Urban Advantage Producers Exclusive Program Online App

Complete the application below for General Liability, Property, Professional Liability, D&O, EPLI, Crime Insurance & Cyber Liability or Data Breach Insurance for your clients.

*We will contact you if additional info is needed.

Become a Producer for the Exclusive Program

I Need Help

Are you an insurance agent or someone looking for insurance?*
START YOUR QUOTE for Business Insurance
Broker or Agent Information
BROKER NAME*
If you do not currently work with us, we will send our producer agreement to you.
Name of Agency or Brokerage
Broker Phone Number*
Broker Email*
About the Client or Applicant
Client Name*
First Last
Business Name or DBA*
If you do not have a business name, just write "none"
Address*
Street Address Address Line 2 City State ZIP Code
Email

Enter the client's email if you would like to provide one. We do not email your client, we email you.
Phone Number - including area code
Some carriers REQUIRE that we enter the insureds phone number just to get them a quote, so please provide it.
Client's website
If none, just write none.
Business Structure*
Business Location
We ask this questions because different insurance carriers have different rules regarding the location of your business. It helps us find the right type of policy.
Please tell us why you are looking for a quote?*
Please provide more information about your response to why you are looking for a quote*
This information is very helpful so that we can more efficiently help you find a quote.
Are we competing against another price? Please tell us the pricing that you are trying to beat if any.
Information to Get Your Quote
What year the business start?*
Current Insurance Status*
Type of Business #1*
Choose the types that represent your business (you may choose more than one) by selecting another on the next drop down. Please choose AT LEAST ONE business type. You can choose OTHER, if you cannot find yours here.
What are your estimated gross receipts from this part of your business?*
Gross receipts means the amount of money that the business makes before the expenses.
Other Business Type - please describe your operations*
Try to describe as much of the business as possible, it makes it easier for us to get a quote.
Type of Business #2
Other Business Type - please describe your operations
What are your estimated gross receipts from this part of your business?
Type of Business #3
Other Business Type - please describe your operations
What are your estimated gross receipts from this part of your business?
Describe the Business or Organization and Provide more details*
Please tell us what services are provided by the business. Use this space if you needed to tell us more information too. You must provide some information here.
Trailer Section
Do you want to purchase coverage for the trailer (inland marine)?*
- No
- Yes
Trailer or Cart Information - Please provide the year, make, value of the trailer. If you have any items to insuer disconnected from the trailer, please list the items and their values. To bind coverage, we will need the serial numbers.*
More Information
What types of insurance are you seeking?
- Professional Liability (errors and omissions)
- General Liability Insurance
- Property Insurance (buildings or equipment)
- Workers Comp
- Commercial Auto Insurance
- Directors and Officers Insurance
- Employment Practices Liability Insurance (EPLI)
- Data Breach of Cyber Liability
- Surety Bond (not insurance)
A signed application will be required to bind.
How many employees do you have?*
You can write "none" if you have do not have any.
How many owners do you have that are active in the business?*
Minimum is 1 (this does not include clerical work)
What is your annual payroll to employees in $? Do NOT include owner payroll.*
If you have no payroll and only owners, please write none.
What is your annual payroll to independent contractors (1099s)? ($)*
If you have no payroll and only owners, please write none.
Do the insured sign a contract or agreement with you clients?
Does a single client represent 50% or more of the insured's business?
Tell us about the customer that provides more than 50% of your business.
What services do you perform for this customer and what are your estimated annual receipts (earnings before expenses) from this customer.
Do you have any prior claims?
Tell us About your Prior Claim
TAX ID / FEIN / Social
To quote workers compensation insurance, we need your Tax ID, FEIN, or Social if you are a sole proprietorship. For general liability, we will need it when you bind the policy.
What types of clients does the insured service?
Carriers have different rules about the types of clients serviced, so this help us with the quoting process.
Beauty Section
How many FULL TIME beauticians or barbers are at the business?
