Professional Insurance Quote Step 1 of 3 33% Applicant Name(s)Email Phone NumberOperating NameRisk Location Addresse.g. 10 Water Street, Somecity, ON. A1A 1A1 Does the Applicant work solely from a home office location? Yes No Year Established:YYYYHow many years of experience does the Applicant have?EmployeesNumber of employees located in Canada:Does the Applicant have any employees outside of Canada? Yes No Number of Employees located in US:Number of Employees located in other Countries:If there are employees located in US or Other Countries, please list the countries, number of employees and describe the situation: Risk InfoProfession 1Please selectAcademic Testing CentresAccident InvestigationActuaryAdoption AgenciesAdult EducationAdvertising ServicesAerial MappersAgrologistsAgronomistsAlternative Dispute Resolution FirmsAnswering ServicesAnthologistAnthropologistAppraisers - Real EstateArbitrators & MediatorsArchaeologistsArt TeacherAuctioneersAuthorAuto AppraisersBiologistBookkeeper & Tax PreparationBusiness Brokers / ManagersBusiness Training CoursesCareer Development CoachCareers Advisory ServiceCartographersCause & Origin Expert - Fire and ExplosionCause & Origin Expert - Materials and EquipmentCereal Growing AdvisorsChartered Professional AccountantsClaims Adjusters & AdministratorsCollection AgenciesCommercial ArtistCompany FormationCompany Search AgencyConservation ConsultantsConstruction Project ManagementContest ManagersCopying & Duplicating ServicesCopywritersCourt ReportersCustom House BrokerCustom & Freight Forwarding AgentsDamage AppraisalData Processing/Word Processing ServicesDecluttering and Organization ServicesDraughtspersonDriving Instructors (licensed automobiles)Driving Instructors (licensed motorcycles)Education Advisory ServiceEducationalists - Consulting onlyElectrical Design ServicesEnergy Consultancy / ConservationEnvironmental Impact ConsultantEscrow AgentsEvent PlannerExecutive RecruitersExpert WitnessesFire Safety ConsultantFood Inspectors / TechnologistsFood Safety AuditorForensic AnalystForensic ConsultingForensic InvestigatorsForestry ConsultantFreight ForwardersGenealogistsGerontologistGIS AnalystGrain BrokerGrant WriterGraphic DesignersHandwriting AnalystsHealth & Safety ConsultantHome Check ServicesHome InspectorHospital ConsultancyHuman Resource ConsultantsIllustrators - Technical & CommercialImage ConsultantsImmigration AdviceImport & Export ConsultancyInclusivity ConsultantInterior DesignersIntroduction AgenciesIrrigation ConsultantLand SurveyorsLandscape DesignerLegal SearchersLibrarianLicensing ServicesLighting ConsultancyLiterary AgentsLogistics ConsultantManagement Consultants BusinessMarketing & Advertising ConsultancyMarriage ConsultancyMeeting PlannersMetallurgistModels - Architectural & EngineeringMotivational Speaker / Keynote SpeakerMusic LessonsMusical Instrument Appraisals, Repairs and RefurbishmentOffice Administrative ServicesPaper Shredders/Document DestructionParalegalPastoral AgencyPersonnel - ConsultantsPersonnel - Office Placement / TempPersonnel Placement - Labourers (Manual Work)Personnel Placement - OfficePhotocopying ServicesPhotographer - CommercialPhotographer - FashionPhotographer - Peronsal - BoudoirPhotographic StudiosProcess ServersProperty ManagersPublic Records Search CompanyQuality Assurance & ControlQuantity SurveyorsRelocation AgencyResearch ConsultancyRisk Management ConsultantsSafety ConsultancySafety Training - Construction Site SafetySafety Training - Food and Beverage Production FacilitiesSafety Training - Hydro Generation Facility SafetySafety Training - Manufacturing Facility SafetySafety Training - Mining IndustrySafety Training - Oil & Gas IndustrySafety Training - Port Facility SafetySafety Training - Transportation IndustrySafety Training - Warehousing Facilities SafetySales RepresentativeShip BrokersSpeech Drama TeachersSustainability ConsultantTechnical WritersTelemarketingTesting Labs / Lab AnalysisTextile DesignerTitle SearchersTraffic ConsultantsTransportation ServicesTranslators & InterpretorsTransport ConsultantsTravel Agents (excluding Tour Operators)Travel Tour OperatorsTutoringUrban PlannersUtility LocatorsWedding PlannerWett InspectorYouth