Commercial Umbrella Quote Request

An umbrella policy sits above the liability cover you already have. When a claim exhausts the limit on your general liability or business auto policy, the umbrella keeps paying. To quote one we need to know what sits underneath it.

Fill in what you know and leave the rest blank — only your name, email and phone are required. We will come back to you for anything missing. Nothing here is an application and nothing is binding.

Your business Business Name

DBA / Trading AsOnly if different from the name above.Business Structure

Business Address

CityZIP Code

Mailing AddressOnly if your mail goes somewhere else.

Your First NameYour Last Name

Email AddressPhone Number

Years in BusinessApproximate Annual RevenueA rough figure is fine.

WebsiteIf you have one.

What you already have General Liability — Insurer and Limits Business Auto — Insurer and Limits

Employers Liability LimitsPart of your workers' compensation policy.

Any Other Liability Cover

Your exposure Describe Your Business Operations Any Products You Sell, Make or Distribute?

Any Operations or Sales Outside the US?Number of Vehicles and DriversIf vehicles are a factor.

The cover you want

Umbrella Limit You WantCommonly $1M, $2M or $5M. Leave blank and we will recommend.Self-Insured RetentionThe amount you would pay yourself before the umbrella responds. Leave blank unless a contract specifies one.

Your current cover and timing Any liability claims in the past 5 years?

Current or Previous InsurerIf you are switching or renewing.What You Pay NowIf you know it.

When Do You Need Cover to Start?

Anything Else We Should Know

This is a solicitation for insurance. Completing this form does not apply for or bind cover. Coverage cannot be bound or changed via this form, e-mail, voicemail, text, or facsimile — only by written confirmation from our office.

Would you rather fill it in on paper?

Download the same questions as a printable form, or as a Word file you can type into, and bring it in or send it back to us.

PDF version · Word version · All quote request forms

Would you rather fill it in on paper?

Rather just talk it through?