Property / BOP Quick Quote

Complete the Business Information section in full. Type N/A if a field does not apply. Skip anything you do not need and attach loss runs and any schedules noted.

To market your account effectively and avoid blocked or duplicate carrier submissions, we ask to serve as your exclusive broker.

Works on any phone, tablet, or computer — no app needed. Type N/A where a field does not apply. Fields marked * are required.

Business Information

How soon do you need quotes? Due Date *

Desired Effective Date *

Legal Business Name *

DBA / Trade Name (if any)

Mailing Address *

City *

State *

ZIP *

Physical location same as mailing address?

Property Address

Address

Business Phone *

Website

Social Media Handles

Business Owner Name *

Cell Phone

Additional Owner Name

Cell Phone

Primary Contact Name

Cell Phone

Title

Business Details

Other Entity Type (if applicable)

FEIN or SSN (optional)

Year Business Started

NAICS / SIC Code

Owner Years in Industry

Gross Sales – Last 12 Mo $

Projected Sales – Next 12 Mo $

Prior Year Annual Payroll $

Est. Annual Payroll (current yr) $

Total # Employees

Current Annual Premium – all lines requested $

Referred By / How Did You Hear About Us?

Preferred Contact Method & Best Time

Provide a Detailed Description of ALL Business Operations *

Subcontractors

Do you use subcontractors?

% of Work Subbed Out

Annual Sub Cost $

Require certificates of insurance from all subs?

# of Additional Insureds

Additional Named Insureds

List below or attach a complete list (Excel or other format) of all additional insureds with addresses and description of work performed.

Property Schedule Attach SOV/Location Schedule for more locations

Current Carrier

Annual Premium $

Expiration Date

Property Schedule / SOV attached — must include ALL details requested below for each property (if attached, you may skip below)

Location Details

Location #

Bldg #

Address

Property valuation requested

Replacement Cost (RC) Actual Cash Value (ACV)

Bldg Replacement Cost $

Bldg Market Value $

Contents / BPP $

Business Income $ (12-mo)

Other property to insure (describe)

Replacement cost = cost to rebuild today; property is insured to rebuild cost, not market value (market value is for reference only).

Value $

Building Characteristics

Year Built

# of Stories

Square Feet

Distance to Hydrant

Construction Type

Roof Material

Roof Shape

Nearest Fire Station

Recent Updates

Year Updated – Roof

Year Updated – Wiring

Year Updated – Plumbing

Year Updated – HVAC

Protection Features

Sprinklered?

Alarms

Fire Burglar Both

Monitored

Centrally Locally

General Liability

Current Carrier

Annual Premium $

Expiration Date

Per-Occurrence Limit

General Aggregate

Estimated Annual Gross Sales $

Estimated Annual Payroll $

Loss History & Additional Comments

Any claims or losses in the past 5 years? (if yes, explain in the box below)

Loss Details and Explanation

Required Documentation

Required with this submission (all needed to quote):

Copy of current policy

Any insurance requirements

List of additional insureds

List of lienholders

5-year loss runs

Authorization & Broker Agreement

Broker of Record / Exclusive Representation Acknowledgment *
I authorize J. Archer Insurance Group to market my account and act as my exclusive broker for this submission. I understand duplicate submissions by other agents can cause carriers to block our access and delay or jeopardize the best available pricing.

Applicant Signature (type full name) *

Date *

Print Name & Title

Tap Submit to send your answers to our team, or Save / Print as PDF to keep a copy and email it to service@archerinsgroup.com. Questions? Call 281-501-8331.

What Happens Next

Your dedicated commercial risk and service team will review your submission and reach out within one business day to discuss coverage options and pricing. Our commercial specialists are here to ensure you get the best protection for your business.