
*Clark Insurance Agency*
	Quotes available for California residents Only Business Insurance - Clark Insurance Agency can provide insurance coverage for your business. Whether your business is small, sole proprietor or a large corporation we can find you the insurance coverage tailored to fit your business. Just some of the types of businesses we insure are: Apartments, Condo/Townhouse HOA, Restaurants, Strip Shopping Centers, Industrial Parks, Office Buildings, Automotive Garages, Manufactures, Retail, Wholesale, Distributors and Workers Compensation Insurance. In order to make sure your free, no obligation quote is accurate, please completely fill out the questionnaire below.

Business Insurance Quote Form Please fill out the form Completely. Owner's Name: DBA: Mailing Address: City: State: CA County: Zip Code: (Required!) Property Address: City: State: CA Zip Code: (Required!) Phone: Are you a: How long in business: How many years experience: What type of experience: Nature of Business/ Description of operations: Do You Own or Lease the Location: If Own, Type of Building and Date Purchased: (i.e. Office, Industrial, Apartment) Are there bars on windows: Yes No Are they quick-release type: Yes No List Number and Type of Occupants in Building: Construction Type: # of SqFt: Year Built: If built prior to 1960, detail type and year of renovations & upgrades: (i.e. electrical, heating, etc.) Does the Building have Circuit Breakers or Fuses? # of Units: # of Stories: Building Sprinklered: Type of Parking Available Is there a Pool? Is the Pool Fenced? Type of Security System Approx Current Annual Gross Receipts/Income: Present Insurance Co.: Renewal Date: # Losses in Last 5yrs: Type & Amount of Loss: Reason for Shopping Insurance: Coverages To Quote: Dwelling Amount: Business Contents Amount: Property Deductible: Loss of Income Amount: Liability Amount: Liability Deductible: Earthquake Insurance? Workers Compensation Ins? If yes or Quote: Approximate Annual Payroll: # of Employees excluding owner & officers: # of Full Time & Average Wage: # of Part Time & Average Wage: # of Seasonal & Average Wage: Please provide a brief discription and Job Title for each of the above: Miscellaneous Coverages and Amounts: * For Commercial Vehicle Insurance, Please see our Auto Insurance Quote Page. * For Group Health Insurance, Please see our Health Insurance Quote Page. Please include a valid email address, phone/fax number, how you'd prefer to be contacted and the best time and day. (Note: For a return quote please leave a fax number if available.)

Business Insurance Quote Form

Please fill out the form Completely.

Owner's Name:              

DBA:                        

Mailing Address:           

City:                        State: CA
County:                    

Zip Code: (Required!)       

Property Address:          

City:                        State: CA
Zip Code: (Required!)       

Phone:                     

Are you a:                 

How long in business:      

How many years experience: 

What type of experience:   

Nature of Business/
Description of operations:



Do You Own or Lease the Location:      
If Own,
Type of Building and Date Purchased:   
(i.e. Office, Industrial, Apartment)

Are there bars on windows:    Yes   No

Are they quick-release type:  Yes   No

List Number and Type of Occupants in Building:



Construction Type:         

# of SqFt:                 

Year Built:                

If built prior to 1960,
detail type and year of
renovations & upgrades:
(i.e. electrical, heating, etc.)





Does the Building have Circuit Breakers or Fuses? 

# of Units:                

# of Stories:              

Building Sprinklered:      

Type of Parking Available  

Is there a Pool?           

Is the Pool Fenced?        

Type of Security System    

Approx Current Annual
Gross Receipts/Income:     

Present Insurance Co.:     

Renewal Date:              

# Losses in Last 5yrs:     

Type & Amount of Loss:     


Reason for Shopping
Insurance:                 

Coverages To Quote:

Dwelling Amount:           

Business Contents Amount:  

Property Deductible:       

Loss of Income Amount:     

Liability Amount:          


Liability Deductible:      

Earthquake Insurance?      

Workers Compensation Ins?  

If yes or Quote:

Approximate Annual Payroll:  

# of Employees excluding owner & officers: 

# of Full Time & Average Wage: 

# of Part Time & Average Wage: 

# of Seasonal & Average Wage:  

Please provide a brief discription and Job Title 

for each of the above:



Miscellaneous Coverages and Amounts:    



* For Commercial Vehicle Insurance, Please see our Auto Insurance Quote Page.

* For Group Health Insurance, Please see our Health Insurance Quote Page.


Please include a valid email address, phone/fax number,
how you'd prefer to be contacted and the best time and day.
(Note: For a return quote please leave a fax number if available.)

(877) 633 - 3454
Email Clark Insurance Agency

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