INSURANCE QUOTE REQUEST
for Ductz Business Owners     .

We would like to provide you with an insurance quote for your Ductz business. Please provide as much information as possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

General Information
 
Tentative training date
Required insurance placement date
Tentative open for business date
Legal Name
d/b/a
 
Physical Address:
.....Street Address
Address 2 (suite #/P.O. Box/etc.)
City
State
Zip Code
 
Mailing Address:.
.....Street Address
Address 2 (suite #/P.O. Box/etc.)
City
State
Zip Code
Primary Contact
Office Phone
Cell Phone
Email Address
Is this a home based business?
I am incorporated as a(an)
Federal Tax Id#
State Specific Id# (if applicable)
My territories will include
(City & County)
   
General Liability (G/L)
 
The required minimum limits are:
$2,000,000 Aggregate
$1,000,000 Per Occurance
$2,000,000 Products/Completed Operations
$1,000,000 Personal and Advertising Injury
List HOODZ International and Belfor USA Group LLC, 731 Fairfield Ct., Ann Arobr, MI 48108 utilizing endorsement CG 20 29 - Additional Insured - Grantor of Franchise
Annual estimated payroll
of technicians
$   ($35,000 is typical)
   
Property Insurance
 
Requested Business Property Values:
  
Contents: Furniture, fixtures and office equipment
$
Tools and equipment owned by you
$
Tools and equipment owned by your employees
$
Building/Residence Information:
  
Age
If building is over 25 years - updates done
. . .
Landord - additional interest
(name & address if applicable
   
Inland Marine Coverqage
 
Contractors Equipment
  $
Miscellaneous Equipmentand Supplies in Van
  $
Business Income
  $
   
Contractors Pollution Liability
 
$1,000,000 Per Occurance Pollution Policy inclding Mold is required
Workers' Compensation
 

Required Limits: $500,00 by Accident or Disease

Franchises in "monopolistic"states (Ohio, North Dakota and Wasington State) should have "Stop Gap" coverage. This can be added to General Liability policy or issued as a stand alone workers' compensation policy.
Please insert your annual estimated payroll l
Technician Payroll for Cleaning (9014)
$   ($35,00 is typical)
Clerical (8810)
$   (if any)
Owner's Salary (8742)
$   ($20,000 is typical)
Other payroll (if needed)
.code ...$
Other payroll (if needed)
.code ...$
As an owner, would you like to be included or excluded (we recommend you be included)
 
Vehicle Information
For all leased and/or owned automobiles

  Required minimum is $1,000,000 combined single limits (bodily injury and property damage)
  include hired and non-owned cars.

  Insurance Coverage must not have a deductible or self-insured retention greater then $5,000.

  Uninsured and Underinsured motorist limits $1,000,000.
Year
 Make/Model Cost New VIN # Owned or Leased
Driver Information
At least one driver must be listed for each vehicle. Please include all drivers (owners and employees)
Name
Date of Birth
Drivers License Number
 
Umbrella Liabitliy
  Required Minimum Limit: $2,000,000
 
Other Coverages Worth Considering

    1. Employment Related Practices Liability
    2. Flood Insurance
    3. Key Man of Buy/Sell Life Insurance
    4. Disability Insurance

 
Additional Comments
 

Click to submit quote request
You will be contacted by
a service team member