ply Membrane SystemsTar & Gravel (Built-Up)Cedar ShakesMetalConcrete TileOtherPouredRockSlateTileAluminum ShinglesWood Shake/ShingleClay TilePlywoodMiles to Fire StationProtection ClassFeet to Fire HydrantPercent SprinkleredOther security features. (Please describe) Has there been any updates to the roof, plumbing, electrical, or heat? No Yes I don't know Year Roof Updated?Select190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022Year Plumbing Updated?Select190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022Year Electrical Updated?Select190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022Year Heat Updated?Select190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022Do you have more than one business location?* No Yes HiddenEACH OCCURENCE HiddenDAMAGE TO RENTED PREMISES HiddenMED EXP HiddenPERSONAL & ADV INJURY HiddenGENERAL AGGREGATE HiddenPRODUCTS-COMP / OP AGG Additional Business LocationsAdditional Location(s)Please add all your additional business locations below.Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Building Information Business DescriptionPlease describe the nature of your business* Customer DataWhat type of customer data do you store?*Do you store date from third parties?*- Select -NoneLess than 50,000 recordsBetween 50,000 - 100,000 recordsMore than 100,000 recordsWhat security policies do you use?* Which industry standards do you comply with?* I don't know PCI/DSS NIST CSF SOC 1/2 ISO 27001/2 ISO 8000/1 GDPR HIPAA FINRA FDIC HITECH Other None Other industry standard* Who manages you cybersecurity?* Internal employee External consultant None Do you encrypt all stored or accessed personal data?* Yes No I don't know How often do you backup your data* Daily Weekly Monthly Infrequently None I don't know How long do you retain those backups?* 30 days or more 2 - 30 days 1 day or less ManufacturingIs there any manufacturing, mixing, re-labeling, or repackaging of products?* No Yes Please describe Claims InformationHave you had any claims or losses in the last 5 years?* No Yes What was the date, amount paid, and description of each loss or claim* Current InsuranceDo you have ANY business insurance currently?* No Yes Name of current insurance carrier?* Expiration date of current policy* MM slash DD slash YYYY Why are you looking for a new quote? Current total insurance premium? Current PoliciesYou may upload copies of your current policies here. File types allowed: .pdf Each file maximum size: 5MB Maximum files: 10 Drop files here or Select files Accepted file types: pdf, Max. file size: 5 MB, Max. files: 10. Do you need any Business Personal Property coverage?* Yes No Not sure, let's discuss How much Business Personal Property coverage do you want? Are you interested in Loss of Use / Business Income coverage?* Yes No Not sure, let's discuss Garage & Dealers InformationWhat types of vehicles you service, repair, or sell?*Select all that apply Private Passenger Motorhomes Motorcycles Utility Trailers Commercial Trucks Commercial Trailers Other Other vehicles* What is the total amount of coverage for other people's vehicles would you like?*Example: If you have 20 vehicles at any one time and each vehicle has an average value of $25,000 then you would want $500,000 in coverage. What parts and accessories do you sell over the counter? None New Parts Used Parts Exterior/Interior Trim Apparel Estimated annual over the counter sales What are your security practices?* 3-Part Ticket Key Cabinet Protected Lot None Where do you store customer's vehicles?* In Building Fenced Area Open Lot Where do you store keys to customer's vehicles?* Key Cabinet In/On the Vehicle Other Please describe Other key storage location* Do you tow for hire?* Yes No Garage & Dealers Information List the percentage of the work you provide for each section below. Where work is performed. Total must equal 100%.Percent of work performed at Your Shop% at Your Shop Percent of work performed at Customer's Location% at Customer's Location Percent of work performed at Other% Other 0%Please describe Other Location Type(s) of work performed (in percent). Total must equal 100%.Type of Work: Body/Paint% Body/Paint Type of Work: Brakes, Transmission or Suspension% Brakes, Transmission or Suspension Type of Work: Electrical% Electrical Type of Work: Mechanical% Mechanical Type of Work: Muffler/Radiator% Muffler/Radiator Type of Work: Oil Change% Oil Change Type of Work: Roadside Assistance% Roadside Assistance Type of Work: Safety Inspection% Safety Inspection Type of Work: Tires/Wheels% Tires/Wheels Type of Work: Tune Up% Tune Up Type of Work: Wash/Detail% Wash/Detail Type of Work: Welding% Welding Type of Work: Other% Other (Upholstery, frame work, body work, window tint, windows, cleaning trailer, stereo system, etc.) 0%Please describe Welding type of work performed* Please describe Other type of work performed* Do you provide any off-site services or mobile services?* No Yes What is the maximum miles away from your business that you offer your services?* Dealer Sales QuestionsHow many Dealer Plates do you have?* Number of Repairer/Transporter plates owned by you? Number of vehicles sold annually* Number held for sale (Average #)* Number held for sale (Maximum #)* Number of vehicles sold on internet auction Number of vehicles sold on consignment Do you sell "salvage titled" vehicles?* No Yes Yes: How much structural repair done?* Additional Insured Information (Optional)Do you have anyone that needs to be listed as Additional Insured? No Yes Additional Insured Information. (i.e. Name & Address)You may upload your additional insured documents using the upload field below.Additional Insured Document(s)You may upload up to 10 PDF documents. If you have more documents you can send them to your agent after they contact you. Drop files here or Select files Accepted file types: pdf, Max. file size: 50 MB, Max. files: 10. Additional Comments and/or Current Policy Upload (Optional)If you have any additional comments, questions, or additional coverage required, please enter those here.Any Additional DocumentsYou may upload up to 5 additional PDF documents here. If a file is over 8MB please email to us at richard@rosenthal-insurance.com Drop files here or Select files Accepted file types: pdf, Max. file size: 8 MB, Max. files: 5. Wrapping UpWhat is the best time to call and discuss your quote?* Morning Afternoon Evening Anytime Other Please specify the best time to call* Would you like a quote from a specific agent?No PreferenceRichard RosenthalHow were you referred to us? Consent*Like most insurance agencies, Rosenthal Insurance Services, Inc. uses information from you and other sources, such as your driving and claims histories, insurance score, and other factors to calculate an accurate rate for your insurance. New or updated information may be used to calculate your renewal premium. I Agree All the above information is accurate and true to the best of my knowledge.* Yes Would you like to create a user account to manage your submissions?* Yes, create my account Not at this time Username*Password* Enter Password Confirm Password EmailThis field is for validation purposes and should be left unchanged.
