Total Dollar Insurance

Barre Fitness Insurance Quote

Company Profile
Legal Business Name: *
DBA Name
Legal Entity type: LLC  S-Corp  Corp  Inc  Other
FEIN# *
Mailing Address
City
State
Zip
Contact Name* *
Cell Phone *
Cell Phone
Business Phone
Business Phone
Preferred Email
Owner's Name & %
List Owner's Names & % of Ownership
  Owner's Name % of Ownership Workers Comp Inc/Expt Email
Email
Cell Phone
Cell Phone
-
-
-
-
-
Building Information Loc 1
Location 1
Physical Location Address
City
City
State & Zip Code
County
County
Name of Landlord or Property Manager
Contact Phone
Contact Email
Construction type: Frame  Joisted Masonry  Masonry noncombustible
Year Built
Number of Stories
Total Square footage of building:
Burglar Alarm : No  Yes ( If Yes: Local or Central Station)
Fire Alarm: No  Yes ( If Yes: Local or Central Station)
Automatic Sprinklers in Building:
Builiding Informaion Loc 2
Location 2
Physical Location Address
City
City
State & Zip Code
Name of Landlord or Property Manager
Contact Phone
Contact Email
Construction type: Frame  Joisted Masonry  Masonry noncombustible
Year Built
Number of Stories
Total Square footage of building:
Burglar Alarm : No  Yes ( Local or Central Station)
Fire Alarm: No  Yes (List Local or Central Station)
Automatic Sprinklers in Building:
Studio Information
Studio Information
Year Business Started
Square footage of your location
# of Exercise Studio Rooms
Replacement Cost of Business Property:
Amount of Betterments and Improvements to Building:
Estimated Annual Revenues/Sales
Estimated Annual Revenues/Sales
Do you provide Day Care? No  Yes (If yes, ratio teachers to children?)
Do you have showers? No  Yes
Do you have non slip surfaces in all potentially wet areas? No  Yes
Do you have AED? No  Yes

Amount of Coverage for Plate Glass:
Approximate Square Footage of Plate Glass Storefront:
Approximate Square Footage of Additional Windows:
Employee Information
Employee Information
Full Time
Part Time
Approximate Annual Payroll for Worker’s Compensation calculations
Most Recent renovation to:
Please enter year of the Most Recent Renovations: if not known I will contact the landlord or property manager
Roof
Heating
Plumbing
Electric
CURRENT INSURANCE INFORMATION:
CURRENT INSURANCE INFORMATION: (Whatever information you can provide is helpful)
  Yes/No Current Insurer Current Premium What is your Renewal Date? Any Claims? Please describe: Other Information
General Liability
Property
EPLI
Commercial Umbrella
Workers Comp
* = Required Field
Disclaimer NoticeThe 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.