Commercial Umbrella Application Step 1 of 5 20% Entry Date Date Format: MM slash DD slash YYYY IndustryClassControllling AgentName*Business NameBriefly describe your business operations.* Location Address* Street Address City State / Province / Region ZIP / Postal Code Phone*Email* Annual Gross Sales (Estimated)*Gross sales are the total amounts (before expenses) that a company earns and records from the sales of its products or services. Entity Type*- Select -IndividualPartnershipCorporationLLCOtherYear Business Started*Is this a home based business?*YesNo Do you have any employees?*YesNoNumber of Employees*12-56-1011-2526-100100+Annual Employee Payroll (Estimated)*Do not include payroll for owners, officers or partners.Do you hire subcontractors?*YesNo Umbrella Limits$1,000,000$2,000,000$3,000,000$4,000,000$5,000,000$6,000,000$7,000,000$8,000,000$9,000,000$10,000,000A commercial umbrella policy will provide excess coverage over your current business liability insurance.Please select the policies for which the umbrella will provide excess coverage. General Liability Professional Liability Workers Compensation Commercial Auto I am not currently insured.
