Home Contact us TechAdvantage® Equipment Breakdown Quotation Request 0:00 0:00 Insured: Date: Mailing Address: Contact Name: Contact Phone no.: May HSB Canada Contact Insured? Yes No Address of location: Occupancy: P.D. Values ($): enter dollar amount Building ($): enter dollar amount Equipment ($): enter dollar amount Office ($): enter dollar amount EDP ($): enter dollar amount Stock ($): enter dollar amount Tenant Improvements ($): enter dollar amount Other ($): enter dollar amount B.I. values: enter dollar amount Prospect information: Loss history (last 5 years): Yes No If Yes, date of loss: Object: Amount paid: enter dollar amount Existing broker: Existing Equipment Breakdown Carrier: Existing Property Carrier: Property damage: limit of liability enter dollar amount Property damage: Deductible/Waiting period Business interruption: Limit of liability Business interruption: Deductible/Waiting period Loss of profits: Limit of liability Loss of profits: Deductible/Waiting period Rent/rental value: Limit of liability Rent/rental value: Deductible/Waiting period Gross earnings: Limit of liability Gross earnings: Deductible/Waiting period Actual loss sustained: Limit of liability Actual loss sustained: Deductible/Waiting period Other: Limit of liability Other: Deductible/Waiting period Extra expense: Limit of liability Extra Expense: Deductible/Waiting period Spoilage: Limit of liability Spoilage: Deductible/Waiting period Product stored: Automatic coverage: By-Laws, Demolition and Increased Cost of Construction: Errors and Omissions: Hazardous Substance: Water Damage: Ammonia Contamination: Professional Fees: Expediting Expense: Brands and Labels: Public Relations: Green Coverage: Data Restoration: Contingent Business Interruption**: Off Premises Transportable Objects: Service Interruption, includes Cloud Coverage**: Civil Authority or Denial of Access: Quote includes: Electronic Equipment Data Compromise/IDR Production Machinery Existing Policy No: Anniversary Date: Date Quotation Required: Quotation required by: Broker Insurance Co. Name: City: Contact person: Phone no.: Fax no.: E-mail: * Additional Information: Submit Thank you for your request. A representative from HSB Canada will contact you within 24 hours. Thank you for your request. A representative from HSB Canada will contact you within 24 hours. Contact us