EducationDo you wish to add a second Profession? Yes No Profession 2Please selectAcademic Testing CentresAccident InvestigationActuaryAdoption AgenciesAdult EducationAdvertising ServicesAerial MappersAgrologistsAgronomistsAlternative Dispute Resolution FirmsAnswering ServicesAnthologistAnthropologistAppraisers - Real EstateArbitrators & MediatorsArchaeologistsArt TeacherAuctioneersAuthorAuto AppraisersBiologistBookkeeper & Tax PreparationBusiness Brokers / ManagersBusiness Training CoursesCareer Development CoachCareers Advisory ServiceCartographersCause & Origin Expert - Fire and ExplosionCause & Origin Expert - Materials and EquipmentCereal Growing AdvisorsChartered Professional AccountantsClaims Adjusters & AdministratorsCollection AgenciesCommercial ArtistCompany FormationCompany Search AgencyConservation ConsultantsConstruction Project ManagementContest ManagersCopying & Duplicating ServicesCopywritersCourt ReportersCustom House BrokerCustom & Freight Forwarding AgentsDamage AppraisalData Processing/Word Processing ServicesDecluttering and Organization ServicesDraughtspersonDriving Instructors (licensed automobiles)Driving Instructors (licensed motorcycles)Education Advisory ServiceEducationalists - Consulting onlyElectrical Design ServicesEnergy Consultancy / ConservationEnvironmental Impact ConsultantEscrow AgentsEvent PlannerExecutive RecruitersExpert WitnessesFire Safety ConsultantFood Inspectors / TechnologistsFood Safety AuditorForensic AnalystForensic ConsultingForensic InvestigatorsForestry ConsultantFreight ForwardersGenealogistsGerontologistGIS AnalystGrain BrokerGrant WriterGraphic DesignersHandwriting AnalystsHealth & Safety ConsultantHome Check ServicesHome InspectorHospital ConsultancyHuman Resource ConsultantsIllustrators - Technical & CommercialImage ConsultantsImmigration AdviceImport & Export ConsultancyInclusivity ConsultantInterior DesignersIntroduction AgenciesIrrigation ConsultantLand SurveyorsLandscape DesignerLegal SearchersLibrarianLicensing ServicesLighting ConsultancyLiterary AgentsLogistics ConsultantManagement Consultants BusinessMarketing & Advertising ConsultancyMarriage ConsultancyMeeting PlannersMetallurgistModels - Architectural & EngineeringMotivational Speaker / Keynote SpeakerMusic LessonsMusical Instrument Appraisals, Repairs and RefurbishmentOffice Administrative ServicesPaper Shredders/Document DestructionParalegalPastoral AgencyPersonnel - ConsultantsPersonnel - Office Placement / TempPersonnel Placement - Labourers (Manual Work)Personnel Placement - OfficePhotocopying ServicesPhotographer - CommercialPhotographer - FashionPhotographer - Peronsal - BoudoirPhotographic StudiosProcess ServersProperty ManagersPublic Records Search CompanyQuality Assurance & ControlQuantity SurveyorsRelocation AgencyResearch ConsultancyRisk Management ConsultantsSafety ConsultancySafety Training - Construction Site SafetySafety Training - Food and Beverage Production FacilitiesSafety Training - Hydro Generation Facility SafetySafety Training - Manufacturing Facility SafetySafety Training - Mining IndustrySafety Training - Oil & Gas IndustrySafety Training - Port Facility SafetySafety Training - Transportation IndustrySafety Training - Warehousing Facilities SafetySales RepresentativeShip BrokersSpeech Drama TeachersSustainability ConsultantTechnical WritersTelemarketingTesting Labs / Lab AnalysisTextile DesignerTitle SearchersTraffic ConsultantsTransportation ServicesTranslators & InterpretorsTransport ConsultantsTravel Agents (excluding Tour Operators)Travel Tour OperatorsTutoringUrban PlannersUtility LocatorsWedding PlannerWett InspectorYouth EducationGross RevenuesGross Revenues last 12 months in CANADA:Gross Revenues last 12 months in USA:Does the Applicant have any revenues that emanate from countries other than CANADA & USA? Yes No Gross Revenues last 12 months in other Countries:If there are Gross revenues from Other Countries, please list the countries:Estimated Gross Revenues (Next 12 Months)Estimated Revenues next 12 months in CANADA:Estimated Revenues next 12 months in USA:Does the Applicant forecast any revenues that will emanate from countries other than CANADA & USA? Yes No Estimated Revenues