Bogert Insurance Agency, Inc.
Full Service Insurance Agency - All Lines
"Serving ALL of Florida"
877-446-6335
877-316-7800 (FAX)
 
E-mail:insuranceflorida@aol.com

Our agency is licensed to quote and write insurance policies only in Florida. To find agents offering these coverage in all of the other states, please click the IQ.net logo.

 


Fill out this form and submit it to our agency to receive an accurate Business Insurance Quote


Our Agency has Package Policies, with a broad range of coverages for your type of business. The flexibility of these packages allows us to customize a policy for your specific needs. We are able to offer to you an appraisal and survey your Insurance exposures.
Company Information (required)
  Owner's Name:  
 Nature of Business/Description of operations:
 Legal Entity  
 DBA:  
 Mailing Address:  
 City: / State:  /
 Zip Code:  
 Phone:  
 Fax  
 E-Mail Address (required)  
   
Covered Property Information
 Property Address:  
 City / State:   /
 Zip Code: (Required!)  
 Do You Own or Lease the Location:  
 If Own, Type of Building and Date Purchased:(i.e. Office, Industrial, Apartment)  
 List Number and Type of Occupants in Building:
 Construction Type:  
 # of Sq Ft occupied  
 Year Built  
 # of Units to be insured  
 Percentage Building Sprinklered:  
 Type of Parking Available  
 Is there a Pool? / Fenced?   /
 Type of Security System  
 Building Improvements and Date: (if any)  
 Present Insurance Co.:  
   Coverages To Quote
 Building Amount  
 Business Contents Amount  
 Loss of Income Amount  
 Deductible  
 Liability Amount  
 Miscellaneous Coverages and Amounts
Underwriting Information
 Renewal Date  
 Current Company  

Give a brief description of any losses in the last 5 years

 




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© Gordon K. Harden, Jr. 1996-99
mail to: gkh@InsuranceQuote.net
 
 
Page Created 11-12-99
 
 
Latest Revision