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Property Casualty Quote


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

First Name
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Last Name
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Street
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City
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State / Province
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ZIP / Postal Code
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Primary Phone Number
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E-Mail Address
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Business Legal Name
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DBA
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Entity Type
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Cannabis Use
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Type of Operation
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Projected Revenue For Next 12 Months
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Past 12 Months Revenue
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In Business How Long
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Liability Coverage Options
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If you selected more then how much coverage
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Regulatory Actions Actions
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Stop Gap Coverage
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Auto Included
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Has your insurance ever been canceled
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Do you currently have insurance?
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Your Insurer
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Any claims in the past 5 years
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If yes then please give details in comment box
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Have or one of your partners ever been convicted or committed any state or federal violations
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If yes please give details
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Name of person that was convicted
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Has any of the owners or employees been convicted to trafficking violations in the past 10 years
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Is your entity currently licensed for cannabis
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Building and Structure Address
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Is your location open and operational
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Describe structure / building
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Hours of Operation
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How old is the building structure you operate out of
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If the building is over 20 years old please provide any renovations
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Describe Renovations
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Hold down the Ctrl Key to make multiple selections.
Building /Structure Construction type
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Number of stores on building/structure
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Building/ structure have sprinkler system
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Is there residential area within 100 yards of you facility
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Is your facility being operated out of your residence
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Any dogs on premises
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If there is a dog on premises is there signage posted
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Is there an Central Stage Alarm system functioning at the facility?
Optional

Is there a safe at the facility
Optional

If yes what is the weight of the safe
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Fire Rating of Safe
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Do you use a vault to safe guard inventory
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Is there a buzz in system or security personnel at you facility
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Does the facility have security cameras
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Does the facility have firearms on site
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Describe Security Guards
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Seed to Sale Tracking System
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What is the name of the systemt
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Additional Insured
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Additional Insured
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Additional Insured Address
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Property Coverage
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If you choose Property Coverage please fill out below, if not you can skip this section
Optional
Building Coverage Value
Optional
Loss of Income Value per month
Optional
Outdoor Signs
Optional
Cannabis Inventory
Optional
Other Inventory
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Indoor Grow Equipment
Optional
Outdoor Grow Equipment
Optional
Business/Personal Property
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Tenant Improvement
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Do you wish to add Property and Equipment in the event of loss or breakdown
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Transport of inventory Add Coverage
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Employee Theft
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Cultivation on site
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How cultivation structures do you have at this location
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Grow Operation
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If other please specify
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Equipment for grow operation
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Hold down the Ctrl Key to make multiple selections.
How many harvests per year
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Seeds Coverage Total Value per harvest
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Immature Seedlings value per harvest
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Vegetative Plant value per harvest
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Flowering Plant value per harvest
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Harvested Plant value per harvest
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Finished Stock value per harvest
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Please warrant the following
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I confirm and warrant that the aforementioned is true
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Manufactured Products List
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List of Vendors Covered
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Do you repackage any products
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If yes please specify
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Have you had any products recalled in the past 2 years
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If yes please specify
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New product coming out in the next 12 months
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Quality Control/ Loss Control
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Hold down the Ctrl Key to make multiple selections.
Claims in the past 5 years
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If yes please specify
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I have read the disclaimer forms
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

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