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Personal Insurance

Business Insurance

Personal Insurance

Home, condo, auto, umbrella, valuables, flood, watercraft, or the full high-net-worth program. Five quick steps. Check what you need and the form only asks what matters. Have your current dec page handy? Upload it and skip half the typing.

Personal Insurance Intake

1. About You
2. Your Home
3. Your Vehicles
4. Umbrella & Valuables
5. Almost Done

Spam protection, skip this field

Full Name

Mobile Number

We text first. No spam calls.

Email Address

ZIP Code

What do you need?

Home

Condo / Co-op

Renters

Auto

Umbrella

Valuables & Collections

Flood

Watercraft

High-Net-Worth Program

Do you currently have insurance for this?

Yes

Some of it

Current carrier(s) (skip if not applicable)

Renewal or effective date you are working toward (skip if not applicable)

Month
January
February
March
April
May
June
July
August
September
October
November
December

Year
1926
1927
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1929
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2045
2046

Upload your current dec page(s) (skip if not applicable)

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Property address (skip if not applicable)

Own or rent? (skip if not applicable)

Own

Rent

Year built (skip if not applicable)

Approximate square footage (skip if not applicable)

Construction (skip if not applicable)

Choose
Frame
Brick / Masonry
Stone
Mixed
Not sure

Roof: year replaced (or age) (skip if not applicable)

Major updates in the last 20 years (skip if not applicable)

Roof

Plumbing

Electrical

Heating / HVAC

None

Not sure

Protection (skip if not applicable)

Central alarm

Smoke detectors

Sprinklers

Gated community

None

Any of these on the premises? (skip if not applicable)

Pool

Trampoline

Dog

Wood stove

Home business

None

Estimated rebuild cost or recent purchase price (skip if not applicable)

Mortgage on the property? (skip if not applicable)

Yes

Any claims in the past 5 years? Briefly describe (or write none) (skip if not applicable)

Drivers: name, date of birth, license state (one per line) (skip if not applicable)

Example: Jane Smith, 4/12/1980, NY

Vehicles: year, make, model (or VIN), owned / financed / leased (one per line) (skip if not applicable)

Approximate annual mileage per vehicle (skip if not applicable)

Accidents, claims, or violations in the past 5 years? (or none) (skip if not applicable)

Current liability limits, if known (skip if not applicable)

Choose
State minimum
100/300
250/500
Higher
Not sure

Desired umbrella limit (skip if not applicable)

Choose
$1M
$2M
$5M
$10M+
Advise me

Underlying exposures (skip if not applicable)

Rental property

Boat / watercraft

Young drivers

Nonprofit board seat

Domestic staff

None

Valuables to schedule: item and approximate value (one per line) (skip if not applicable)

Watercraft: year / make / length / horsepower (skip if not applicable)

Anything else we should know? (skip if not applicable)

Preferred contact

Text me

Email me

Call me

Best time to reach you (skip if not applicable)

Choose
Morning
Midday
Evening

Consent

I agree that ZRM Brokerage may contact me at the number provided, including by text message. Message/data rates may apply. Consent is not a condition of purchase.

Business Insurance

Five quick steps. Tell us what you run and the form adapts: habitational portfolios get building questions, contractors get trade and payroll questions, healthcare gets provider questions. Upload dec pages and loss runs at the end, and Daniel can often quote before the first conversation.

Business Insurance Intake

1. Your Business
2. Size & History
3. About Your Operation
4. Documents
5. Almost Done

Spam protection, skip this field

Legal business name

DBA (if different) (skip if not applicable)

Your name and role

Mobile Number

We text first. No spam calls.

Email Address

Website (skip if not applicable)

Industry

Choose
Habitational / Real Estate
Construction & Trades
Healthcare
Technology / Professional Services
Nonprofit & Religious
Cannabis & Hemp
Hospitality
Financial Services
Manufacturing & Distribution
Retail
Other

Years in business (skip if not applicable)

States where you operate (skip if not applicable)

What coverage do you need?

Property

General Liability

Umbrella / Excess

Workers Comp

Commercial Auto

Cyber

D&O / Management Liability

EPLI

Professional / E&O

Bonds

Full program review

Not sure

Current carrier(s) and approximate total premium (skip if not applicable)

Renewal date (skip if not applicable)

Month
January
February
March
April
May
June
July
August
September
October
November
December

Year
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
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1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
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1997
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1999
2000
2001
2002
2003
2004
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2011
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2013
2014
2015
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2020
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2033
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2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046

Even a rough month helps us time this right.

