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Thank you for your interest in receiving a quote from Davidson Insurance Agency. This form should only take about 5-10 minutes to complete. Don't worry if you don't have everything. You can always click the "Save and continue later" button below. We'll email you a private link to pick up where you left off.

When do you want the policy, or policies, to start?*

MM slash DD slash YYYY

Which type of insurance are you looking for?*

Check all that apply.

Garage & Dealers Policy

General Liability

Professional Liability (E&O)

Workers Comp

Property (Building coverage, contents, etc.)

Commercial Auto

Cyber Liability

Equipment Floater (Tools coverage, etc.)

Other

Other type of insurance*

How were you referred to us?

Business Information

Legal Business Name*

DBA

Entity Type*

FEIN

Website

Business Address*

Street Address City State Zipcode

Mailing Address*

Same as Business Address

Street Address City State Zipcode

Year Business Started*

Years of experience operating this business?*

Years of experience in this field?*

Is this business affiliated with a franchise?

Yes

Primary Contact Information

Primary Contact: Name*

First Last

Primary Contact: Date of Birth*

Month

Day

Year

Email*

Work Phone

Mobile Phone*

Can we text you?*

Yes

Please visit our Privacy Policy regarding Texting/SMS communication.

Number of Owners

Additional Business Owners

Owner 2

2. Owner Name*

First Last

2. Owner Date of Birth*

Month

Day

Year

2. Owner Phone

2. Owner Email

2. Owner Role

Owner 3

3. Owner Name*

First Last

3. Owner Date of Birth*

Month

Day

Year

3. Owner Phone

3. Owner Email

3. Owner Role

Owner 4

4. Owner Name*

First Last

4. Owner Date of Birth*

Month

Day

Year

4. Owner Phone

4. Owner Email

4. Owner Role

Vehicles

Number of Vehicles*

Are all vehicles garaged at the business address?*

Yes

Are all vehicles titled in the name of the business?*

Yes

Vehicle 1

1. Year*

1. Make*

1. Model*

1. VIN*

1. Gross Vehicle Weight

1. Radius of Travel

1. Garaging Zip*

1. Collision Deductible

1. Comprehensive Deductible

1. Does this vehicle have permanently attached equipment?

Yes

1. Value of attached equipment

Vehicle 2

2. Year*

2. Make*

2. Model*

2. VIN*

2. Gross Vehicle Weight

2. Radius of Travel

2. Garaging Zip*

2. Collision Deductible

2. Comprehensive Deductible

2. Does this vehicle have permanently attached equipment?

Yes

2. Value of attached equipment

Vehicle 3

3. Year*

3. Make*

3. Model*

3. VIN*

3. Gross Vehicle Weight

3. Radius of Travel

3. Garaging Zip*

3. Collision Deductible

3. Comprehensive Deductible

3. Does this vehicle have permanently attached equipment?

Yes

3. Value of attached equipment

Vehicle 4

4. Year*

4. Make*

4. Model*

4. VIN*

4. Gross Vehicle Weight

4. Radius of Travel

4. Garazing Zip*

4. Collision Deductible

4. Comprehensive Deductible

4. Does this vehicle have permanently attached equipment?

Yes

4. Value of attached equipment

Vehicle 5

5. Year*

5. Make*

5. Model*

5. VIN*

5. Gross Vehicle Weight

5. Radius of Travel

5. Garaging Zip*

5. Collision Deductible

5. Comprehensive Deductible

5. Does this vehicle have permanently attached equipment?

Yes

5. Value of attached equipment

Vehicle 6

6. Year*

6. Make*

6. Model*

6. VIN*

6. Gross Vehicle Weight

6. Radius of Travel

6. Garaging Zip*

6. Collision Deductible

6. Comprehensive Deductible

6. Does this vehicle have permanently attached equipment?

Yes

6. Value of attached equipment

Drivers

Primary Insured: Drivers License Number*

Primary Insured: Drivers License State*

Commercial License? (CDL)

Yes

Year CDL Issued

Number of Additional Drivers*

Let's add 8 of your drivers now. We will contact you to get your additional drivers information.

