Business Name:    
Address:
City:
Florida
Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email: (Required) 
Federal Employer's ID #:
Explanation of Business Operations:


Number of Employees:              
Payroll (not including owners): $
Estimated Gross Receipts:       $

Select all that apply to your Florida business:
Operate or lease aircraft/watercraft     Work Underground
Work above 15 feet                           Require out of state travel
Use Subcontractors                            Delivery Service
Pre-employment physicals                   Offer safety incentive programs
Store, treat, dispose, or transport hazardour waste
Work on vessels, docks, or bridges over water
Other

Recent Insurance Information:

Current Insurance Company: 
Policy #: Expiration Date: (mm/dd/yyyy)

What types of coverages do you currently have:
Benefit Liability               Business Liability
Commercial Umbrella     Directors & Officers Liability
Discrimination                 Errors & Omissions
Product Liability              Professional Liability
Other

Other Insurance Company Used Within Past 3 Years: 
Policy #:
Losses past 3 years:     Amount paid for each loss: $
Explanation of losses, including amount paid on each accident:


Choose Florida Business Liability Insurance Limits:

General Aggregate Limit (other than products completed)   
Products/Completed Operations Aggregate Limit                
Umbrella Amount:

If you've already filled out information on your buildings or facilities
in another insurance quote form then skip the section below.


Building 1
Building Value: $   Inventory Value: $
Total Building Area:        Year Built:
Construction Type:          Sprinklers:
Electrical Type:                             Amps:
Electrical Renovation Year: 
Plumbing Renovation:     Plumbing Renovation Year:
Heating Type:               Heating Renovation Year:   
Roofing Renovation:       Roof Age (years):  
Central Alarm:

List Neighboring Businesses:
To the right:   Distance:
To the left:     Distance:
To the rear:    Distance:

Additional Information:


Click on the "Submit Quote Information" button below to send
your Florida Business Liability Insurance quote request.


**Information received from this Florida Business Liability Insurance quote request form sent to FCI Auto Tag & Insurance Agency will be for our use only and will not be sold, given to or distributed to any other parties. A quote will be based on the Florida business liaiblity insurance information provided and does not guarantee acceptance of the risk by us. The precise coverage afforded is subject to meeting underwriting guidelines, and the terms, conditions and exclusions of the policy as issued. By submitting this request you acknowledge that this is neither an offer to insure nor a guarantee of insurance. Completion of this form does not entitle your business to a Florida Business Liability Insurance policy. We are licensed in Florida and will not provide business liability insurance quotes for other states.


Florida Business
Liability Insurance Quote
FCI Auto Tag &
Insurance of Davie, FL
offers affordable and
comprehensive business
insurance coverage
services throughout
Florida.
In addition to Florida
Business Liability
Insurance quotes, we
also offer affordable
Group Health Insurance
policy premium quotes.
Contact us about Florida
Business Liability, Group
Health, and Commercial
Auto Insurance at
(954) 434-6515.

We are a Davie, FL insurance agency offering Florida business liability
insurance quotes to small, mid-sized and large businesses located in the
following cities and counties: Coral Springs, Fort Lauderdale, Parkland,
Coconut Creek, Margate, North Lauderdale, Lighthouse Point, Hillsboro Beach,
Deerfield Beach, Boca Raton, The Hamptons, Highland Beach, Weston,
Plantation, Playland Isles, Melrose Park, Lauderhill, Sunrise, Tamarac, Wilton
Manors, Oakland Park, Lauderdale Lakes, Sea Ranch Lakes, Villages of
Oriole, Pompano Beach, Lauderdale-by-the-Sea, Boca West, Delray Beach,
Boca Pointe, Boynton Beach, Lantana, Rainbow Lakes, Atlantis, Lake Worth,
Miami, South Palm Beach, Palm Springs, Greenacres, Wellington, Haverhill,
Palm Beach, Golden Lakes, Riviera Beach, Glen Ridge, West Palm Beach,
Lake Park, Royal Palm Beach, Jupiter, Juno Beach, North Palm Beach,
Loxahatchee, Belle Glade, Palm Beach Shores, South Miami, Cutler Ridge,
Princeton, Perrine, Naranja, Homestead, Florida City, Leisure City, Richmond
Heights, Pinecrest, Howard, Coral Way Village, Westchester, Westwood
Lakes, Brownsville, Sweetwater, Key Biscayne, North Bay Village, Miami
Beach, Miami Springs, Virginia Gardens, Hialeah, El Portal, Miami Shores,
Medley, Indian Creek, Surfside, Bal Harbour, North Miami, Biscayne Park,
Pinewood Park, Opa Locka, Bunche Park, Hialeah Gardens, Palm Springs
North, Carol City, Norland, Ojus, Miami Lakes, Biscayne Gardens, Hallandale,
Sunny Isles Beach, Golden Beach, Aventura, Uleta, Miramar, Pembroke
Pines, North Miami Beach, Hallandale Beach, Ives Estates, Pembroke Park,
Coral Gables, Kendall, Dania Beach, Cooper City, West Miami, Hollywood,
Broward County, Palm Beach County, and Miami-Dade County, FL. We can
also offer Florida business liability insurance quotes to small businesses
throughout the Sunshine state, including in Orlando, Tampa, St. Petersburg,
Sarasota, Tallahassee, Gainesville, and Jacksonville, FL.

We offer affordable Florida Business Liability Insurance
coverage services throughout south Florida!
Florida Business Information:
Your Florida Business
Liability Insurance Source
F.C.I. Auto Tag
& Insurance Agency, Inc.
8276 Griffin Road
Davie, Florida 33328
Broward County FL
(954) 434-6515
Fax: (954) 434-6524

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