Free Commercial Insurance Quote — Golden Insurance Agency PC

Get a Free Commercial Insurance Quote

Complete the form below and one of our agents will prepare your personalized quote. Your information is secure and confidential.

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Gross Receipts

Year Business Began

Years in Business

States Operating In

Radius of Operations

Description of Operations

Owners / Officers / Members

Owners / Officers / Members	Title	% of Ownership	Date of Birth

Currently Insured?

Yes No

Current Carrier (if yes)

Lines of Business / Limits Requested

Limit	GL	AUTO	PROP	IM	WC	UM/X’S
100,000
500,000
1,000,000
5,000,000
10,000,000
Other / Unknown

State	Class Code	Payroll / Gross Sales	Class Description

* If Class Code is not available, please include a description of work done.

Additional Coverages Needed

Blanket Additional Insured

Yes No

Blanket Waiver of Subrogation

Yes No

Sudden & Accidental Pollution

Yes No

Underground Resources & Equipment

Yes No

Use the license scanner located below to add drivers. Alternatively, attach a list you have created yourself; likewise, attach the list of vehicles (year, make, model, VIN, value, comprehensive coverage, collision coverage, garaging address) as a document.

🪪 Driver’s License Scanner — Auto-Fill

Take a photo or upload an image of a driver’s license to automatically extract the information.

Reading license data with AI…

✅ License scanned successfully! Review and edit if needed, then click Add Driver.

Last Name

First Name

Date of Birth

License Number

State

CDL?

Drivers List (added from scanner or manually)

Last Name	First Name	Date of Birth	DL Number	State	CDL?

Notes / Additional Vehicle Info

Radius of Operation

Local 0–50 miles Intermediate 51–200 miles Long Distance 201+ miles

Deductible

$500 $1,000 $2,500 $5,000

📎 Upload Vehicle Schedule / Other Documents

📂 Click to browse or drag & drop
Vehicle list, insurance dec pages, etc. (max 10MB each)

Do you work in any of the following states: North Dakota, Ohio, Washington, Wyoming?
If so, additional “Stop Gap” coverage for Employers Liability will be required under the General Liability Policy.

State	Payroll	Class Code	Description	# of Employees

* Please indicate the number of full-time and part-time employees.

Experience Mod

Number of WC Claims in the past 3 years

Effective Date

Prior Carrier

Owner Information

Name	Included / Excluded?	Class Code	Salary

✅

Quote Request Submitted!

Thank you! Your commercial insurance quote request has been received.
An agent from Golden Insurance Agency will review your information and contact you shortly.

Questions? Call us at 1-844-736-1500

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