next 12 months in other Countries:If there are Estimated revenues from Other Countries, please list the countries:Other InformationDoes the Applicant abide by all required privacy laws and regulations? Yes No Does the Applicant’s contract contain warranties or guarantees that could exceed the fees charged for the work performed? Yes No Please describe details:Loss HistoryHas the applicant had any claims in the last five years? Yes No Date of claim: MM slash DD slash YYYY Nature of claim:Please selectLiability - Property damage to othersLiability - Bodily injuryLiability - Financial loss to othersLiability - OtherProperty - Vehicle impact/aircraft impactProperty - Fire (not arson)Property - Fire by arsonProperty - BurglaryProperty - Change in TemperatureProperty - Change in temperatureProperty - EarthquakeProperty - Electrical currentProperty - ExplosionProperty - Falling objectProperty - FloodProperty - FreezingProperty - HailProperty - LandslideProperty - LightningProperty - Malicious actsProperty - OtherProperty - Overland waterProperty - RiotProperty - Sewer backupProperty - SmokeProperty - WindstormProperty - VandalismProperty - Vandalism by tenantProperty - TheftProperty - WaterProperty - Snow or iceProperty - Equipment breakdownLoss / Expenses Paid:Is the claim closed? Yes No Have all damages been repaired? Yes No Describe the loss control measures that are now in place to avoid a future similar loss:Has the Applicant had more than one claim or loss in the past five (5) years? Yes No Date of 2nd claim: MM slash DD slash YYYY Nature of 2nd claim:Please selectLiability - Property damage to othersLiability - Bodily injuryLiability - Financial loss to othersLiability - OtherProperty - Vehicle impact/aircraft impactProperty - Fire (not arson)Property - Fire by arsonProperty - BurglaryProperty - Change in TemperatureProperty - Change in temperatureProperty - EarthquakeProperty - Electrical currentProperty - ExplosionProperty - Falling objectProperty - FloodProperty - FreezingProperty - HailProperty - LandslideProperty - LightningProperty - Malicious actsProperty - OtherProperty - Overland waterProperty - RiotProperty - Sewer backupProperty - SmokeProperty - WindstormProperty - VandalismProperty - Vandalism by tenantProperty - TheftProperty - WaterProperty - Snow or iceProperty - Equipment breakdownLoss / Expenses Paid on 2nd claim:Is the 2nd claim closed? Yes No Have all damages been repaired? Yes No Describe the loss control measures that are now in place to avoid a future similar loss:Has the Applicant had more than two claims or loss in the past five (5) years? Yes No Date of 3rd claim: MM slash DD slash YYYY Nature of 3rd claim:Please selectLiability - Property damage to othersLiability - Bodily injuryLiability - Financial loss to othersLiability - OtherProperty - Vehicle impact/aircraft impactProperty - Fire (not arson)Property - Fire by arsonProperty - BurglaryProperty - Change in TemperatureProperty - Change in temperatureProperty - EarthquakeProperty - Electrical currentProperty - ExplosionProperty - Falling objectProperty - FloodProperty - FreezingProperty - HailProperty - LandslideProperty - LightningProperty - Malicious actsProperty - OtherProperty - Overland waterProperty - RiotProperty - Sewer backupProperty - SmokeProperty - WindstormProperty - VandalismProperty - Vandalism by tenantProperty - TheftProperty - WaterProperty - Snow or iceProperty - Equipment breakdownLoss / Expenses Paid on 3rd claim:Is the 3rd claim closed? Yes No Have all damages been repaired? Yes No Describe the loss control measures that are now in place to avoid a future similar loss:Prior InsuranceDoes the Applicant currently carry Commercial General Liability coverage? Yes No Current Insurer Name:Policy Number:Premium:Current Insurance Expiry Date MM slash DD slash YYYY Does the Applicant currently carry Errors & Omissions Liability coverage? Yes No Current Insurer Name:Policy Number:PremiumRetroactive Date on current in-force policy: MM slash DD slash YYYY Limits on current in-force policy:Please select:$250,000 / $250,000 (Aggregate)$500,000 / $500,000 (Aggregate)$500,000 / 1,000,000 (Aggregate)$1,000,000 / 1,000,000 (Aggregate)$2,000,000 / 