General Liability Insurance Application – Tiger Insurance Group LLC

General Liability Only - Insurance Application

Submit your General Liability Only application today!

"*" indicates required fields

1General Liability Insurance Quote

2Insured Information

3Policy Information

4Coverages

5Property Location

6For Underwriting

Consent

I agree to the privacy policy.

General Liability Only Application

Save up to 20% on your insurance. Get a quote and get covered.

Insured Information

Fun Fact - Tigers

Applicant

Name*

DBA

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Entity Type*

Is this a Non-Profit?*

Yes

Years in Business:*

When was business established?*

MM slash DD slash YYYY

Business Phone #*

Email Address*

Business Website Address

POLICY INFORMATION

Proposed Effective Date*

MM slash DD slash YYYY

Nature of the business:*

Description of Operation:*

Hours of Operations:*

Any Towing / Roadside Assistance?*

Yes

Any Tire Sales?*

Yes

% Of Tire Sales*

Please enter a number from 0 to 100.

Any Vehicle Sales?*

Yes

# Of Vehicles Sold Per Year*

Please enter a number greater than or equal to 0.

Work Performed On Heavy / Extra Heavy Trucks?*

Yes

Supplemental App might be required based on carrier approached

Classification?*

Retail store or service operations % of total sales?*

Please enter a number from 0 to 100.

% Of Liquor Sales*

Please enter a number from 0 to 100.

Are there any gas pumps?*

Yes

Number of Gas Pumps?*

Please enter a number from 1 to 20.

Is Building coverage needed for this property?*

Yes

Is the building undergoing structural renovations currently or are any extensive renovations planned?*

Yes

Does the prospect need coverage for a canopy and/or gas pumps?*

Yes

Is there propane tank filling at this location?*

Yes

What is the percentage of occupancy?*

Please enter a number from 0 to 100.

What are the annual receipts from the sale of gasoline?*

Please enter a number greater than or equal to 0.

What are the annual receipts from the sale of convenience store items?*

Please enter a number greater than or equal to 0.

Number Of Rooms?*

Please enter a number greater than or equal to 1.

Vacancy Rate?*

Please enter a number from 0 to 100.

Avg Cost Per Night?*

Please enter a number greater than or equal to 0.

Any Kitchenettes?*

Yes

Any Stoves?*

Yes

Restaurant On Premises?*

Yes

Exterior Facing Room Doors?*

Yes

Extended Stay Options?*

Yes

Security Cameras In Place?*

Yes

Any table side cooking?

Yes

% Of Liquor Sales?*

Please enter a number from 0 to 100.

Any entertainment?*

Yes

Please explain:*

Retail store or service operations % of total sales?*

Please enter a number from 0 to 100.

Retail store or service operations % of total sales?*

Please enter a number from 0 to 100.

Any direct importing, owned label and repackaging?*

Yes

Please explain:*

See a required field but don't understand? Don't worry! You can hover over the question mark to get details to help with your selection. Your agent will go over your choices before policy binding.

Coverage Form*

Hired & Non-Owned Auto?*

Yes

Limit*

Liquor Liability?*

Yes

Limit*

Directors & Officers Liability?*

Yes

Limit*

Garage Keepers Liability?*

Yes

Coverage From*

Limit*

Please enter a number greater than or equal to 0.

Employment Practice Liability(EPL)?*

Yes

Coverage From*

Beautician Liability?*

Yes

Number of Beauticians?*

Coverage From*

Limit Applies Per?*

Each Occurrence?*

General Aggregate?*

Products & Completed Operations Aggregate?*

Personal & Advertising Injury ?*

Damage To Rented Premises (Each Occurrence)?*

Medical Expense ?*

Employee Benefits?*

Yes

Limits?*

See a required field but don't understand? Don't worry! You can hover over the question mark to get details to help with your selection. Your agent will go over your choices before policy binding.

Covered Locations

Row ID	Location Address	Actions

There are no Locations.

Maximum number of locations reached.

UNDERWRITING

Is the applicant a subsidiary of another entity?*

Yes

Entity Name*

Parent Company Name Relationship Description

Number*

Please enter a number greater than or equal to 0.

% Owned

Does the applicant have any subsidiaries?*

Yes

Entity Name*

Parent Company Name Relationship Description

Number*

Please enter a number greater than or equal to 0.

% Owned

Is a formal safety program in operation?*

Yes

Safety Programs...*

Safety Manual

Safety Position

Monthly Meetings

Osha

Other

Explain Other*

Any exposure to flammables, explosives, chemicals?*

Yes

Exposure...*

Any policy or coverage declined, canceled or non-renewed during the prior three (3) years for any premises or operations?*

Yes

Untitled*

Non-Payment

Non-Renewal

Underwriting

Condition Corrected

Agent No Longer Represents Carrier

Any past losses or claims relating to sexual abuse or molestation allegations, discrimination or negligent hiring?*

Yes

untitiled*

During the last five years (TEN IN RI), has any applicant been indicted for or convicted of any degree of the crime of fraud, bribery, arson or any other arson-related crime in connection with this or any other property?*

