Insurance Quote for Business or Not-For-Profit Organization

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

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 & Truck 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
Liability Limit Up To	$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.