Business Information Quote

Bio Information

Whats your policy start date?

What is the Legal name of your business?(Required)

Doing Business As?(Required)

Yes

Doing Business As

FEIN

Business Formation(Required)

Business start date?(Required)

Years of Industry experience?(Required)

Primary Contact Name

Contact Type(Required)

Email(Required)

Phone Number(Required)

Website

Business Mailing Address(Required)

Type of business insurance requested

General Liability

Property Coverage

Workers Compensation

Excess Liability

Business Auto (NTL/APD)

General Liability

Premises Information

Location #1

Is Business Physical Address same as Mailing address?

Yes

Address

Street Address Address Line 2 City State ZIP Code

Square Feet?

Occupancy Type?

Full Time Employees(Required)

Part Time Employees(Required)

Expected total sales over next 12 months?

Expected payroll for next 12 months?

Description of Location Operations

Are you currently Covered?

Yes

Do you currently have a policy in place?

Yes

Carrier

Premium

Expiration date

Have you filed any claims?

Yes

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

#2 Premises Information

Location #2

Is Business Address same as Location 2 address?

Yes

Address

Square Feet?

Occupancy Type?

Full Time Employees

Part Time Employees

What is your expected total sales in the next 12 months?

What is your expected payroll over the next 12 months?

Description of Location Operations

Are you currently Covered?

Yes

Do you currently have a policy in place?

Yes

Carrier

Premium

Expiration date

Have you had any claims?

Yes

Have you filed any claims?

Yes

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

#3 Premises Information

Location #3

Is Business Address same as Location 3 address?

Yes

Adress

Square Feet?

Occupancy Type?

Full Time Employees

Part Time Employees

What is your expected total sales in the next 12 months?

What is your expected payroll over the next 12 months?

Description of Location Operations

Are you currently Covered?

Yes

Do you currently have a policy in place?

Yes

Carrier

Premium

Expiration date

Have you had any claims?

Yes

Have you filed any claims?

Yes

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Property Coverage

Premises Information

Location #1

Is Business Address same as Location 1 address?

Yes

Address

Square Feet?

Do you need property coverage for this location?

Yes

Building Value

Year Built

Building Construction type

Roof Type

Burglar Alarm

Fire Alarm

Is your building equipped with fire sprinklers?

Yes

Building Improvements in recent years?

Have Business Personal Property? (Furniture, Computers, etc.)

Yes

Please enter the details of personal property

Have Inventory?

Yes

Have Inventory

Want to protect your Business Income?

Yes

How much in income protection each month?

Do you need flood coverage?

Yes

Are you currently Covered?

Yes

Do you currently have a policy in place?

Yes

Carrier

Premium

Expiration date

Have you had any claims?

Yes

Have you filed any claims?

Yes

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

#2 Premises Information

Location #2

Is Business Address same as Location 1 address?

Yes

Address

Square Feet?

Do you need property coverage for this location?

Yes

Building Value

Year Built

Building Construction type

Roof Type

Fire Alarm

Is your building equipped with fire sprinklers?

Yes

Building Improvements in recent years?

Have Business Personal Property? (Furniture, Computers, etc.)

Yes

Please enter the details of personal property

Have Inventory?

Yes

Please enter the information

Want to protect your Business Income?

Yes

How much in income protection each month?

Do you need flood coverage?

Yes

Are you currently Covered?

Yes

Do you currently have a policy in place?

Yes

Carrier

Premium

Expiration date

Have you had any claims?

Yes

Have you filed any claims?

Yes

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

#3 Premises Information

Location #3

Is Business Address same as Location 1 address?

Yes

Address

Square Feet?

Do you need property coverage for this location?

Yes

Building Value

Year Built

Building Construction type

Roof Type

Burglar Alarm

Fire Alarm

Is your building equipped with fire sprinklers?

Yes

Building Improvements in recent years?

Have Business Personal Property? (Furniture, Computers, etc.)

Yes

Please enter the details of personal property

Have Inventory?

Yes

Please enter the information

Want to protect your Business Income?

Yes

How much in income protection each month?

Do you need flood coverage?

Yes

Are you currently Covered?

Yes

Do you currently have a policy in place?

Yes

Carrier

Premium

Expiration date

Have you had any claims?

