INSURANCE QUOTE REQUEST
for Mr. Handyman Business Owners     .

We would like to provide you with an insurance quote for your Mr. Handyman 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#
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 Mr. Handyman International, LLC, 3948 Ranchero Drive, Ann Arobr, MI 48108 as an Additional Named Insured.

This G/L policy shoud be in the form of a Package or Business Owners Policy, with endorsement CG 20 29 - Additional Insured - Grantor of Franchise

Annual estimated payroll
of technicians
$   
Annual estimated receipts
$  
   
Property Insurance
Requested Business Property Values:
  
Contents: Furniture, fixtures and office equipment
$   ($1,500 limit will be quoted if no other entry appears)
Computer hardware and software
$  ($2,500 limit will be quoted if no other entry appears)
Small tools and equipment owned by you
$  ($1,500 limit will be quoted if no other entry appears)
Small tools and equipment of employees
$   ($1,000 limit will be quoted if no other entry appears)
Office/Home Information:
  
Age
If building/home is over 25 years - updates done
. . .
Additional Interests/Landlord Information if applicable
(name, address, fax , email)
   
Workers' Compensation

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
Building Operations
$   (if allowed)
Clerical
$  
Owner's Salary
$   
Other payroll (if needed)
$
Other payroll (if needed)
$
As an owner, would you like to be included or excluded (we recommend you be included)

Do you work in more than one state?

If yes, which ones?

  



 
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 auto.

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

  Uninsured and Underinsured motorist limits $1,000,000.

  Use Symbol "1", "Any Auto" for Liability.

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
 
Employee Dishonesty (Third Party coverage)
Required Minimum Limit: $25,000 per loss
 
Umbrella Liabitliy

  Required Minimum Limit: $2,000,000
 Self Insured Retention: $10,000 Max

Note: it is generally accepted that your General Liability, Automobile, Umbrella and Workers' Compensation coverage
should be purchased from a single insurance provider. We are not able to schedule other insurance policies under our umbrella.

 
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
 
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a service team member