Annual revenue (skip if not applicable)

Choose
Under $1M
$1M - $5M
$5M - $25M
$25M - $100M
Over $100M

Number of employees (skip if not applicable)

Annual payroll (approximate) (skip if not applicable)

Claims or losses in the past 5 years? Briefly describe (or write none) (skip if not applicable)

Number of buildings / total units (skip if not applicable)

Year(s) built and construction type (skip if not applicable)

Stories (tallest building) (skip if not applicable)

Sprinklered? (skip if not applicable)

Choose
Fully
Partially
No
Not sure

Occupancy (skip if not applicable)

Choose
Rental
Condo
Co-op
HOA
Mixed

Commercial tenants? (roughly what % of square footage) (skip if not applicable)

Total insured value (building values) (skip if not applicable)

Property manager (who?) (skip if not applicable)

Trade(s) / operations (skip if not applicable)

General contractor or subcontractor? (skip if not applicable)

Sub

Both

Percent of work subcontracted (skip if not applicable)

Work in New York / NYC? (skip if not applicable)

Yes

Work above 2 stories? (skip if not applicable)

Yes

Payroll by trade (rough) (skip if not applicable)

Wrap-ups (OCIP/CCIP) involved? (skip if not applicable)

Yes

Sometimes

Bonds needed? (skip if not applicable)

Yes

Facility / practice type (skip if not applicable)

Number of providers (MD/DO/mid-level) (skip if not applicable)

Locations and approximate patient visits per year (skip if not applicable)

Services beyond office visits? (surgery, imaging, telehealth) (skip if not applicable)

Malpractice currently claims-made or occurrence? (skip if not applicable)

Choose
Claims-made
Occurrence
Not sure

What you do (one line) (skip if not applicable)

Largest client contract value (skip if not applicable)

Do contracts require specific insurance limits? (skip if not applicable)

Yes

Not sure

Revenue % from largest client (skip if not applicable)

Mission (one line) (skip if not applicable)

Annual budget (skip if not applicable)

Employees vs volunteers (counts) (skip if not applicable)

Work with minors or vulnerable populations? (skip if not applicable)

Yes

Special events per year / board size (skip if not applicable)

License type(s) and states (skip if not applicable)

Operations split (% cultivation / processing / retail / distribution) (skip if not applicable)

Armed security or significant cash on site? (skip if not applicable)

Yes

Concept and number of locations (skip if not applicable)

Annual sales / liquor % of sales (skip if not applicable)

Live entertainment or late-night hours? (skip if not applicable)

Yes

Seating capacity (skip if not applicable)

Firm type (RIA / BD / bank / PE-VC / family office) (skip if not applicable)

AUM or assets (skip if not applicable)

Licensed professionals / registrations (skip if not applicable)

What you make or sell (one line) (skip if not applicable)

Annual sales (skip if not applicable)

Products sold to consumers? (skip if not applicable)

Yes

Property values (building / contents / stock) (skip if not applicable)

Current dec pages / policy schedule (skip if not applicable)

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Loss runs (up to 5 years) (skip if not applicable)

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Your current broker or carrier must provide these on request. We can show you how to ask.

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Anything else useful (SOV, driver list, payroll by class) (skip if not applicable)

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Target effective date (skip if not applicable)

Month
January
February
March
April
May
June
July
August
September
October
November
December

Year
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046

What is driving this? (skip if not applicable)

Renewal coming up

Premium jumped

Non-renewed

New venture

Claim experience

Just comparing

Anything else we should know? (skip if not applicable)

Preferred contact

Text me

Email me

Call me

Consent

I agree that ZRM Brokerage may contact me at the number provided, including by text message. Message/data rates may apply. Consent is not a condition of purchase.

What happens after you hit send?

Your details go straight to the principal, not a call center. You get a text within one business day with either a quote, a short list of follow-up questions, or an honest “your current program is worth keeping.”

Start Your Quote

Personal Insurance

Personal Insurance Intake

Business Insurance

Business Insurance Intake

What happens after you hit send?

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