How many FULL TIME beauticians or barbers are at the business?
How many FULL TIME nail professionals are at the business?
How many PART TIME nail professionals are at the business?
Does the business offer any of the following?
- Chemical Peels
- Treatments that Modify Peoples' Skin
- Permanent Makeup
- Skin Needling
- Tatooing
Choose your Limits of Liability
General Liability
These numbers are written as the per occurrence limit and the aggregate limit.
What is the square footage of your office (or home office)? If you own and occupy the building, please write in the total building square footage.*
If you are not certain of the size, please round it to the nearest 100 square feet.
Professional Liability - Errors and Omissions Insurance
Property Insurance Section
In this section, you can choose how much coverage you want for your equipment, a building, glass, or other items.
Do you own the building?
How much coverage ($) do you want for the building?
Enter an amount in this box. The underwriter will still require that your amount of coverage meet a minimum rebuilding cost per square foot. We will contact you with more information.
How much coverage ($) for your business personal property?*
This includes your furniture, inventory, printers, file cabinets, etc. We'll ask you about computers in the next box.
How much coverage ($) do you want to Tenant Improvements?
This includes, flooring, painting, wallpapering, and other permanent renovations that you did to you space. Also include permanently mounted equipment here.
How much coverage ($) for computers and laptops?
How much coverage ($) for awnings or canopies?
How much coverage ($) for Signs?
Signs are expensive to replace, so let us know the value or your signed mounted to the building or that's not connected.
What Year was the building that you are in built? (Estimate OK)*
At the least, please write the decade. To get a quote for property insurance, we must provide some data to the underwriter.
If the building is more than 25 years old, please provide the date that the heating, plumbing, electrical, and roofing were updated. If it is less than 25 years old, please just write "n/a". If you do not provide this information, neither replacement cost nor special form coverage may be available.*
Do you want coverage for any specific items? Tell us about them and include the value.
If you know the year, make, and model of your equipment, please provide it. We will contact you for more information, if needed. Example: 1 tractor, 2005 model, $25000 value.
Does your location have any of the following?
- Central Station Alarm - one that calls the alarm company of the policy
- Local Alarm Only - it does not call the policy or an alarm company
- Fire Sprinklers on the interior - covering 100% of the building
- Fire Sprinklers on the interior - covering only part of the building
- A security guard
VACANT SECTION
Is the building located on a piece of land is greater than 5 acres?*
Is there a mortgagee that needs to be added as additional insured?*
How many acres of vacant land are there?*
Commercial Auto Section
Driver #1 - Provide the name and birthdate of at least 1 driver
Driving Record for Driver #1
Vehicle #1 - Year, make, and model (if you have the VIN, include it)
Vehicle #1 - how much is it worth? (not including permanently attached equipment)
Vehicle #1 - how much coverage do you want for permanently attached equipment
Examples: a dog grooming truck may have a vacuum permanently mounted; a food truck may have cooking equipment mounted to the truck.
Do you need to add more drivers or vehicles?
- Yes
- No
Tell us about the other drivers and/or vehicles. Please provide the name, birthdate, and marital status of each driver. Provide the year/make/model and value of each vehicle. If you know the VINs, please provide them.
If there is something special that you want to tell us, please do so here.
Directors and Officers Insurance Section
How many VOLUNTEER board members do you have?
How many PAID board members do you have?
Industry Specific Questions
If you see no questions, please continue.
Employment of Temporary Staffing
Does your business provide temporary staffing?
- No - we do NO temporary staffing
- Yes
Does your business provide temporary staffing?
Translator or Interpreter Section
Do you do simultaneous translation where 2 or more interpreters translate/interpret at once?
Do you do any translating for medical professionals?
Child Care and Day Care
How many children is the city licensed for?*
What is the state license number?
If you do not have this information, it will be required prior to binding.
Does the location have a pool?*
Does the location have bars on the windows?*
Underwriting Questions
How many FULL TIME professionals perform services for the business?*
