Commercial Quote

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Thank you for choosing Gibb Agency for your Commercial Insurance quote. This form will take about 5-10 minutes to fill out. Don’t stress if you don’t have all the details right now. Simply click the ‘Save and continue later’ button below, and we’ll send you a private link so you can finish at your convenience.

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Step 1 of 36

Which type of insurance are you looking for?*

Check all that apply.

Trucking

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*

Primary Insured Name*

First Last

Date*

Month

Day

Year

Email*

Work Phone

Mobile Phone*

Yes, I may be contacted by text message.*

Yes

Business Information

Legal Business Name*

First

DBA

Entity Type*

FEIN

Website

Business Address*

Street Address City State ZIP Code

Mailing Address*

Same as Business Address

Street Address City State ZIP Code

Year Business Started*

Years of experience operating this business?*

Years of experience in this field?*

Is this business affiliated with a franchise?

Yes

DOT#

MC#

Number of Owners

Additional Business Owners

2nd Owner

2. Owner Name*

First Last

2. Owner Date of Birth*

Month

Day

Year

2. Owner Phone*

2. Owner Email*

3rd Owner

3. Owner Name*

First Last

3. Owner Date of Birth*

Month

Day

Year

3. Owner Phone*

3. Owner Email*

4th Owner

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

Upload File*

Upload an Excel Sheet if there are more than 6 vehicles.

Accepted file types: xlsx, xlsm, Max. file size: 8 MB.

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. Garaging 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

Underwriting

Projected annual mileage*

Number of Trailers to insure

What coverages are you looking to have in place?*

Check all that apply

Auto Liability

Physical Damage

Cargo

General Liability

Bobtail

Non-Trucking Liability

Umbrella / Excess

Commercial Property / Premises

Occupational Accident

Workers Comp

Hired / Non-Owned Auto

What are the minimum years of CDL experience required for drivers?

What are the maximum Daily and Weekly driving hours for each driver?

How are drivers paid?*

Hourly

By Trip

By Mile

Other

Which of the following is part of your driver screening/hiring process?*

Check all that apply

Employment Background Check

Criminal Background Check

MVR Review

Behavioral / Integrity Test

Pre-Employment Drug Test

Road Test

Pre-Employment Screening Program (PSP) report for FMCSA

In the past 5 years have you, or any driver, been convicted of any of the following?

Check all that apply

Leaving the scene of an accident / hit and run

Felony conviction involving a motor vehicle

Driving while license suspended or revoked

DUI or DWI

Negligent Homicide

Unlawful use of vehicle

Speed contest or racing

Reckless Driving

Speeding 20mph+ over the limit

Name, conviction, date, and details

Are drivers covered by workers comp?*

Yes

Do you haul for hire?*

Yes

Do you Barter Hire or Lease any drivers or vehicles out for others to use?*

Yes

Which party provides primary auto liability coverage?*

My Business

Other Party's Business

Do you Barter Hire or Lease any drivers or vehicles to haul under your authority?*

Yes

Are owner-operators subject to the same hiring, training, and equipment maintenance standards as company drivers?

Yes

On what basis are vehicles and drivers leased?*

Permanent

Temporary / Trip Basis

Do you require and get evidence that leased vehicles owners purchase non-trucking liability?*

We will need a copy of the lease agreement

Yes

Does your company allow any of the following practices?*

Check all that apply

Deadheading

Trailer Spotting

Double and/or Triple Trailer Hauling

Team Driving

Slip Seat / Relay Drivers

Non-Employee Passengers

All drivers to bring vehicles home

Underwriting

Do you need Federal Filings?*

Yes

Note: For Federal Filings, an MCS 90 Endorsement is needed too.

Do you need State Filings?*

Yes

State(s) and Permit #s*

Is any part of your operation seasonal?

Yes

Does vehicle(s) have an ELD installed?

Yes

ELD Provider

What state(s) does your business operate in?

What are the 3 largest cities you enter?

Does your business provide any of the following general services?*

Storage

Loading / Unloading

Packing / Crating

Rigging

Decking / Tarping / Blanket Wrapping Freight

Delivery / Installation Services

Garaging

Vehicle and Equipment Repair

Commercial or Residential Moving Services

None of These

Does your business generate revenue from any services other than trucking for hire?*

Yes

Please explain other revenue generated*

Have you ever changed your operating name?*

Yes

Do you operate under any other names currently?*

Yes

Do you operate as a subsidiary of another company?*

Yes

Have you purchased, sold, or applied for authority over the past 3 years?*

Yes

Have you ever lost, or had authority withdrawn, or have been/are under probation by any regulatory authority? (FHWA, PUC, etc.)*

Yes

Do you agree to report all newly hired operators?*

Yes

Do you agree to report all newly purchased or leased equipment?*

Yes

Business Information Continued

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

Do you have employee(s)?*

Yes

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 and Property 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?*

Daily

Weekly

Monthly

Infrequently

I don't know

None

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 (Optional)

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%.

% at Your Shop