OCB Quote – Waugh-Dane Insurance Brokers

Get 10% off your business insurance premiums with our program designed specifically for you

1 Basic Information

2 Insurance History

3 Location

4 Operation

Name of Brewery*
Legal Name of Brewery
Name of Principal*
First Last
Phone*
Email*
Enter Email Confirm Email
Website
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is your mailing address the same as your operating address?*
- YES
- NO
Operating Address
Street Address Address Line 2 City Province Postal Code

do you currently have insurance?*
- YES
- NO
Please explain why you do not currently have insurance
i.e - First time insured
Name of current insurance company
Current Policy Number
Current Premium
Policy Renewal Date
Attach a copy of your current policy so we can compare coverage for a more accurate quote
Accepted file types: jpg, gif, png, pdf.
Have you ever had insurance declined or cancelled by an insurance company?*
- YES
- NO
Please explain why your insurance was declined or cancelled
Have you had any insurance claims in the past 5 years?*
- YES
- NO
Please list and explain all claims in the past 5 years

Wall Construction*
Floor Construction*
Roof Construction*
Type of Heat*
Type of Electrical*
Is there a sprinkler system?*
- YES - Full coverage
- YES - Partial coverage
- NO
Number of stories (total for building)*
Square Footage*
Distance to Fire Hydrant*
Distance to Fire Hall*
How many years old is the building?*
Please enter a value between 0 and 200.
When was the last year the following were updated?
Heat Wiring Roof Plumbing
Fire Alarm*
Burglar Alarm*

How many years have you been in business?*
Gross Revenue (per year)*
Any U.S or Foreign sales?*
- YES
- NO
What % of total revenue is from U.S sales?
Please enter a value between 0 and 100.
What % of total revenue is from Foreign sales?
Please enter a value between 0 and 100.