Insurance by the Woods | Family-Owned Insurance Agency

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Business Insurance Quote Request

Business Name:

Contact First Name:

Contact Last Name:

Phone:

Email:

Website/Social Media:

Physical Address:

Other Locations:

County:

Legal Entity Type:

Federal Tax ID Number:

Franchise:

Yes

No

Current Carrier Name:

Years with Current Carrier:

Number of Claims:

Claim Details (If Any)

Policy Expiration Date:

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Operations Overview

Description of Operation:

Lines of Business Proposed:

Number of Employees (Full-Time / Part-Time):

Annual Sales:

Annual Payroll:

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Property Coverage

Building Value:

Construction Type:

Year Built:

Year Roof Installed:

Total Building Square Footage:

Your Occupied Square Footage:

List of Other Tenants (if any):

Coinsurance Amount:

Deductible Amount:

Coverage Type:

Replacement Cost

Actual Cash Value

Income Protection Coverage:

Yes

No

Install Coverage:

Yes

No:

Equipment Breakdown

Yes

No

Money & Securities Coverage

Yes

No

Employee Dishonesty Coverage

Yes

No

Business Personal Property (BPP) / Contents:

Additional Property (signs, lights, fences, playgrounds, etc.):

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General Liability & Specialty Coverages

General Liability Limit:

Deductible:

Rating Basis (Sales / Receipts):

Employment Practices Liability:

Yes

No

Data Breach Liability:

Yes

No

Employee Benefit Liability:

Yes

No

Umbrella Coverage:

Yes

No

Third-Party Coverage:

Yes

No

Select Limits:

300/600

500/1000

1000/2000

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Workers' Compensation

Workers’ Comp Needed:

Yes

No

Corporate Officer Coverage:

Yes

No

Sole Proprietor / Partner Coverage:

Yes

No

Do Corporate Officers Maintain Personal Auto Policy?:

Yes

No

Experience Modification Factor:

Experience Mod Date:

Class Code 1 / Payroll:

Class Code 2 / Payroll:

Class Code 3 / Payroll:

Class Code 4 / Payroll:

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Commercial Auto Insurance

Auto Insurance Needed:

Yes

No

Vehicles Used in Business:

Yes

No

Hired / Non-Owned Auto Use:

Yes

No

Autos Titled To:

Coverage Options:

Liability

Med Pay

UM / UIM

Comprehensive

Collision

Vehicle List (Year / Make / Model / VIN):

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Insurance

About Us
Insurance Services
Support
News & Blog
Contact

Contact us

Sheboygan Office

1019 Michigan Avenue, Sheboygan, Wisconsin 53081, United States

Phone: 9205287788

Port Washington Office

463 West Grand Avenue, Port Washington, Wisconsin 53074, United States

Phone: 2622849441

Cascade Office

Cascade, Wisconsin 53011, United States

Phone: 9204588400

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