Commercial Umbrella Application Step 1 of 5 20% HiddenEntry Date MM slash DD slash YYYY HiddenIndustry HiddenClass HiddenControllling Agent Name* Email* Briefly describe your business operations.* Business Name Phone*Location Address* Street Address City State / Province / Region ZIP / Postal Code 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?* Yes No Do you have any employees?* Yes No Number of Employees*12-56-1011-2526-100100+Annual Employee Payroll (Estimated)*Do not include payroll for owners, officers or partners.Do you hire subcontractors?* Yes No 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. Questions? Call 800-858-1315 Mon-Fri, 7am-5pm Pacific Time
