AAHA Business Owners Package (BOP) Quote Form Survey

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* 5. When should we contact you? Please include preferred time of day, your timezone, and the days of the week which work best.

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* 6. What is the name of your practice?

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* 7. What your practice's legal business name?
Including DBA names.

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* 8. What is your practice's address?

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

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* 9. Who is the practice owner?

Name

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* 10. What is the practice's legal structure?

Sole Proprietor

Corporation

Partnership

LLC

PLLC

Other (please specify)

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* 11. How is the practice classified by animal type?
The Trust classifies wildlife, zoo, and fur-bearing animals as small animal. Cervidae, poultry, and ratites are classified as food animals

Equine Exclusive (90% or more)

Small Animal Exclusive (90% or more)

Predominately Small Animal (70% or more)

Predominately Large/Food Animal (70% or more)

Mixed practice (no dominant species or group)

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* 12. How many years has the practice been in business?

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* 13. What is the practice's estimated total revenue($)?

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* 14. How many employees work at the practice?

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* 15. What is the estimated total value of all building contents?
Computer, medications, equipment, etc.

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* 16. What is the estimated annual payroll ($) for all employees?

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* 17. Does the practice utilize any of the following?

Store semen and/or embryos

Breed animals

Employ mobile practitioner(s)

Practice-owned vehicles

Practice employees use their personal vehicles for business purposes

Offer a 401(k) plan to employees

All doctors at the practice carry an individual professional liability policy through the PLIT-sponsored Program

None of the above

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* 18. Does the practice currently have a package (property/general liability) insurance policy?

Yes

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* 19. Who is the practice's current package policy carrier, the policies expiration date and the current premium?

Name of Carrier

Expiration Date

Current premium?

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* 20. When would you like a new package (property/general liability) policy to begin?

Please list the ideal date

Date

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* 21. What is the physical address of the primary covered location (if different from the previously entered address)?
Please note: buildings located more than 1,000 feet from the primary covered location must be listed separately

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

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* 22. Does the practice own or lease this property?

Own

Lease

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* 23. In the event of a total loss, how much would it cost to rebuild this property?

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* 24. Has the practice made any permanent additions or changes to the property?

Yes

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* 25. What is the dollar ($) value of those additions or changes?

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* 26. Are you interested in purchasing additional liability limits?
typically in the form of an umbrella policy

Yes

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* 27. Does your practice own mobile equipment?

Yes

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* 28. What is the replacement dollar ($) value of your mobile equipment?
In other words, how much would it cost to buy replacements for your mobile equipment if it were destroyed?

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* 29. Please select your preferred deductible amount for the practice's package policy
This is how much the practice would owe before the insurance carrier pays out on a covered claim

$500

$1,000

$2,500

$5,000

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* 30. What is the building's construction type?

Frame

Non-combustible

Modified fire resistive

Mobile home

Jointed masonry

Fire resistive

Masonry non-combustible

Unknown/unsure

Other (please specify)

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* 31. Which most accurately describes the practice's alarm system?

Central station

No alarm

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* 32. Does the building have a basement?

Yes

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* 33. Does the building have multiple, above-ground floors?
ie. levels or stories

Yes

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* 34. How many above-ground floors?

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* 35. What is the square footage of the building?

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* 36. Does another business occupy the building?

Yes

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* 37. What percentage (%) of the building does the practice occupy?

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* 38. In what year was the building constructed?

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* 39. Please list the date of and describe the extent of any renovations to: wiring, heating, plumbing or roof.

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* 40. Do you require property coverage for additional locations/buildings?

Yes

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* 41. Please list all entities who have ownership in the practice's property.

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* 42. Please name loss payees, mortgagees and any additional insureds who should be listed on the policy

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* 43. Please list all claims that have occurred in the past four (4) years.
Include date, description of incident and amount paid

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* 44. Check all that apply regarding your current safety program

New employees participate in an orientation program

Management endorses a no smoking policy

Management has posted emergency evacuation plan in a visible area of each unit

All buildings and parking areas are well lit and there is appropriate emergency lighting

Regular maintenance is performed on all electrical and plumbing within the building

Building has operable smoke detectors that are checked monthly

None of the above

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* 45. Are you interested in any of these other AAHA business insurance program products?