Do any of your drivers take the vehicle(s) home at night?*

Yes

Driver 1

1. Name*

First Last

1. Date of Birth*

Month

Day

Year

1. Drivers License #*

1. Drivers License State*

1. Commercial License? (CDL)

Yes

1. Year CDL Issued

1. Hire Date

Month

Day

Year

Driver 2

2. Name*

First Last

2. Date of Birth*

Month

Day

Year

2. Drivers License #*

2. Drivers License State*

2. Commercial License? (CDL)

Yes

2. Year CDL Issued

2. Hire Date

Month

Day

Year

Driver 3

3. Name*

First Last

3. Date of Birth*

Month

Day

Year

3. Drivers License #*

3. Drivers License State*

3. Commercial License? (CDL)

Yes

3. Year CDL Issued

3. Hire Date

Month

Day

Year

Driver 4

4. Name*

First Last

4. Date of Birth*

Month

Day

Year

4. Drivers License #*

4. Drivers License State*

4. Commercial License? (CDL)

Yes

4. Year CDL Issued

4. Hire Date

Month

Day

Year

Driver 5

5. Name*

First Last

5. Date of Birth*

Month

Day

Year

5. Drivers License #*

5. Drivers License State*

5. Commercial License? (CDL)

Yes

5. Year CDL Issued

5. Hire Date

Month

Day

Year

Driver 6

6. Name*

First Last

6. Date of Birth*

Month

Day

Year

6. Drivers License #*

6. Drivers License State*

6. Commercial License? (CDL)

Yes

6. Year CDL Issued

6. Hire Date

Month

Day

Year

Driver 7

7. Name*

First Last

7. Date of Birth*

Month

Day

Year

7. Drivers License #*

7. Drivers License State*

7. Commercial License? (CDL)

Yes

7. Year CDL Issued

7. Hire Date

Month

Day

Year

Driver 8

8. Name*

First Last

8. Date of Birth*

Month

Day

Year

8. Drivers License #*

8. Drivers License State*

8. Commercial License? (CDL)

Yes

8. Year CDL Issued

8. Hire Date

Month

Day

Year

Business Information Continued

What is your total annual sales/revenue? (Gross)*

Do you have employee(s)?*

Yes

Owner payroll*

Number of employees*

Estimated annual payroll*

Do you lease your employees?*

Yes

Do you use any subcontractors? (1099s)*

Yes

Number of subcontractors*

Subcontractor annual payroll*

What type of work do your subs perform?*

Do you have a written contract with your subs requiring them to name your business as Additional Insured and show proof every year?*

Yes

Not yet

Building and Property Information

My business location is*

Leased Property

Owned Property

Work From Home

Do you need coverage for the building?*

Yes

Have you made any tenant improvements?*

Yes

In the future

How much tenant improvement coverage do you need?

Square footage of your business*

Do you have more than 1 business location?*

Yes

Building Information

Year Built*

Number of stories of the building*

Construction Type*

Roof Type*

Other construction type*

Other roof type*

Has there been any updates to the roof, plumbing, or electrical?*

Yes

I don't know

Year Roof Updated?

Year Plumbing Updated?

Year Electrical Updated?

Additional Location(s)

Location 2 is*

Owned

Leased

Location 2: Address*

Street Address Address Line 2 City State ZIP Code

Location 2: Square Feet

Add 3rd Location

Yes

Location 3 is*

Owned

Leased

Location 3: Address*

Street Address Address Line 2 City State ZIP Code

Location 3: Square Feet

Business Description

Please describe the nature of your business*

Customer Data

What type of customer data do you store?*

Do you store date from third parties?*

What security policies do you use?*

Which industry standards do you comply with?*

I don't know

PCI/DSS

NIST CSF

SOC 1/2

ISO 27001/2

ISO 8000/1

GDPR

HIPAA

FINRA

FDIC

HITECH

Other

None

Other industry standard*

Who manages you cybersecurity?*

Internal employee

External consultant

None

Do you encrypt all stored or accessed personal data?*

Yes

I don't know

How often do you backup your data*

Daily

Weekly

Monthly

Infrequently

None

I don't know

How long do you retain those backups?*

30 days or more

2 - 30 days

1 day or less

Manufacturing

Is there any manufacturing, mixing, re-labeling, or repackaging of products?*

Yes

Please describe

Claims Information

Have you had any claims or losses in the last 5 years?*

Yes

What was the date, amount paid, and description of each loss or claim*

Current Insurance

Has your business been cancelled or non-renewed in the last 4 years?*

Yes

Have you ever filed for bankruptcy?*

Yes

Bankruptcy: Please describe when and why*

Do you have ANY business insurance currently?*

Yes

Name of current insurance carrier?*

Expiration date of current policy*

Month

Day

Year

Why are you looking for a new quote?

Current total insurance premium?

Current Policies

Drop files here or

Accepted file types: pdf, Max. file size: 5 MB, Max. files: 10.

Liability Limits (Optional)

What is the Liability limit requested?

Do you need any Business Personal Property coverage?*

Yes

Not sure, let's discuss

How much Business Personal Property coverage do you want?

