Business Quote

3748 Oakton Street

Skokie, IL 60076

1-877-447-6646

(1-877-4IRMOINS)

Irmo Insurance Agency, Inc.

Licensed in Illinois, Indiana,

Kentucky, New York

Pennsylvania & Wisconsin

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Interested in a quote for business insurance? Please complete the form below and click submit to send it to Irmo Insurance Agency, Inc. If you have any questions while completing this form, please email us at office@irmoinsurance.com or call us at 847-677-0505.

Business Insurance Quote

No coverage is bound until you are contacted by one of our representatives

Name
Business Name
Street Address
Street Address
City, State, Zip
Phone Numbers	Home Work
Email Address

BUSINESS ACTIVITIES

1. Type of organization
2. How many owners, partners, or officers?
3. How many employees, excluding owners, partners or officers?
4. Date Business Started?
5. Last year's payroll:
6. This year's projected payroll:
7. Last year's gross sales:
8. This year's projected sales:

9. Describe your normal business activities

10. Have you had liability losses or claims in
the past 5 years?

If yes, please give description, date and amount paid for each

PROPERTY INFORMATION

a. Year Building was built
b. Type of building construction:
c. Number of Stories
d. Other Occupancies:
e. Total Square Feet
f. Square Feet You Occupy

IF THE BUILDING IS OVER 25 YEARS OLD, PLEASE ANSWER THE FOLLOWING:

f. Year Electricity was Updated
g. Is it on Circuit Breakers
h. Year Plumbing was Updated
i. Copper or Galvanized Plumbing	If Other

PROTECTIVE DEVICES:

22. Do you have a security system?
If yes, please describe what type
Burgler Alarm
Type of Alarm
Alarm Company
Sprinkler System In Building
Smoke Detectors
23. Have you had any property losses in the past 3 years?
If yes, please describe

PRIOR COVERAGE

1. Previous Carrier
2. Policy Number
3. Prior Premium $
4. Policy Renewal Date
5. Continuous Coverage in Force Since

DESIRED COVERAGE

	Liability Coverage Limit:
	Property Coverage Limit: Deductible:
	Buildings Coverage Limit: Deductible:
	Contents Coverage Limit: Deductible:
	Signs Coverage Limit: Deductible:
	Other If Other: Coverage Limit:
	Other If Other: Coverage Limit:
	Other If Other: Coverage Limit:

ADDITIONAL INSURED

Name
Address
Phone Number	Phone FAX
Account or Loan #

LIENHOLDER/MORTGAGE INFO

Name
Address
Phone #
Fax #
Loan #
Legal Description
Building Owned or Leased

COMMENTS

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