Mark Smith
Mark Smith
V.P. Commercial
Insurance

Use the form below to email your request for a no obligation quotation. If you prefer, you can fill in the details, print the form and fax it to us. One of our licensed brokers will contact you shortly with added information on our products.
Please note we only insure operations within Canada.

The following will give us some basic details so we can assign your request to the appropriate Customer Representative who specializes in your particular industry.

For immediate service from a friendly J.D. Smith Insurance professional, call:
1-800-917-SAVE (7283) throughout Ontario,
or 905-764-7868 within the G.T.A.

Commercial Insurance
Commercial Insurance

Church & Non-Profit Insurance
Church Insurance

FOR SPECIFIC COVERAGES, PLEASE COMPLETE THE FOLLOWING SHORT APPLICATIONS

1- Directors and Officers 5 - Commercial Property 9 - Camp Insurance
2 - Church 6 - Employee Dishonesty 10 - Sports
3 - Non Profit 7 - Liability 11 - Retail Store
4 - Business Interruption 8 - Auto Fleet 12 - T.V. & Magazine Liability

All Other Businesses

Company
Name
Address
City
Postal Code
Telephone
Fax
Email
Quote my insurance needs for 

Required Information

Building Limit
Contents Limit
Computer Limit
Liability Limit Up To $1,000,000 $2,000,000
$5,000,000 $10,000,000
Location Info
(description)
Square Footage Occupied
Building Type Single
Strip Plaza		 Enclosed Mall
High Rise
Adjacent Bldgs.   Left Side:
Right Side:
# of Storeys
Construction Type Fire Resistive
Non-Combustible Frame		 Masonry
Masonry Veneer
Masonry/Non-Combustible
Sprinklered? Yes  No
Alarm None
Central Station
Monitoring Station		 Local Alarm
ULC Certified
Details of Physical Protection (type of doors, locks, window protection, security, etc)
Years in Business
Present Insurance Company
Renewal Dates Property Auto
Date Quote Required by

Operation Description

Do you own or lease your building? Own          Lease
Approximately when was your building built?
Approximately when did you move into your present premises?
Do you have Directors and Officers Insurance? Yes            No
Number of employees?   Office
   Plant
List your last 3 claims and describe each:

Date

Description

Claim #1
Claim #2
Claim #3
We have a Unique Insurance Program that gives up to 15% Discount on Employee Personal Insurance.
Do you have a Group Personal Auto and Home program for your staff?
     Yes      No     Please develop a proposal
Do you have a Commercial Auto Fleet of vehicles?
     Yes      No
Brief Description of the Fleet
A Brief Description of Your Operations
Additional Comments & Questions

             

For Operations Within Canada Only

Quotations are provided in accordance with the information submitted.
Any incorrect information may alter the amount you are quoted.

The submission results are for quotation purposes only,
and does not guarantee you of any coverage. E. & O. E.

 
 
 
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