Commercial Insurance Quote Intake | Prosperity Insurance Partners

Commercial Auto Coverage Details

Vehicle #1

Year *

Make *

Model *

VIN (If Available)

Coverages Requested for Vehicle #1:

Comprehensive Collision Rental Reimbursement Towing / Roadside

Commercial Driver #1

Driver Name *

Date of Birth *

Driver's License # *

State Issued *

Liability Structure *

Liability Limit Requested *

Uninsured Motorist (UM) *

Medical Payments *

Policy Options & Endorsements Requested:

Additional Insured (AI) Waiver of Subrogation (WOS) Primary & Non-Contributory (PNC) Hired & Non-Owned Auto (HNOA)

Prior Auto Coverage?

Yes No

Prior Auto Losses (Past 3 Years)?

Yes No

Commercial Auto Notes

Property Coverage Details

Property Physical Address *

Property Coverage Line #1

Coverage Type *

Requested Limit ($) *

Property Coverage Notes

Commercial Flood Coverage

Building Limit ($)

Contents Limit ($)

Flood Coverage Notes

General Liability (GL)

ℹ️ Standard Quoting Notice: Unless otherwise requested below, all General Liability policies are quoted at standard commercial limits of $1,000,000 Each Occurrence / $2,000,000 General Aggregate.

Check if NO General Liability Coverage is needed

General Liability Notes & Custom Limit Requests

Workers' Compensation

ℹ️ Standard Quoting Notice: Unless otherwise requested, all Workers' Compensation policies are quoted at standard limits of $500,000 / $500,000 / $500,000 Employer's Liability.

Check if NO Workers' Comp Coverage is needed

Officer / Owner #1

Owner Name *

Annual Payroll ($) *

Duties / Description *

Employee Group #1

Role / Group Name *

Total Annual Payroll ($) *

Duties & Job Functions *

Prior Workers' Comp Coverage?

Yes No

Prior Workers' Comp Losses (Past 3 Years)?

Yes No

Workers' Comp Notes

Commercial Umbrella Protection

Requested Umbrella Limit ($) *

Umbrella Notes

Specialty Coverage Requests

Type of Specialty Coverage Requested *

Specialty Coverage Details & Limit Notes

Commercial Coverage Intake