Golden Empire Insurance Agency
Welcome Our Staff Personal Insurance Business Insurance Life Insurance Health Insurance Specialty Insurance Free Online Quotes
Golden Empire
   Golden Empire Insurance Agency
"Old World Values With New World Technology"
  Business Owners Package Insurance Quote

We would like to provide you with a free, no-obligation business owners package insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

General Information
Name of Insured:
City:   State:   Zip:
Business Phone:   Fax Number:
Email Address:
Location Address 
(type "same" if same as above):
City:   State:   Zip:

Current Insurance Information
Company Name (not agency):
Policy Expiration Date:   Premium Amount: $
What type of coverages do you currently have:
Commercial Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors & Officers Liability
Group Health
Group Life
Professional Liability
Workers' Compensation

Property Questions
Age of building
/Year Built:
Type of building
Number of
Square feet
you occupy:
sq. ft.
If the building is over 25 years old, please answer the following:
Year Electricity was updated:

Is it on circuit breakers?:

Yes   No

Year Plumbing was updated:

Copper or Galvanized plumbing?:

Copper   Galvanized   Other:

Year Building was last re-roofed:

Type of roofing material:

Type of heating system in the building:

Protective Devices
Burglar Alarm:
Central Station
or local alarm?:
Name of
alarm company:
Is the building
Are there
smoke detectors?:
Y   N
 Central Station
 Local Alarm
Y   N
Y   N

Liability Questions
Please provide information on previous insurance carrier:
Previous Ins. Carrier:
Policy number:
Prior premium:
Policy renewal date:
Please provide information about your business:
Years in business:
Projected Gross annual receipts:
Projected annual payroll:
    Describe your business, product or service:

Coverage Limits
Contents (equipment,
inventory, supplies, etc.):
Loss of Income:
Money and Securities:
Glass or signs:
General Liability Limit:
Non-owned and Hired
Automobile Liability:
Is liquor liability needed?
Yes   No
    If Glass Coverage is needed, please provide dimensions:
    Please list other coverages you may need:

Miscellaneous Information
Name of Additional Insured
(Landlord or vendor):
Mailing Address:
City:   State:   Zip:

Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have additional
information where there was not enough fields above, please enter them here.

Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.


Online Forms by ENHANCED Web Services
This Business Quote Form Copyright Copyright © 1998-2003 by ENHANCED Web Services

Golden Empire Insurance

Golden Empire Insurance Agency

28720 Roadside Drive, #376
Agoura Hills, CA 91301
Phone: (800) 899-5556   /   (818) 597-7880   Fax: (818) 597-0078

CA License #: 0338632

Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.

© Copyright 1999-2003 Golden Empire Insurance Agency

Site Hosted by Curry Computer Technology / Site Designed by Enhanced Web Services