Paragon Risk Management, Inc.

Business Insurance Quote

Company Name:

Address:

City:

State:

Zip:

Telephone:

Contact Person:

FEIN No.:

General Information

Year Business Started:

Current Carrier:

Estimated Current Premium:

Policy Expiration:

Property

Building Limit (if owned):

Contents Limit:

Construction of Building:

Deductible:

Equipment (on trucks):

General Liability

Gross Sales:

Payroll

Use of Subs

Y N

Cost of Subs

Work Subs Do

GL Limits Occurrence/Aggregate

Umbrella

Limit

Other Coverages
Please specify type of coverage and limit (scheduled equip., business interruption, emp. benefits, etc.)

Loss History
Over the past 3 years, please describe losses by policy (auto, property) and give amount.

An agent will process this information and get a quote to you within 24 hours.
Thank you for your time.