Kyle Insurance Co. Commercial GL/WC/Other Quote.-Kyle Ins Co

Business Name

What best describes your business's ownership structure?

How many owners are there in your company?

EIN Number

What state is your business based/operated out of?

Primary Business Owners Name

Date of Birth

Phone Number

Email

Website or Facebook address

Physical Address

Mailing Address (leave blank if physical address is also mailing address)

Is your business operated out of your home?

New Venture?

What date did your business start?

Reason for Shopping?

What type of coverage are you looking for? (check all that apply)

Prior losses or claims in the past 5 years?

Tell us what you do, describe your business & key business operations

Are you required to have specific coverage for a Job or Contract?

Do you perform any other work outside the scope of your key business operations?

Percentage of Residential vs Commercial Work

Are you required by the State of Florida or USA to have a license to do your scope of work?

What percentage of work is over 2 stories?

Is a formal safety program in operation?

Estimated Annual Revenue (next 12 months)

Do you use Subcontractors? Percentage base on annual revenue!

Do any of the following apply? Work performed on, (select all that apply)

Do you work at any of the following types of jobsites: airports, amusement facilities, hospitals, industrial plants, docks, marinas, shipyards, ethanol or biodiesel plants, mines or quarries, power plants, or oil Fields

Number of Employees (W-2, including yourself)

Number of Employees paid on a 1099(including yourself)?

What is your employee payroll for the next 12 months (include full time and part time)? Note: Exclude owners

Years of Experience in your line of work?

To get an accurate quote we need to run your loss history and consumer reports (soft credit check) If you ask us to bind coverage you automatically agree for the reports to be run.

How did you hear of Kyle Insurance Co?

Facebook

Friend or Coworker

Realtor or Lender

Other

Terms and Conditions

I understand that proof or prior coverage (declarations page unobscured) may be required prior to quoting and/or binding and carriers may require additional documentation
Fraud

Any person who knowingly and with intent to injure, defraud or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. The information provided for revenue, payroll, ETC is subject to audit by the carrier. Audits are typically done at the end of a policy period, or when you cancel a policy. New businesses and small business owners often rely on estimates for their financial projections, and small businesses can change rapidly over time, so the audit is a chance to make sure your insurance coverage and premiums accurately reflect your level of risk.

Commercial Auto

I understand any employee rated on my quote/policy for them to be covered driving a company vehicle. If a driver is not rated on the policy, they are not covered to drive the vehicle — even if you gave them permission to use the vehicle. If you need an employee to be covered to drive the vehicle, you must notify your agent/carrier before. I agree to notify Kyle Ins Co. of any driver that needs to be rated or excluded on the quote/policy.

Claims and Loss History

Based upon your knowledge and the knowledge of your business’s current and past partners, officers, directors, and employees, during the last five years a third party has never made a claim against your business, and you do not know of any reason why someone may make a claim.

I agree to the terms & conditions above.

Note to agent