Ficke & Associates

General Business Quote

General Information
Contact Name *
Phone Number:
Email *
Fax
Other Contact Information

Business Name
Address
City
State
Zip
Other Location
Other Location
Address
Occupancy Status Owner  Tenant
Year Built
% Occupied
Sprinklers Yes  No
Construction Type
Stories
# Basements
Sq. Footage
Burglar Alarm Yes  No
Building Value
Contents
Other Property (specify)
Current Insurance Company
(not agency)
Company Name
Policy Expiration Date
Other Location
# of Full-Time Employees
# of Part-Time Employees
How long in Business? (yrs)
How many locations?
Please give a brief description of your business and clientele
Current Insurance Coverages
Current Coverages Bond
Commercial Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors & Officers Liability
Disability
Group Health
Group Life
Professional Liability
Workers' Compensation
Other
Insurance Information
Other
Annual Gross Sales: (before taxes)
Number of Employees
Annualized Payroll
Cost of any Subcontracted Work
Limits Requested $300,000
$500,000
$1,000,000
$2,000,000
Describe any claims you've had in the past 5 years
Additional Comments
* = Required Field
Disclaimer Notice - The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.


     3 LOCATIONS

271 Route 46 West ,Suite A201
Fairfield, NJ 07004
Phone: 1-877-516-3749    
Fax: 1-888-717-776
Click Here for Email
Click Here for Directions

Windsor Business Park
186 Princeton Hightstown Road
Building 3A, Suite 9
West Windsor NJ 08550
Phone: 1-877-516-3749    
Fax: 1-888-717-7763
Click Here for Email
Click Here for Directions

300 E Royal Lane
Suite 116
Irving, TX 75039
Phone: 1-877-516-3749
Fax: 1-888-717-7763
Click Here for Email
Click Here for Directions



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