Are you interested in Loss of Use / Business Income coverage?*

Yes

Not sure, let's discuss

Garage & Dealers Information

What types of vehicles you service, repair, or sell?*

Select all that apply

Private Passenger

Motorhomes

Motorcycles

Utility Trailers

Commercial Trucks

Commercial Trailers

Other

Other vehicles*

What is the total amount of coverage for other people's vehicles would you like?*

Example: If you have 20 vehicles at any one time and each vehicle has an average value of $25,000 then you would want $500,000 in coverage.

What parts and accessories do you sell over the counter?

None

New Parts

Used Parts

Exterior/Interior Trim

Apparel

Estimated annual over the counter sales

What are your security practices?*

3-Part Ticket

Key Cabinet

Protected Lot

None

Where do you store customer's vehicles?*

In Building

Fenced Area

Open Lot

Where do you store keys to customer's vehicles?*

Key Cabinet

In/On the Vehicle

Other

Please describe Other key storage location*

Do you tow for hire?*

Yes

Garage & Dealers Information

List the percentage of the work you provide for each section below.

Where work is performed. Total must equal 100%.

Percent of work performed at Your Shop

% at Your Shop

Percent of work performed at Customer's Location

% at Customer's Location

Percent of work performed at Other

% Other

Please describe Other Location

Type(s) of work performed (in percent). Total must equal 100%.

Type of Work: Body/Paint

% Body/Paint

Type of Work: Brakes, Transmission or Suspension

% Brakes, Transmission or Suspension

Type of Work: Electrical

% Electrical

Type of Work: Mechanical

% Mechanical

Type of Work: Muffler/Radiator

% Muffler/Radiator

Type of Work: Oil Change

% Oil Change

Type of Work: Roadside Assistance

% Roadside Assistance

Type of Work: Safety Inspection

% Safety Inspection

Type of Work: Tires/Wheels

% Tires/Wheels

Type of Work: Tune Up

% Tune Up

Type of Work: Wash/Detail

% Wash/Detail

Type of Work: Welding

% Welding

Type of Work: Other

% Other (Upholstery, frame work, body work, window tint, windows, cleaning trailer, stereo system, etc.)

Please describe Welding type of work performed*

Please describe Other type of work performed*

Do you provide any off-site services or mobile services?*

Yes

What is the maximum miles away from your business that you offer your services?*

Dealer Sales Questions

How many Dealer Plates do you have?*

Number of Repairer/Transporter plates owned by you?

Number of vehicles sold annually*

Number held for sale (Average #)*

Number held for sale (Maximum #)*

Number of vehicles sold on internet auction

Number of vehicles sold on consignment

Do you sell "salvage titled" vehicles?*

Yes

Yes: How much structural repair done?*

Additional Insured Information (Optional)

Do you have anyone that needs to be listed as Additional Insured?

Yes

Additional Insured Information. (i.e. Name & Address)

You may upload your additional insured documents using the upload field below.

Additional Insured Document(s)

You may upload up to 10 PDF documents. If you have more documents you can send them to your agent after they contact you.

Drop files here or

Accepted file types: pdf, Max. file size: 12 MB, Max. files: 10.

Additional Comments and/or Current Policy Upload (Optional)

Any additional comments

Any Additional Documents

Drop files here or

Accepted file types: pdf, Max. file size: 8 MB, Max. files: 5.

Wrapping Up

What is the best time to call and discuss your quote?*

Morning

Afternoon

Evening

Anytime

Other

Please specify the best time to call*

Would you like a quote from a specific agent?

Consent*

Like most insurance agencies, we use information from you and other sources, such as your driving and claims histories, insurance score, and other factors to calculate an accurate rate for your insurance. New or updated information may be used to calculate your renewal premium.

I Agree

All the above information is accurate and true to the best of my knowledge.*

Yes

Would you like to create a user account to manage your submissions?*

Yes, create my account

Not at this time

Username*

Password*

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Comments

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Davidson Insurance Agency

Links

Connect with us

Commercial Auto Quote

Business Information

Primary Contact Information

Additional Business Owners

Owner 2

Owner 3

Owner 4

Vehicles

Vehicle 1

Vehicle 2

Vehicle 3

Vehicle 4

Vehicle 5

Vehicle 6

Drivers

Driver 1

Driver 2

Driver 3

Driver 4

Driver 5

Driver 6

Driver 7

Driver 8

Business Information Continued

Building and Property Information

Building Information

Additional Location(s)

Business Description

Customer Data

Manufacturing

Claims Information

Current Insurance

Liability Limits (Optional)

Garage & Dealers Information

Garage & Dealers Information

Dealer Sales Questions

Additional Insured Information (Optional)

Additional Comments and/or Current Policy Upload (Optional)

Wrapping Up

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Springfield Branch

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