Yes

untitiled*

Any uncorrected fire and/or safety code violations?*

Yes

Occur Date*

MM slash DD slash YYYY

Explanation*

Resolution*

Resolve Date*

MM slash DD slash YYYY

Occur Date*

MM slash DD slash YYYY

Explanation*

Resolution*

Resolve Date*

MM slash DD slash YYYY

Has applicant had a foreclosure, repossession, bankruptcy or filed for bankruptcy during the last five (5) years?*

Yes

Occur Date*

MM slash DD slash YYYY

Explanation*

Resolution*

Resolve Date*

MM slash DD slash YYYY

Occur Date*

MM slash DD slash YYYY

Explanation*

Resolution*

Resolve Date*

MM slash DD slash YYYY

Has applicant had a judgment or lien during the last five (5) years?*

Yes

Occur Date*

MM slash DD slash YYYY

Explanation*

Resolution*

Resolve Date*

MM slash DD slash YYYY

Occur Date*

MM slash DD slash YYYY

Explanation*

Resolution*

Resolve Date*

MM slash DD slash YYYY

Has business been placed in a trust?*

Yes

Untitled*

Any foreign operations, foreign products distributed in USA, or us products sold / distributed in foreign countries?*

Yes

Does applicant have other business ventures for which coverage is not requested?*

Yes

Untitled*

Does applicant own / lease / operate any drones?*

Yes

Untitled*

Does the applicant hire others to operate drones?*

Yes

Untitled*

Any medical facilities provided, or medical professionals employed or contracted?*

Yes

Untitled*

Any exposure to radioactive / nuclear materials?*

Yes

Untitled*

Do/have past, present or discontinued operations involve(d) storing, treating, discharging, applying, disposing, or transporting of hazardous material? (e.g. landfills, wastes, fuel tanks, etc.)*

Yes

Untitled*

Any operations sold, acquired, or discontinued in last five (5) years?*

Yes

Untitled*

Any watercraft, docks, floats owned, hired or leased?*

Yes

Untitled*

Any parking facilities owned / rented?*

Yes

Untitled*

Is a fee charged for parking?*

Yes

Untitled*

Recreation facilities provided?*

Yes

Untitled*

Are social events sponsored?*

Yes

Untitled*

Any structural alterations contemplated?*

Yes

Untitled*

Any demolition exposure contemplated?*

Yes

Untitled*

Has applicant been active in or is currently active in joint ventures?*

Yes

Untitled*

Is there a labor interchange with any other business or subsidiaries?*

Yes

Untitled*

Are daycare facilities operated or controlled?*

Yes

Untitled*

Have any crimes occurred or been attempted on your property within the last three (3) years?*

Yes

Untitled*

Is there a formal, written safety and security policy in effect?*

Yes

Untitled*

Does the business promotional literature make any representations about the safety and security of the premises?*

Yes

Untitled*

Do you rent equipment to others?*

Yes

Equipment Description*

Type Of Equipment*

instruction Given?

Yes

Is there a swimming pool on premises?*

Yes

Untitled*

APPROVED FENCE

LIMITED ACCESS

DIVING BOARD

SLIDE

ABOVE GROUND

IN GROUND

LIFE GUARD

Are there any lodging operations including apartments?*

Yes

# Apts / Units?*

Total Apt / Unit Area?*

SQ FT

Describe other operations*

Are athletic teams sponsored?*

Yes

Input type of sport*

Contact Sport?

Yes

Age Group?*

Extent Of Sponsorship?*

Do you lease employees to or from other employers?*

Yes

Input employee lease*

FINAL DETAILS

Additional Interest?*

Yes

Untitled

Row ID	Interest Type	Actions

There are no Additional Interest.

Maximum number of additional interest reached.

Would you like to quote umbrella coverage?*

Yes

Effective Date*

MM slash DD slash YYYY

Limit of Liability?*

Any other related topics you wish to disclose or communicate?

Attachments (Any optional or pertinent information to include with this application)

Max. file size: 750 MB.

Consent*

*To provide you with an accurate quote, our carrier partners obtain information about you and other household members from consumer reporting agencies. This includes credit-based insurance score, driving and claim histories and other consumer reports. They use this information to underwrite and rate your policy. They may order additional reports to update or renew your insurance. Our carrier partners may use a third party to develop a credit-based insurance score. Not all reports are ordered in all states.

* I affirm that I have reviewed this information with the customer as required by law.

Insurance Quote

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What would you like to quote?(Required)

Commercial Lines

Personal Lines

Life Insurance

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Commercial Product?(Required)

Would you like to submit an application yourself OR securely and quickly connect your existing policy for a Tiger agent to take over?(Required)

I want to submit myself.

I'd like a Tiger agent to help.

Do you have an existing policy?(Required)

Yes

CONNECT EXISTING POLICY

Name(Required)

First Last

Phone(Required)

Email(Required)

Enter Email Confirm Email

Upload documents here:

Drop files here or

Accepted file types: pdf, Max. file size: 750 MB, Max. files: 3.

We prefer you upload your policy declarations page. However, you may upload any documents you have.

[email protected]

702.518.1535

General Liability Only - Insurance Application

General Liability Only Application

Insured Information

Applicant

POLICY INFORMATION

UNDERWRITING

FINAL DETAILS

Save up to 20% on your insurance. Get a quote and get covered.

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