Insurance Quick Quote

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

FOR MORE INFORMATION ABOUT THIS INSURANCE PROGRAM, CLICK THE APPROPRIATE JOB TITLE ABOVE.

First Name:	Middle Initial: Last Name:
Business Name:

Do you operate from a residence?	Yes No
	THE BUSINESS ADDRESS MUST BE A STREET ADDRESS - NOT A PO BOX.
Business Address:
City:	State: Zip Code:
	If both addresses are the SAME, please leave MAILING Address BLANK.
Mailing Address:
City:	State: Zip Code:

Email Address:

Business Phone:	- -	Home Phone:	- -
Mobile Phone:	- -	Fax Number:	- -

Information About Your Business

State License Number and Type:

(if applicable)

Corporation	Partnership	Limited Liability Corp (LLC)
Individual	Other - Explain:

Date Business was Established:

Years of Experience:

Brief Details of Experience:

(150 characters)

Do you use a written contract?

Yes No

Staff

	Full Time	Part Time
Owners / Officers / Partners

	Full Time Armed	Full Time Unarmed	Part Time Armed	Part Time Unarmed
Armored Car Operations
Private Investigators
Private Patrol
Security Consultants
Security Guards

Percentage of each type of work performed

Total must equal 100%

% Airport Work	% Domestic	% Process Service
% Alarm Response	% Fast Food Restaurants	% Product Liability
% AOE / COE	% Fidelity	% Property / Arson
% Armored Car / Courier / Money Escort	% Forensic Investigation	% Public Records
% Attorney Service	% Hospitals	% Residential Patrol
% Background	% Hotels / Motels	% Restaurants
% Banks	% Liquor Stores	% Schools
% Bars / Lounges	% Locates / Skip Tracing	% Shopping Mall Interior
% Car Dealerships	% Low Income Housing	% Shopping Mall Parking Lot
% Churches	% Manufacturing Plants	% Strike Work
% Civil	% Medical Malpractice	% Sub-Rosa
% Computer Fraud	% Mystery Shopping Service	% Surveillance
% Condominiums	% Offices	% Traffic Control
% Construction Sites	% Polygraph	% Warehouses
% Criminal
% Apartment Work - Please describe duties performed.
Yes No Any Subsidized - Section 8 (HUD) or Low Income Housing?

% Athletic Events - Please describe duties performed and locations. (Crowd control?)

% Concerts and Special Events - Please describe duties performed and locations. (Crowd control?)

% Consulting Investigation - Please describe.

% Executive Protection - Please describe duties. Any celebrities, entertainers, or athletes? If so, who? (We must have the name of each person being protected and type of operation or they will be excluded from quote.)

% Government Facilities - Please describe where work is performed (i.e. offices, train station, etc.)

% Marijuana / Dispensaries - Please describe.

% Retail Work - Please describe duties, types of stores, and hours that guards are on duty.

% Security Consulting - Please describe.

% Other Work - Please describe.

Current Insurance Information

Any claims in the last five years?	Yes No

If claims in the last five years - explain:	(200 characters)

Do you currently have insurance?	Yes No

	If YES, please complete this section.
Prior or Current Insurance Company:		Policy Number:
Policy Limit: $		Premium Amount: $

Rating Information

Annual Payroll: $	(Guards, Patrol, and Investigators)
Annual Receipts: $	(Guards, Patrol, and Investigators)
Annual Independent Contractors Cost: $	(Guards, Patrol, and Investigators)
Describe training for guards, patrol, and investigators / detectives:
Number of Hours Billed Annually - All Guards:
Number of Armed Guards:
Number of Unarmed Guards:
Where are guards stationed?
Describe supervisors' duties:
Where and how are canines used? Describe any drug- or bomb-sniffing activities:

	Number	Payroll	Avg. Hours / Week
Full-Time Guards:		$
Part-Time Guards:		$
			Are They Armed?
Full-Time Investigators / Detectives:		$	Yes No
Part-Time Investigators / Detectives:		$	Yes No
Full-Time Security Consultants:		$	Yes No
Part-Time Security Consultants:		$	Yes No
Supervisors:		$
Attended Canines:
Unattended Canines:

Limits of Liability / Coverage Information

Requested Effective Date for New Policy: / / (M / D / 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?

Licensed Agent / Broker Information

Are you a licensed insurance agent or broker?	Yes No

	If YES, please complete this section.
Producer (Insurance Agent/Broker):
Insurance Agency Name:
Email Address:

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.
Did you previously provide your agency information to AMIS?	Yes No

	If NO, please complete this section.
Agency License Number:
Street Address:
City:	State: Zip Code:
Contact Person Phone:	- -
Name of E&O Insurance Company:
E&O Policy Number:
E&O Policy Expiration Date:	/ / (M / D / YYYY)

Comments, Priority, Terms of Use

Comments or Additional Info:	(200 characters)

Please Prioritize Your Request:	Hurry! I need it ASAP! Please quote prior to my renewal No hurry, just checking

By submitting this quick quote application, you declare that:

the information you are providing is accurate and complete to the best of your knowledge and belief
you have read and agree to our underwriting conditions (Click here to view the conditions)
you have read and agree to our Fraudulent Acts Notice (Click here to view the notice)
you have read and agree to our California Notice (CA businesses only) (Click here to view the CA notice)
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.

You agree:	Yes NoNOTE: This constitutes a digital signature.

ATTENTION: You must click the Submit button to complete this request for a quote.
Please wait for an acknowledgement before closing your browser or window.

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.

Insurance Quick Quote

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

FOR MORE INFORMATION ABOUT THIS INSURANCE PROGRAM, CLICK THE APPROPRIATE JOB TITLE ABOVE.

Information About Your Business

Staff

Percentage of each type of work performed

Current Insurance Information

Rating Information

Limits of Liability / Coverage Information

Licensed Agent / Broker Information

Comments, Priority, Terms of Use

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