America's #1 nationally brokered Bed and Breakfast / Country Inn Insurance

Thank you for using our online quote form.

There are three forms to complete. (File Information Form, Premise Form (complete 1 for each premise to be submitted), and Building Forms (complete 1 for each building to be submitted).

Enter a Tracking Number and reuse it on each form. When you have completed form #1 (complete all questions) click on "Continue to Form #2 - Premise Info" to move to a premise form.  Complete the premise form and click "Need Additional Form" if you have another premise to record (repeat as necessary to record all premises) or click on "Continue to Form #3 - Bldg. Info" to move to building forms.  Complete one building page for each building to be quoted.  After completing the form the first time, click "Need Additional Bldg. Form" for an additional building form if you have more than one building or click "Send Quote Request"  Once received, we will provide a quote based on the information you have submitted. We hope your experience is a good one, and please let us know how we might make improvements.

  1. Please provide your agency contact information :

    First Name
    Last Name
    Organization
    Street Address
    Address (cont.)
    City
    State
    Zip/Postal Code
    Country
    Work Phone
    FAX
    E-mail
    URL

  2. Inland Marine Required?

    Yes No

  3. Work Comp Required?

    Yes - if yes, enter FEIN number or S.S. number:

  4. No

  5. Earthquake Required?

    Yes No

  6. Deductible ($1,000 required for restaurant) :


  7. Trade name of Inn :


  8. Name each individual with insurable interest (NA if corporate) :


  9. Enter legal name if applicable :


  10. Corporate name :


  11. Building owners if applicable:


  12. Contact name at Inn :

    First Name
    Last Name
    Work Phone

  13. Entity :


  14. Does the named insured (individual) reside at an insured premise ?

    Yes No

  15. Is the named insured involved in any other business ?

    Yes No

  16. If yes please describe :

  17. Mailing address of insured :

    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country

  18. Mortgagee(s) ?

    Yes No

  19. If yes please fill out the following information :

    Name
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country

  20. Loan Number :


  21. Loss payee(s) ?

    Yes No

  22. If yes please fill in the information below :

    Name
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country

  23. Additional named insured ?

    Yes No

  24. If yes please fill in the information below :

    Name
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country

  25. If coastal state, distance to ocean (mi) :

  26. Is breakfast provided on premise? (mandatory)

    Yes No

  27. Does the location have a boiler ?

    Yes No

  28. If yes does the boiler produce pressure and steam heat ?

    Yes No

  29. Date current operations started :

    -- mm/dd/yy

  30. Number of employees :


  31. Types of operations involved at this location (all that apply) :

    Bed and Breakfast
    Restaurant
    Catering
    Gift Shop
    Other

  32. Is premise occupied year around ?

    Yes No

  33. If no are buildings winterized ?

    Yes No

  34. Is the Inn operational year around ?

    Yes No

  35. If no to above, length of operations during the course of a year (3 mo. minimum) :


  36. What type of fire station ?


  37. Distance to fire station (mi) :


  38. Other forms of fire control (select all that apply) :

    Pool
    Pond / Lake
    Other

  39. If yes to pool, pond / lake is there a diving board ?

    Yes No

  40. If yes to pool, pond / lake, is there a sign "Swim at Own Risk?"

    Yes No

  41. Closest fire hydrant (yd) :


  42. Number of guestrooms in all buildings :


  43. Number of long term rentals in all buildings:


  44. Are there smoke alarms in all bedrooms and corridors ? (mandatory)

    Yes No

  45. If yes, type of connection used to power smoke alarms :


  46. Are temporary space heaters used ?

    Yes No

  47. If yes, type of heat source :


  48. Automatic emergency lighting in each guestroom ? (mandatory)

    Yes No

  49. Is there any operable knob and tube or aluminum wiring ?

    Yes No

  50. Are wood burning fireplaces / stoves used ?

    Yes No

  51. If yes, are all chimneys and flues cleaned annually ?

    Yes No

  52. Total value of contents in all buildings (non scheduled items) including personal if insured lives in building :


  53. Are there items to be scheduled (prior to binding an appraisal will be required) ?

    Yes No

  54. Value of furs to be scheduled:


  55. Value of jewels to be scheduled:


  56. Value of fine art to be scheduled:

  57. Do you have a 3rd party list and appraisal? (mandatory)

    Yes No

  58. Gross restaurant receipts :


  59. Gross room receipts :


  60. Gross liquor receipts :


  61. Other gross receipts :


  62. Total receipts :


  63. Any claims in the last three years ?

    Yes No

  64. If yes, please explain :


  65. Carrier name and expiration date :


  66. Has prior insurance been (check all that apply) :

    Declined
    Canceled
    Non-renewed

  67. If yes please explain :


  68. Are bicycles provided to guests ?

    Yes No

  69. If yes are helmets provided ?

    Yes No

  70. Is a waiver signed, (a copy of the waiver must be supplied prior to binding) ?

    Yes No

  71. Are boats available to guests ?

    Yes No

  72. If yes, types of craft (all that apply) :

    Canoe
    Kayak
    Pontoon
    Paddle
    Motorized with greater than 10 HP
    Sail boat larger than 18 feet

  73. Are PDF's provided ?

    Yes No

  74. Is a waiver signed, (a copy of the waiver must be supplied prior to binding) ?

    Yes No

  75. Are cross country skis provided to guests ?

    Yes No

  76. If yes, are helmets provided ?

    Yes No

  77. Is a waiver signed, (a copy of the waiver must be supplied prior to binding) ?

    Yes No

  78. Are any of the above amenities offered to the public, (non-guests) ?

    Yes No

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