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Business Details

Named Insured:*

DBA (Business Name):*

Business Entity:

FEIN / Tax-ID Number:

Phone Number:*

Email:*

Contact Person:

Tax ID:

Mailing Address:

Street Address City State ZIP Code

Is Physical Address Same As Mailing Address?

Yes

Physical Address:

Street Address City State ZIP Code

Website Address:

Effective Date:

Are You A Contractor?

Yes

Brief Description of Operations:

Names and % of Ownership for all Officers:

Full Name

Position

% of Ownership

Year Business Started:

Years’ experience:

Business Organization:

Yearly Premium:

Losses:

Number of Employees: Full Time

Number of Employees: Part Time

Estimated Annual Payroll:

Estimated Annual Revenue:

Current Insurance Carrier:

Sales/Receipts:

Property

Building value:

Year Built:

Construction:

Alarms:

Sprinklers:

Sq Footage:

Updates:

Contents value:

Property off premises:

General Liability

Insurance Limits:

Professional liability:

EPLI:

Cyber:

Employee Dishonesty:

Business Auto

Insurance limits:

Attach or ask for VIN’s of each car

Attach or ask for use of each car

Workers Compensation

Insurance Limits:

Payrolls by classification:

Owners if excluded:

Additional Contractor Details

Contractors License #

% of work Subcontracted out

% of Residential Work

% of Commercial Work

% of Remodel/Install work

% of New Construction Work

% of Service/Maintenance Work

Do you perform Government/Municipality Work?

Dec Pages / Consent

Add Dec Pages

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Are you ready to save time, aggravation, and money? The team at the Oak Insurance Group is here and ready to make the process as painless as possible. We look forward to meeting you!

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Tom is the best. He has been my insurance guy for years and has never led me astray. He is quick to answer my questions,...

a month ago

Art Wood

Awesome insurance firm. It was super seamless to setup contents and liability policies for our business! Dolan is amazing.

in the last week

Nicholas Alexander

Thomas Warnke is absolutely amazing. Superior customer service from the very first engagement and continues to make my life easier. The man should be fitted...

a month ago

Carl Onubogu

Worked with Dolan to consolidate my auto and home insurance. He provided a great savings on my auto insurance and he is very professional and...

3 months ago

Dan Shivaiah