2,000,000 (Aggregate)$3,000,000 / 3,000,000 (Aggregate)$5,000,000 / 5,000,000 (Aggregate)Has the Applicant(s) had continuous professional liability coverage since the retroactive date indicated in this application? Yes No Has the Applicant ever had insurance cancelled, declined or refused? Yes No Reason for decline/refusal/cancellationPlease selectDue to claimsDue to condition of buildingDue to non-payment, all outstanding premium has been paidDue to non-payment, all outstanding premium has NOT been paidDue to online salesDue to other underwriting reasonsDue to types of goods soldDue to vacancyInsurer is no longer willing to write this classOtherProvide details: CoveragesErrors & Omissions-(Claims) MadePlease select:$250,000 / $250,000 (Aggregate)$500,000 / $500,000 (Aggregate)$500,000 / 1,000,000 (Aggregate)$1,000,000 / 1,000,000 (Aggregate)$2,000,000 / 2,000,000 (Aggregate)$3,000,000 / 3,000,000 (Aggregate)$5,000,000 / 5,000,000 (Aggregate)Commercial General Liability:Please selectNot Required$1,000,000$2,000,000$3,000,000$5,000,000Tenants Legal Liability:Please select$250,000$500,000$1,000,000Tenants Legal Liability:Please select$250,000$500,000$1,000,000$2,000,000Tenants Legal Liability:Please select$250,000$500,000$1,000,000$2,000,000$5,000,000Employment Benefits Liability Extension:Please select$0 - Not required$1,000,000Employment Benefits Liability Extension:Please select$0 - Not required$1,000,000$2,000,000Employers Liability:Please select$0 - Not required$1,000,000Employers Liability:Please select$0 - Not required$1,000,000$2,000,000Non-owned Auto Limit:Please select$0 - Not required$1,000,000Non-owned Auto Limit:Please select$0 - Not required$1,000,000$2,000,000Non-owned Auto Limit:$0 - Not required$1,000,000$2,000,000$5,000,000Optional Miscellaneous Articles FloaterDoes the Applicant require Miscellaneous Articles Floater coverage? Yes No Miscellaneous Articles FloaterOptional Property CoverageDoes the Applicant require property coverage? Yes No COED - Contents of Every Description (combined single limit of Business Personal Property (including tenants improvements) and Stock/Inventory):Does the applicant require Business Interruption - Actual Loss Sustained coverage ? Yes No Business Interruption – Profits (ALS -12 months' indemnity):Flood Coverage Yes No Earthquake Coverage Yes No Sewage Backup Coverage Yes No Water Damage Deductible:Please select$5,000$10,000$25,000Optional Crime CoverageOptional Crime Coverage:Please select$0 - Not required$10,000$25,000Optional Equipment Breakdown CoverageOptional Equipment Breakdown Not required Required Value of equipment:Building InformationProperty Deductible:Please select$1,000$2,500$5,000$10,000$25,000Location / Building DetailsBuilding Construction:Please selectWood FrameMasonry veneerMasonry (including mill)LogNon-combustable - HCBNon-combustable - (All steel structure)Fire resistive (poured concrete)Fire resistive (concrete tilt up)Modular / PrefabSteel frame with fabric coveringClayStrawInsulated concrete formsWhat year was the building built?Square footage:Roofing Material:Please selectAsphalt shinglesCedarClay / slateFlat Deck / Tar + GravelGreenMetalRubberStrawThatchedZincMultiple - more than one of the above roof typesYear of latest roof update:Heating:Please selectBaseboard electricBoiler - in floor radiant heatBoiler - water baseboardCombination - forced air furnace with add on wood burning unitFireplace insertsForced air furnaceHeat pumpPlug-in space heatersRadiant ceiling heat panels - electricStoves (Wood heat, pellet)Wall furnace Wall heaterWood heat applianceBuilding is not heatedRoof top HVAC systemYear of latest heating update:Electrical:Please selectCircuit breakersFusesMixed - more than one of the above typesYear of latest update to electricalPlumbing type:Please selectCopper, PEX, PVC, ABSPolybutyleneGalvanized steelKitecCast ironMixed - more than one of the above types of plumbingBuilding does not have plumbingYear of latest update to plumbingDoes the premises have a monitored alarm (both fire and burglary) system? Yes No Does the premises have security bars or security film installed on all glass windows and doors? Yes No Is the premises sprinklered? Yes No
