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Home
About
Our Agency
About Us
Agency Blog
Our Location
Testimonials
Refer Friends and Family
Get in Touch
Menu Widget 2
Services
PERSONAL
Homeowners
Auto Insurance
Earthquake Insurance
Flood Insurance
Condo Insurance
High Net Worth Insurance
Specialty Dwelling Insurance
Course of Construction
Renters Insurance
Umbrella Insurance by April
Premises Personal Liability
Dwelling Fire Insurance
Motorcycle Insurance in California
PERSONAL
Annuity Insurance
Life & Disability Insurance
Health Insurance
Jewelry Insurance
Vision Insurance
Umbrella Insurance
Boat Watercraft Insurance
Fire Insurance
Disability Insurance
Mortgage Protection
Final Expense
Non-Owned Auto Insurance
BUSINESS
Commercial Auto
Business Package
Commercial Property
Contractors Insurance
Cyber Liability
General Liability
Workers Comp
Towing Insurance
Cargo Insurance
Commercial Umbrella
Trucking Insurance
Liquor Liability Insurance
Liquor Liability Off Premise
Tree Trimming Insurance
Banquet Hall Liquor Liability
Auto Service Insurance
Bailees Customer Insurance
Animal Service
Boat Marinas Repair Service
Clergy Error & Omission Insurance
Commercial Fine Art Insurance
Commercial Fire Insurance
Commercial Inland Marine Insurance
Owner Occupied Commercial Building Insurance
Climbing Wall Insurance
Brochure by Briteco in California
Welding Contractor in California
Cyber Liability by ANZEN
Contractors Equipment Rental General Liability
Hole in One for Golf in California
Flea Markets/Swap Meets/Bazaars General Liability
BUSINESS
Limousine Insurance
Bonds
EPLI Insurance
Apartment/Mixed-Use Building
Long-Term Care Insurance
Director and Officer Insurance
Vacant Building Insurance
Workers Compensation
Building Under Construction Insurance
Roofing Contractor Insurance
Home-Based Business
Vacant Property with Course of Construction
Apartment with Commercial Occupancy
Adult Day Care Insurance
Bar & Tavern Insurance
Beauty Barber Insurance
Auto Repossessor Insurance
Church / Mosque / Temple Supplemental Application Insurance
Blasting Contractor Insurance
Club Program Insurance
Caterers and Halls General Liability Insurance
Condo Director and Officer Liability Insurance
Condominium and Homeowners Association Insurance in California
Welding Supply/Gas Distributor Insurance
Consultant Liability in California
Day Nursery or Preschool Insurance
Demolition Contractor Insurance
Fire Sprinkler Contractor Insurance in California
Resources
RESOURCES
Customer Service Center
Trucking Insurance Estimator
Mortgagee Change Request
Condo Policy Upload
Frequently Asked Questions
Company Links
Get Credit Score
Insurance Glossary
Downloadable Free Insurance Reports
RECENT ARTICLES
Widget Menu 1
All Articles
Chat AI
Contact
Start Quotes Here
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Premises Personal Liability Quote
Premises Personal Liability Quote
John Oei
2025-10-20T16:28:57-07:00
Step
1
of
3
33%
Applicant’s Name:
First
Last
Mailing Address:
Phone
Email
Proposed Effective Date:
LIMIT OF LIABILITY REQUESTED: $
Located at
Untitled
1 Family
Owner
Vacant
Tenant (not rented to others)
Seasonal
Builder's Risk (not eligible)
Year of Construction:
Updated:
Yes
No
If yes, confirm the date the following items were updated:
Roof:
Wiring:
Plumbing:
Heating & Air Conditioning:
Physical condition of property:
Please answer all questions
Swimming pool
Yes
No
Diving board or slide
Yes
No
Fenced and self-locking gate
Yes
No
Fenced and self-locking gate
Yes
No
Any other water exposure; i.e.: ponds, lakes, jacuzzi/hot tubs
Yes
No
If yes, please describe other water exposure
Any animals?
Yes
No
If yes, any bite history?
If yes, is the animal with the bite history still on premises?
Smoke detectors
Yes
No
Trampolines
Yes
No
Trip and fall hazards
Yes
No
Steps greater than three have secure handrails
Yes
No
NA
Daycare on premises
Yes
No
Number of children
Any business on premises
Yes
No
Applicant's Occupation
If under minor renovation, who is the contractor? (Provide certificate of insurance)
Adjacent structures, other than a garage?
Yes
No
If yes, what are they used for:
Is there more than 10 acres? (Ineligible if over 10 acres)
Yes
No
What is it used for?
Has any company cancelled, nonrenewed or refused coverage to the applicant? (Not applicable to Missouri applicants)
Yes
No
Section Break
PREVIOUS INSURER AND PRIOR LOSS INFORMATION
Has the insured or applicant had 3 years of prior coverage?
Yes
No
Has the insured or applicant had any prior claims or losses in the last 3 years?
Yes
No
If yes, please complete the Loss information below (Date of Loss, Loss $ Amount Paid, Loss $ Amount Reserved and Description).
Year
Insurance Company
Pol.#
Premium
Date of Loss
Loss $ Amount Paid
Losses $ Amount Reserved
Description of Losses
Prior Policy
Prior Policy Date
_______ to ________
Carrier Name
Coverage Type: Liab/PHD/MTC
POLICY #
# of Units Insured
Any loses within the past 5 years?
If YES please upload on the related documents attaching box below.
Amount Paid
Driver Involved in Loss
Upload Your Current Insurance Policy or Related Documents
Drop files here or
Select files
Max. file size: 20 MB, Max. files: 10.
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CA Dept of Insurance 0659943