Manufacturing Insurance Quote

Contact Name *

Title / Position

Email Address *

Phone Number *

City *

State * Select WA OR CA ID AK AZ MT NV UT CO TX Other

Zip Code *

Type of Manufacturing * Select Manufacturing Type Food Processing Beverage Manufacturing Bakery / Confectionery Meat / Poultry Processing Dairy Products Cannabis / CBD Products Metal Fabrication Machine Shop Steel / Iron Works Foundry Heavy Equipment Manufacturing Aerospace Components Electronics Manufacturing Circuit Board Assembly Computer / Tech Hardware Semiconductor Chemical Manufacturing Pharmaceutical Cosmetics / Personal Care Paint / Coatings Plastics / Rubber Lumber / Sawmill Wood Products / Furniture Paper / Pulp Printing / Publishing Textile Manufacturing Apparel / Clothing Leather Goods Concrete / Cement Products Glass Manufacturing Building Materials HVAC Equipment Windows / Doors Consumer Goods Toys / Games Sporting Goods Appliances Auto Parts Manufacturing Vehicle Assembly Marine / Boat Manufacturing Medical Devices Packaging Contract Manufacturing Other (please specify)

Years in Business * Select New / Startup Less than 1 year 1-2 years 3-5 years 6-10 years 11-20 years 20+ years

Annual Gross Revenue * Select Under $500,000 $500,000 - $1 million $1 million - $2.5 million $2.5 million - $5 million $5 million - $10 million $10 million - $25 million $25 million - $50 million $50 million - $100 million $100 million+

Annual Payroll *

Full-Time Employees *

Part-Time Employees

Temp / Contract Workers

Business Entity Type Select Sole Proprietorship Partnership LLC Corporation S-Corporation

Federal Tax ID (EIN)

Do you own or lease your facility? * Select Own Lease Both (multiple locations)

Number of Locations Select 1 location 2-3 locations 4-5 locations 6+ locations

Total Square Footage *

Year Building Constructed

Building Construction Type Select Fire Resistive (concrete/steel) Non-Combustible (metal) Masonry (brick/block) Frame (wood) Mixed Construction Not Sure

Fire Protection Select Full Sprinkler System Partial Sprinklers Fire Extinguishers Only Fire Alarm System (no sprinklers) None

Burglar Alarm Security Cameras Security Guards Fenced Perimeter Access Control 24/7 Monitoring

Do you use or store hazardous materials? Select No Yes - Chemicals Yes - Flammables Yes - Chemicals & Flammables Yes - Other hazardous materials

Building Value (if owned)

Tenant Improvements (if leased)

Machinery & Equipment Value *

Raw Materials & Inventory Value *

Finished Goods Value

Office Contents & Furniture

Computers & Electronics

Vehicles Owned (if any)

General Liability Property Insurance Product Liability Workers' Compensation Equipment Breakdown Business Income / Interruption Commercial Auto Cyber Liability Umbrella / Excess Liability Pollution Liability Inland Marine / Transit Product Recall Employment Practices (EPLI) Directors & Officers (D&O) Crime / Fidelity Not Sure - Need Guidance

Desired Effective Date

Current Policy Expiration Date

Current Insurance Carrier

Current Annual Premium

Any claims in the past 5 years? * Select No claims 1 claim 2 claims 3+ claims

Has coverage ever been cancelled or non-renewed? Select No Yes

ISO Certified OSHA Safety Program FDA Registered Quality Control Program Written Safety Manual Environmental Compliance Program

Do you export products internationally? Select No Yes - Under 10% of revenue Yes - 10-25% of revenue Yes - Over 25% of revenue

Preferred Contact Method Select Phone Call Email Text Message Any method is fine