Flood

Commercial Auto

Umbrella & Excess Liability

Employment Practices Liability (EPL)

Directors & Officers Liability

Cyber Liability

Workers' Compensation

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* 1. Your Name:

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* 2. Email Address:

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* 3. Telephone Number:

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* 4. What is your job title/role at the practice?

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* 5. When should we contact you? Please include preferred time of day, your timezone, and the days of the week which work best.

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* 6. What is the name of your practice?

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* 7. What your practice's legal business name? Including DBA names.

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* 8. What is your practice's address?

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* 9. Who is the practice owner?

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* 10. What is the practice's legal structure?

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* 11. How is the practice classified by animal type? The Trust classifies wildlife, zoo, and fur-bearing animals as small animal. Cervidae, poultry, and ratites are classified as food animals

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* 12. How many years has the practice been in business?

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* 13. What is the practice's estimated total revenue($)?

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* 14. How many employees work at the practice?

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* 15. What is the estimated total value of all building contents? Computer, medications, equipment, etc.

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* 16. What is the estimated annual payroll ($) for all employees?

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* 17. Does the practice utilize any of the following?

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* 18. Does the practice currently have a package (property/general liability) insurance policy?

Question Title

* 19. Who is the practice's current package policy carrier, the policies expiration date and the current premium?

Question Title

* 20. When would you like a new package (property/general liability) policy to begin?

Question Title

* 21. What is the physical address of the primary covered location (if different from the previously entered address)? Please note: buildings located more than 1,000 feet from the primary covered location must be listed separately

Question Title

* 22. Does the practice own or lease this property?

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* 23. In the event of a total loss, how much would it cost to rebuild this property?

Question Title

* 24. Has the practice made any permanent additions or changes to the property?

Question Title

* 25. What is the dollar ($) value of those additions or changes?

Question Title

* 26. Are you interested in purchasing additional liability limits? typically in the form of an umbrella policy

Question Title

* 27. Does your practice own mobile equipment?

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* 28. What is the replacement dollar ($) value of your mobile equipment? In other words, how much would it cost to buy replacements for your mobile equipment if it were destroyed?

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* 29. Please select your preferred deductible amount for the practice's package policy This is how much the practice would owe before the insurance carrier pays out on a covered claim

Question Title

* 30. What is the building's construction type?

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* 31. Which most accurately describes the practice's alarm system?

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* 32. Does the building have a basement?

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* 33. Does the building have multiple, above-ground floors? ie. levels or stories

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* 34. How many above-ground floors?

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* 35. What is the square footage of the building?

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* 36. Does another business occupy the building?

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* 37. What percentage (%) of the building does the practice occupy?

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* 38. In what year was the building constructed?

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* 39. Please list the date of and describe the extent of any renovations to: wiring, heating, plumbing or roof.

Question Title

* 40. Do you require property coverage for additional locations/buildings?

* 7. What your practice's legal business name?
Including DBA names.

* 11. How is the practice classified by animal type?
The Trust classifies wildlife, zoo, and fur-bearing animals as small animal. Cervidae, poultry, and ratites are classified as food animals

* 15. What is the estimated total value of all building contents?
Computer, medications, equipment, etc.

* 21. What is the physical address of the primary covered location (if different from the previously entered address)?
Please note: buildings located more than 1,000 feet from the primary covered location must be listed separately

* 26. Are you interested in purchasing additional liability limits?
typically in the form of an umbrella policy

* 28. What is the replacement dollar ($) value of your mobile equipment?
In other words, how much would it cost to buy replacements for your mobile equipment if it were destroyed?

* 29. Please select your preferred deductible amount for the practice's package policy
This is how much the practice would owe before the insurance carrier pays out on a covered claim

* 33. Does the building have multiple, above-ground floors?
ie. levels or stories

* 43. Please list all claims that have occurred in the past four (4) years.
Include date, description of incident and amount paid