Product Liability Insurance Quote Online

What is Product Liability InsuranceProduct Liability Insurance covers the liability of the manufacturer or supplier of goods for damage caused by their products.

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Sample QuoteThis is just a SAMPLE INSURANCE QUOTE based solely on the information provided in a SAMPLE application. This quotation may not offer all of the coverages, terms or endorsements that applicable to your business operations, or to what you requested on your actual application. Please call or email us for an explanation of the terms, coverages and endorsements that the insurer has offered, and how they may differ from what you applied.

Insurance GlossaryCovers liability incurred by a manufacturer, importer, wholesaler, retailer or distributor because of injury or property damage resulting from the use of their product.

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Product Liability Insurance

Please fill out an application bellow to receive insurance quotes from multiple carriers. Your information will never be shared, leased, sold, or otherwise disclosed to any third party. For more information see Terms of Service | Privacy Policy. Coverage is available in California and Colorado only.

Business Name/DBA:*

List the names of all predecessor organizations of the Applicant

Date Business Established:*

Business Entity:*

Business Website: (please provide if you have one, to expedate the underwriting process)

Physical Address:*

Mailing Address if different from physical address:

Contact Phone:*

Contact Email:*

Fax:

Contact Person First and Last Name:*

When do you want your insurance to start?*

Provide details if the Applicant controlled by, owned by, or commonly owned, affiliated or associated with any other organization:

Description of Business Operations*

Specified Products and Completed Operations

	Product 1*	Product 2	Product 3

Applicant Acts As:*(please check all that apply)
Manufacturer
Wholesaler
Retailer
Importer
Manufacturer's Rep.
Number of Years:*
% of Gross Sales:*
Provide Installations
Repair & Service
Product Sold To:*(please check all that apply)
Manufacturer
Wholesaler
Retailer
Importer
Manufacturer's Rep

Check here if you distribute more products:

Are any of your products or services used in connection with aircraft/missiles/aerospace?*

Yes No

Estimated annual gross receipts for the next 12 month: *

Annual gross receipts for the last twelve month: * (enter 0 if not applicable)

First prior year annual gross sales: * (enter 0 if not applicable)

Check here if presently considering any change in the mix of products including adding new products or services for the coming year:

Check here if discontinued or is it considering discontinuing any product or service listed above:

If there are any products or ingredients or components thereof, originate from outside of the United States, please list countries of origin and name of each organization manufacturer, distributor or supplier:

If other manufacture, assemble, package or install products under the Applicant's name or label, provide the name(s) and address(es) of contract manufacturer(s):

Check here if you manufacture, assemble, package or install products for others under their name of label?

Yes No

If you have a quality control and testing procedure, how long does the Applicant keep quality control and testing records?

Can you identify its product(s) from those of competitors?*

Yes No

Do all records show to whom and the date each product was sold?*

Yes No

Do you require certificates of insurance evidencing Products Liability Insurance from suppliers?*

Yes No

Who designs the Applicant's products? *

Are products designed reviewed, tested and verified by others?*

Yes No

Check here if ever recalled or is it considering recalling any products:

Check here if any of your products or ingredients or components thereof, ever been the subject of any investigation, enforcement action, or notice of violation of any kind by any governmental, quasi-governmental, administrative regulatory or oversight body:

Insurance Information

Coverage/Limits Desired:*

Deductible:* (The Company does not guarantee to offer any of the above limits and/or deductibles)

Check here if any prior insurance cancelled or non renewed:

Check here if you currently have insurance:

Check here if you want to receive quote for Workers Compensation Insurance:

Notice to Applicants:Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and civil penalties.

	Duties or Classification	# of FT empl.	# of PT empl.	Annual Gross Payroll
1
2
3
4

Any prior coverage declined, cancelled, non-renewed in last 3 years?	Yes No
Are you engaged in any other type of business?	Yes No
Do you have any employees under 16 or over 60 years of age	Yes No
Do you have any volunteers	Yes No
What are the hours of operation?
Any work performed underground or above 15 feet?	Yes No
Are physicals required after offers of employment are made?	Yes No
If employees travel out of state, provide details:
Do you provide benefits to all employees eligible?	Yes No
Do you provide health insurance for your employees?	Yes No
Any employees with physical handicaps?	Yes No
If the owners wish to be covered by workers comp. insurance, provide the name of each owner, duties, and payroll
Do you use any subcontractors?	Yes No
Are subcontractors allowed to work without providing you with a certificate of insurance where you're named as an additional insured?	Yes No
How many years of experience owners have in this field?
Do you have a safety coordinator?	Yes No
Describe your formal safety program
How often safety meetings conducted?
Describe the unique safety measures in place, if any:
What types of job training are in place?
Do you maintain your facilities and equipment?	Yes No
How do you address housekeeping, industrial hygiene & ergonomics issues?
If applicable, are all machines equipped with safety guards?	Yes No
Is there an aircraft or watercraft exposure?	Yes No
Is there any athletic sponsorship?	Yes No
Do employees drive their vehicles on the job?	Yes No
Do you check the driving record of your employees?	Yes No

	Product 4	Product 5	Product 6

Applicant Acts As:
Manufacturer
Wholesaler
Retailer
Importer
Manufacturer's Rep.
Number of Years
% of Gross Sales
Provide Installations
Repair & Service
Product Sold To:
Manufacturer
Wholesaler
Retailer
Importer
Manufacturer's Rep

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Product Liability Insurance