Bed and Breakfast Insurance Program Request for Quotation

Although most fields in the following form are optional, by supplying us with detailed information your request will be processed faster and more accurately. All information is kept strictly confidential. For more detailed information, please see our Privacy Statement.

This form is only for use by residents of Ontario, Canada. Yellow indicates a mandatory field.

Contact Information

Name of your Bed and Breakfast:
Address
Contact Person:
Phone No.:
Fax No.:
Email
Web Site:
Present Insurance Company:
Policy No.:
Expiry Date:
Current Premium:
Renewal Premium:
Present Deductible:
Present Auto Insurance Company:
Auto Expiry Date:
	Are you a member of any Bed and Breakfast Associations?

Property Information

Distance to nearest body of water?
	Is your building at a lower elevation than those in the surrounding area?
	Is your property located on a flood plain?
	Do you live on-site?
	If so, year round?
	Seasonal only?
	Do you have permanent borders?
	Do you have any employees?
	Do you operate any other business from this location?
Building Replacement Value?
Any other special coverage required?
	Do you have any woodburning stoves?
	Do you have a fireplace with an airtight insert?
Age of building (years)?
	If over 25 years old, what year was the wiring, heating, plumbing, and roof last updated?

	Fire Hydrant Protected (within 1000 ft.)
	Firehall Protected (within 8 miles)
	Does your company own other property?
If Yes, location of property
	Our package includes $2,000,000 General Liability; is a higher limit required?
If Yes, value required?
Sales per year?
No. of rooms for rent?
	Do you rent any equipment, snowmobiles, bicycles, etc. to others?
	Do you operate a restaurant on premises?
	Is alcohol served on premises?
No. of years in business?
Additional Information:

Discounts / Claims / Complete Request

Discounts
	Claims Free (3 years)
	Age Discount (Over 50)
	Monitored Alarm System
	Mortgage (on your house)
	Non-smokers
Claims
	Any claims in past 6 years?
	For any claims, list date of loss, description, and amount paid out

By checking this box, I indicate that I have read, understood, and AGREE to the terms of McFarlan Rowlands’ Privacy Statement.