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Beach Cities Insurance Services

Contact person:Bryan McDonald
1105 N. Coast Highway
Laguna Beach, CA 92651
Toll Free: 800-205-8400
P.: 949-494-0421
F.: 949-494-0956

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Commercial Auto Insurance Quote Form

Owner's Name:
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Business Name:
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Street Address:
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City:
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State/Province:
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Zip/Postal code:
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Years in business:
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Day Phone:
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Evening Phone:
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Fax:
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E-mail:
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Current Insurance Status:
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Current Insurance Company:
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Expiration date of current policy:
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Is the vehicle registered in your personal name or business/corporation:
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Is your business incorporated?
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Do you have a general liability policy now?
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Are you or your workers covered by workers compensation?
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How many vehicles does the company own?
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Hired/Non-Owned Auto:
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Driver's Full Name:
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Driver's Date of Birth:
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Marital Status:
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Drivers License Number:
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Years Licensed:
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Accident Prevention Course in last 3 yrs?
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Number of Tickets in 3.5 yrs:
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Number of Accidents in 3.5 yrs:
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Model Year:
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Make (ex. Dodge):
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Model (ex. Ram):
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Vehicle Type:
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Vehicle identification number:
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Stated current value of vehicle (required for full coverage):
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Describe any special equipment, its value and serial number (i.e. cranes, lift gates, utility beds, etc...)
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Give a description of the business use or this vehicle:
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Add trailer makes, model, id#, value:
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What is the radius in miles of your operation?
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Annual mileage of vehicle:
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Type of coverage you require:
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Liability Limits:
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Comprehensive Deductible:
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Collision Deductible:
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D.O.T. Filings Required?
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Fax/Attach - Loss Runs and copy of Registration (Fax:949-720-1489)