Example - 1 full time life coach performing coaching services. You would choose 1. We are not asking about clerical only employees, like receitionists. We are asking about those that perform the services.
How many PART TIME (less than 30 hours a week) professionals perform services for the business?*
Example - 1 part time life coach performing coaching services. You would choose 1. We are not asking about clerical only employees, like receitionists. We are asking about those that perform the services.
After inquiry, do any partners, members, directors, or officers of the firm for which coverage is sought, have knowledge of any incident, a circumstance, an event, or unresolved fee dispute that may result in a claim?*
Please let us know if the applicant is aware of a potential or currently existing claim.
Within the past 5 years, have any claims been made or legal action brought against the firm, its predecessor(s), or any past or present principals, partners, insurance managers, or employees? Claim(s) means a demand received by the Insured for money or services and which alleges a wrongful act. Claim(s) includes but is not limited to lawsuits, petitions, arbitrations or other alternative dispute resolution requests filed against the Insured.*
Do you want to add any notes or more information?
Restaurant Questions
How would you describe the restaurant?
- Fast Food
- Take Out Online
- Sit down with table or wait service
- Sit down without table or wait service
- Food Kiosk or Cart
Does the applicant offer delivery?*
What type of fire suppresion system does the applicant use?*
Does the applicant serve alcohol?*
Special Event Section
Will there be any inflatables at your event? Examples - moon bounce, slide, bounce house*
Does the business operation have any of the following
- Petting Zoo
- Hay Ride
- Carriage Ride
Contractors Questionnaire
How many owners or partners operation in the business?
Please list all of the tasks performed by EMPLOYEES (not sub contractors) and the payroll for that classification. Example: Painting Indoors - $20,000. If there are no enmployees, write "none".*
What is the total payroll to all subcontractors? If none, write "0"*
Does the applicant build any new homes or residential units in AZ, CA, OR, NV, CO, WA, or NY?*
Does the applicant subcontract more than $150,000 of roof work?*
Graffiti Removal Section
Does the applicant also offer pressure washing services for cleaning?*
Lessors Risk and Landlord Section
Provide a list of the tenant (meaning the types of businesses that rent the space, the names of the businesses are not necessary)
Freight Forwarding and Logistics Businesses
Which describes the applicants business?*
Other - please describe their business*
Farm Section
Describe all activities that take place on the farm*
Are any of the following part of the farm? Check ALL that apply.
- Standing Crops or Crop Production
- Second Choice Groves or Orchards
- Nurseries
- Livestock
- Aquaculture
- Swine Houses
- Poultry Houses
- Fruit/Vegetables Stands
- Dwellings, Lakes, and Swimming Pools
The last questions - finish your quote
Do you want to subscribe to our small business newsletter?
- Yes, please
- No, thank you
We do not send a lot of newsletters, but when we do, they are filled with valuable risk prevention and small business ideas.

Instant Online Quotes

Real time quotes are available for:

Umbrella and Excess Quotes

For stand alone umbrella or excess quotes, you can upload Acord forms, another carrier application, or a copy of the policies over which you need the quote.

Start an Umbrella/Excess Quote

How to Request a Quote Online?

Complete the online application. If we need additional information, we will contact you. If you want to upload a paper application, click here to upload.

Need help?

If you cannot find what you are seeking or have a question, start in the help section here.

Urban Advantage Producers Exclusive Program Online App

START YOUR QUOTE for Business Insurance

Broker or Agent Information

About the Client or Applicant

Information to Get Your Quote

Trailer Section

More Information

Beauty Section

Choose your Limits of Liability

Property Insurance Section

VACANT SECTION

Commercial Auto Section

Directors and Officers Insurance Section

Industry Specific Questions

Employment of Temporary Staffing

Translator or Interpreter Section

Child Care and Day Care

Underwriting Questions

Restaurant Questions

Special Event Section

Contractors Questionnaire

Graffiti Removal Section

Lessors Risk and Landlord Section

Freight Forwarding and Logistics Businesses

Farm Section

The last questions - finish your quote

Instant Online Quotes

Umbrella and Excess Quotes

How to Request a Quote Online?

Need help?

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