Retail Bike Shop Insurance Questionnaire

Please fill out and submit the form below to receive a customized insurance quote from MMA.

General Business Description

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Business Location Address*
 
City* State*
 
ZIP Code* Country*
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Mailing address (if different from business address listed above)

Street
 
City State
 
Postal Code Country
Business Type*
What does your business do? Choose All That Apply*
Please describe in 2-5 sentences your experience within the bicycle industry.

Property Insurance

Do you own or lease your building?
If there are other tenants in the building, what other types of occupants are they? (Describe the businesses)
Which of the following have been updated within the last 20 years? (Check all that apply)
Type of Construction
Alarm Type
Sprinklered
If you own other equipment (like demo bikes, trailers, tools, etc.) that you want included with your insurance coverage, please describe and list the value.

General Liability

Please list your current General Liability limits:

Revenues:

Do You Sell eBikes?
Describe any unique or special exposures (Shop rides, other sponsored activities, etc.):

Workers' Compensation

Will owners be included in your workers' compensation insurance? (Note: State rules may apply. Minimum payroll limits may apply per each office included for coverage.)

Auto/Business Auto

Do you own vehicles titled in the business name?*
If YES, please enter YEAR, MAKE, MODEL, VIN, and original cost for any vehicles titled in the business name:
If YES, what are vehicles used for? (Choose All That Apply)
If YES, please enter the following information for ALL drivers: Full Name, Date of Birth, License # and State of Issue

Limits Requested ($)

Deductibles Requested ($): 

Employment Practices Liability

Do you currently have employment practices liability insurance (EPL or EPLI) coverage?*

Employee Benefits Liability

Do you have employee benefits liability insurance coverage?*

Certifications

Are you a certified mechanic?
Are any of your employees certified mechanics?

Special Events

Please list any types of events you host at your shop:

Business History

Have you had any prior claims?*
If YES, please summarize your three-year claim history
How did you learn about us?