Yes

Have you filed any claims?

Yes

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Workers Compensation

Desired Employers’ Liability Limits

How many owners/officers do you have?

Owners/Officers

Name

Title

Duties

Payroll/Compensation

Ownership %

Included or Excluded from policy

Do you use subcontractors?

Yes

Provide percentage of work subcontracted

Use volunteer or donated labor?

Yes

Does the insured have any employees that drive more than 10% of the time?

Yes

Perform any work underground or above 15 feet?

Yes

% of The Time

Have a written safety program in operation?

Yes

Provide an employee health plan?

Yes

Have an employee wellness program in place?

Yes

Have a return-to-work program?

Yes

Waiver of subrogation needed?

Yes

Are you currently Covered?

Yes

Do you currently have a policy in place?

Yes

Carrier

Premium

Expiration date

Have you had any claims?

Yes

Have you filed any claims?

Yes

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Excess Liability

Which lines of business are you requesting Excess Liability

Business Auto

Commercial

General Liability

Crime Liability

Professional Liability

Workers Compensation

Liquor Liability

Are you currently Covered?

Yes

Do you currently have a policy in place?

Yes

Carrier

Premium

Expiration date

Have you had any claims?

Yes

Have you filed any claims?

Yes

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Date of Occurrence

Description

Amount paid

Has your claim been closed out

Business Auto (NTL/APD)

Vehicles

Vehicle Type

What is the gross vehicle weight (Weight of vehicle + Weight of load)?

What is the vehicles tonnage?

How many driving wheels does the vehicle have?

What type of trailer hitch does this vehicle have?

What type of trailer?

Other

VIN

Make

Model

Year

Garaging Address

Farthest one-way distance this vehicle typically travels (90% or more of the time)

Is there a loan/lease on this vehicle?

Yes – Loan

Yes – Lease

Do you have permanently attached equipment?

Yes

What is the value of the permanently attached equipment?

If this vehicle was sold today, how much would it be worth (excluding any permanently attached equipment)?

Do you need Comprehensive or Collision coverage?

Yes

Do you have permanently attached equipment?

Yes

What is the value of the permanently attached equipment?

If this vehicle was sold today, how much would it be worth (excluding any permanently attached equipment)?

#2 Vehicles

Vehicle Type

What is the gross vehicle weight (Weight of vehicle + Weight of load)?

What is the vehicles tonnage?

How many driving wheels does the vehicle have?

What type of trailer hitch does this vehicle have?

What type of trailer?

Other

VIN

Make

Model

Year

Garaging Address

Farthest one-way distance this vehicle typically travels (90% or more of the time)

Is there a loan/lease on this vehicle?

Yes – Loan

Yes – Lease

Do you have permanently attached equipment?

Yes

What is the value of the permanently attached equipment?

If this vehicle was sold today, how much would it be worth (excluding any permanently attached equipment)?

Do you need Comprehensive or Collision coverage?

Yes

Do you have permanently attached equipment?

Yes

What is the value of the permanently attached equipment?

If this vehicle was sold today, how much would it be worth (excluding any permanently attached equipment)?

#3 Vehicles

Vehicle Type

What is the gross vehicle weight (Weight of vehicle + Weight of load)?

What is the vehicles tonnage?

How many driving wheels does the vehicle have?

What type of trailer hitch does this vehicle have?

What type of trailer?

Other

VIN

Make

Model

Year

Garaging Address

Farthest one-way distance this vehicle typically travels (90% or more of the time)

Is there a loan/lease on this vehicle?

Yes – Loan

Yes – Lease

Do you have permanently attached equipment?

Yes

What is the value of the permanently attached equipment?

If this vehicle was sold today, how much would it be worth (excluding any permanently attached equipment)?

Do you need Comprehensive or Collision coverage?

Yes

Do you have permanently attached equipment?

Yes

What is the value of the permanently attached equipment?

If this vehicle was sold today, how much would it be worth (excluding any permanently attached equipment)?

Drivers

Name

DOB

Driver License State

Driver License Number

Has a CDL?

Yes

Have you had any accidents or violations in the past 5 years?

Yes

Date of Incident

Type of Accident/Violation

#2 Drivers

Name

DOB

Driver License State

Driver License Number

Has a CDL?

