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Insurance Quick Quote

Security Consultants, Private Patrols, Armored Car Operations, and Private Investigators

Business & Contact Information

First Name

M.I.

Last Name

Business Name

Yes No

Do you operate from a residence?

NOTE: Business address must be a street address - NO PO BOXES.

Business Street Address

City

State

Zip Code

Mailing Address (If different)

If both addresses are the same, please leave blank.

Email Address

Business Phone

- -

Home Phone

- -

Mobile Phone

- -

Fax Number

- -

Information About Your Business

State License Number and Type

(If applicable)

Legal Entity Type

Corporation

Partnership

Limited Liability Corp (LLC)

Individual

Other:

Date Business Established

Years of Experience

Years

Details of Experience

150 character limit

Yes No

Do you use a written contract?

Staffing Details

Owners / Officers / Partners

Position

Full Time

Part Time

Owners / Officers / Partners

Full Time

Part Time

Staff Categories

Staff Category

FT Armed

FT Unarmed

PT Armed

PT Unarmed

Armored Car Operations

Full Time Armed

Full Time Unarmed

Part Time Armed

Part Time Unarmed

Private Investigators

Full Time Armed

Full Time Unarmed

Part Time Armed

Part Time Unarmed

Private Patrol

Full Time Armed

Full Time Unarmed

Part Time Armed

Part Time Unarmed

Security Consultants

Full Time Armed

Full Time Unarmed

Part Time Armed

Part Time Unarmed

Security Guards

Full Time Armed

Full Time Unarmed

Part Time Armed

Part Time Unarmed

Please enter "0" for any categories that do not apply.

Percentage of Work Performed

Total must equal 100%

Work Performed Total:

% Airport Work

% Domestic

% Process Service

% Alarm Response

% Fast Food

% Product Liability

% AOE / COE

% Fidelity

% Property / Arson

% Armored Car / Courier

% Forensic Investigation

% Public Records

% Attorney Service

% Hospitals

% Residential Patrol

% Background

% Hotels / Motels

% Restaurants

% Banks

% Liquor Stores

% Schools

% Bars / Lounges

% Locates / Skip Tracing

% Mall Interior

% Car Dealerships

% Low Income Housing

% Mall Parking Lot

% Churches

% Manufacturing Plants

% Strike Work

% Civil

% Medical Malpractice

% Sub-Rosa

% Computer Fraud

% Mystery Shopping

% Surveillance

% Condominiums

% Offices

% Traffic Control

% Construction Sites

% Polygraph

% Warehouses

% Criminal

Detailed Categories

% Apartment Work

Subsidized / Section 8?

Yes

% Athletic Events

% Concerts & Special Events

% Consulting Investigation

% Executive Protection

% Government Facilities

% Marijuana / Dispensaries

% Retail Work

% Security Consulting

% Other Work

Current Insurance Information

Yes No

Any claims in the last five years?

Selecting "Yes" will reveal additional detail field.

Yes No

Do you currently have insurance?

Selecting "Yes" will reveal additional detail field.

Personnel Category

Number

Payroll ($)

Hours/Wk or Armed?

Full-Time Guards

Number

Payroll ($)

Hrs/Wk

Part-Time Guards

Number

Payroll ($)

Hrs/Wk

Full-Time Investigators

Number

Payroll ($)

Armed?

Armed Unarmed

Part-Time Investigators

Number

Payroll ($)

Armed?

Armed Unarmed

Full-Time Consultants

Number

Payroll ($)

Armed?

Armed Unarmed

Part-Time Consultants

Number

Payroll ($)

Armed?

Armed Unarmed

Supervisors

Number

Payroll ($)

Attended Canines

Number

Unattended Canines

Number

Limits of Liability / Coverage Information

Requested Effective Date for New Policy:

YYYY

Limits of Liability

$1,000,000/$2,000,000

$1,000,000/$3,000,000

$2,000,000/$3,000,000

$3,000,000/$4,000,000

$4,000,000/$5,000,000

$5,000,000

Other:

Deductible

$0 Per Claim

How many Additional Insureds?

(Enter 0 if none)

Licensed Agent / Broker Information

Yes No

Are you a licensed insurance agent or broker?

Selecting "Yes" will reveal additional detail field.

Producer Name

Insurance Agency Name

Email Address

Notice: Prior to binding any coverage with AMIS, we must have a signed Broker Agreement, a copy of your Broker/Insurance License, and a copy of the declaration page of your E&O Insurance policy. Click here for more information.

Yes No

Did you previously provide your agency information to AMIS?

Selecting "No" will reveal agency and E&O detail fields.

Comments & Priority

Comments or Additional Info:

Maximum 200 characters

Please Prioritize Your Request:

Hurry! I need it ASAP!

Please quote prior to my renewal

No hurry, just checking

Declarations and Legal Notices

By submitting this quick quote application, you declare that:

The information provided is accurate and complete to the best of your knowledge.
You agree to our Underwriting Conditions.
You agree to the Fraudulent Acts Notice.
You agree to the California Notice (CA businesses only).
You have reviewed and confirm as true, correct and complete each of the representations and warranties and all other information set forth in the application.

Depending on the size of the risk, a full completed application may be required in order to receive a formal quotation prior to binding coverage. AMIS may elect to withdraw any indication quote upon review of a full completed application if the application does not meet the underwriting guidelines of the insurance company. Click here to view the underwriting conditions.

AMIS/Alliance Marketing & Insurance Services does not warrant or guarantee suitability or adequacy of coverage in meeting any generic, specific or contractual requirements of any insurance company, state, county, corporation, public entity, or public party that you may provide services to during the policy period, including any written or oral request forwarded to AMIS or its staff. You assume the risk of obtaining suitable or adequate coverage to meet any generic, specific or contractual requirements of your client or company. The information contained herein is provided with the understanding the AMIS is not engaged in rendering legal services, including legal opinions or advice, or professional risk management consulting. If legal services or professional services are required, you will need to seek the advice of legal counsel.

NOTE: An application or information form is not an insurance policy and does not bind any coverage. All applications must be underwritten and a quotation will be issued subject to underwriting guidelines. The quotation does not bind coverage.

Do you agree to the above? *

This constitutes your digital signature.

Yes No

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