Yes

Have you had any accidents or violations in the past 5 years?

Yes

Date of Incident

Type of Accident/Violation

#3 Drivers

Name

DOB

Driver License State

Driver License Number

Has a CDL?

Yes

Have you had any accidents or violations in the past 5 years?

Yes

Date of Incident

Type of Accident/Violation

Insurance History

Are you currently insured? Personal Auto policies also qualify as proof of prior insurance.

Yes

Carrier

Expiration Date

Have you had continuous coverage for at least one year?

Bodily Injury and Property Damage Liability

Is a Blanket Additional Insured endorsement needed by contract?

Yes

Is a Blanket Waiver of Subrogation endorsement needed by contract?

Yes

Are state or federal filings required?

Yes

Coverages

Bodily Injury and Property Damage Liability

Uninsured/Underinsured Motorist Bodily Injury

Uninsured Motorist Property Damage

Personal Injury Protection

Comprehensive

Collision

Rental Reimbursement

Roadside

Fire & Theft w/ Combined Additional Coverage

Do you need Motor Truck Cargo?

Yes

Does the customer require cargo coverage for mobile homes?

Yes

Does the customer require cargo coverage for business documents or non-negotiable securities?

Yes

Does the customer require Refrigeration Breakdown coverage?

Yes

Please list the top 4 commodities you hail on a regular basis.

Ebony Jackson

2 years ago

Roger was incredibly thorough, attentive, and patient in assisting me with finding coverage for both my business and car insurance. This was, without a doubt, the best customer service I've ever experienced. It was clear that he wasn’t just trying to make a sale like he genuinely cares about his clients, and it shows in his work. I will definitely choose this place again for any of my insurance needs.

Michael Hogan

Roger and his team were great and very helpful throughout the process. Definitely recommend giving him a call.

Adam Beason

Excellent service and five star coverage

Hiren Chudasama

Thank you Lifeway for everything you all have done for me from Commerical to residential Insurance. Best prices with the best customer service.

Lori Lord

Lifeway is a great insurance broker! They have been able to support my home, auto and business needs which makes things so much easier. And they are always available to answer my questions when needed.

WRX Team

4 years ago

Roger has done an excellent job with providing clarity and insight every year for our business. I'm consistently impressed with the simple to understand approach and detailed answers.

Prince Henro

Roger Gets me right everytime. Use him for all my businesses and life. Even takes care of my taxes. Definitely recommend.

Candice McGlen

5 years ago

I would recommend Lifeway to anyone who is looking for not just outstanding customer service but SOLUTIONS that will support your needs and goals. Roger is a wealth of knowledge and always willing to share what he knows to ensure his customers are empowered to make the best choices for their lives. When you work with Roger, you’re guaranteed to protect your assets while becoming more enlightened in the process. I am very pleased and will continue to use LifeWay for my insurance needs.

ari miller

The team at Lifeway made sure that I understood my insurance policies, and gave me real life examples of why I needed certain coverages. Lifeway seemed to care about me as another human, not just as an insurance client. They helped me protect myself against heavy financial losses that would have placed extreme Financial burdens on my family. I’m grateful for the thoroughness of the team at Lifeway & i am a client for life!

Also, Lifeway’s tax advisory service was extremely patient and the Broker was sure to do his due diligence in filing my taxes accurately and most logically so that I could make the most of this tax year. Love it here!

Ben Freelon

If you are looking for an expert to offer great service in the process of acquiring insurance for your business, Roger is the man!

He explained my policy in a manner that was easy to understand, answered all of my questions, and walked me through the process.

I usually don't do reviews, But His Service Definitely Deserves a 5⭐

Bio Information

General Liability

Premises Information

Location #1

#2 Premises Information

Location #2

#3 Premises Information

Location #3

Property Coverage

Premises Information

Location #1

#2 Premises Information

Location #2

#3 Premises Information

Location #3

Workers Compensation

Owners/Officers

Excess Liability

Business Auto (NTL/APD)

Vehicles

#2 Vehicles

#3 Vehicles

Drivers

#2 Drivers

#3 Drivers

Insurance History

Coverages

Contact Us

Personal Risk

Commercial Risk