Law Offices of Bradford & Barthel, LLP Referral Partner

Law Offices of Bradford & Barthel, LLP and 360 Risk Partners have partnered to offer B&B employees access to Personal Auto Umbrella Insurance to meet the requirements of their employment contract. Start your insurance quote below, and our expert agents at 360 Risk Partners will reach out shortly with your quotes and to discuss your options.

www.bradfordbarthel.com

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Date you want the policy to start*

Primary Applicant

Primary Applicant Name*

First Last

Email Address*

Primary Phone*

Primary Phone Type

Secondary Phone

Secondary Phone Type

Occupation

Co-Applicant

Co-Applicant Name

First Last

Employer Name

Employer Address

Occupation

If self-employed, please describe

If additional household members, please describe each person's name and occupation.

Primary Policy Information

For each type of current policy you have, please enter the policy information.

Current Policy: Auto

Auto Policy

Auto Insurance: Company Name*

Auto Insurance: Policy Number*

Auto Insurance: Effective Date*

Auto Insurance: Liability Limit*

Auto Insurance: Property Damage Limit*

Current Policy: Homeowners

Homeowners Policy

Home Insurance: Company Name*

Home Insurance: Policy Number*

Home Insurance: Effective Date*

Home Insurance: Personal Liability Limit*

Current Policy: Dwelling Fire

Dwelling Fire Policy Including Rentals

Dwelling Fire Insurance: Company Name*

Dwelling Fire Insurance: Policy Number*

Dwelling Fire Insurance: Effective Date*

Dwelling Fire Insurance: Personal Liability Limit*

Current Policy: Watercraft

Watercraft Policy

Watercraft Insurance: Company Name*

Watercraft Insurance: Policy Number*

Watercraft Insurance: Effective Date*

Watercraft Insurance: Liability Limit*

Current Policy: RV

Recreational Vehicle Policy

RV Insurance: Company Name*

RV Insurance: Policy Number*

RV Insurance: Effective Date*

RV Insurance: Liability Limit*

RV Insurance: Property Damage Limit*

Current Policy: Farm

Farm Policy

Farm Insurance: Company Name*

Farm Insurance: Policy Number*

Farm Insurance: Effective Date*

Farm Insurance: Liability Limit*

Current Policy: Umbrella

Underlying Umbrella Policy

Umbrella Insurance: Company Name*

Umbrella Insurance: Policy Number*

Umbrella Insurance: Effective Date*

Umbrella Insurance: Liability Limit*

Autos and Recreational Vehicles Information

Please list all autos owned, or leased for regular use including motorcycles, snowmobiles, and motorhomes.

List of Vehicles

Year	Make	Model	Actions

There are no Vehicles.

Do any vehicles have any attached special equipment?

Yes

Explain vehicle and attached special equipment

Property Information

Please list all properties owned, or leased including residences, buildings, farms, vacant land, etc.

List of Properties

Property Address	Occupanncy / Usage	Actions

There are no Properties.

Watercraft Information

Please list all watercraft owned, leased, or chartered.

List of Watercraft

Year	Manufacturer	Model	Length	Actions

There are no Watercrafts.

Operators / Drivers

List all members of household, including Primary Applicant and Co-Applicant that operate any vehicle, watercraft, or motorhome, motorcycle, etc.

List of Operators

Name	Date of Birth	Drivers License Number	Drivers License State	Actions

There are no Operators.

Do any drivers have a physical impairment?

Yes

Explain driver and impairment

General Information

Do you employ any residence employees?

Yes

Do you, or any tenant, have any animals or exotic pets?

Yes

Describe animal types(s), breed(s), and if animal(s) have any bite history

Any aircraft owned, leased, or chartered for regular use?

Yes

Any real estate, vehicles, watercraft, or aircraft used commercially or for business purposes?

Yes

Any real estate, vehicles, watercraft, or aircraft Not covered by primary policies?

Yes

Do you engage in any type of farming operation?

Yes

Do you hold any non-compensated positions?

Yes

Any non-owned property in your care, custody, or control?

Yes

Any business activities included in your primary policies?

Yes

Does any primary policy have reduced limits of liability, or eliminate coverage for specific exposures?

Yes

Any pending litigation, court proceedings, or judgements?

Yes

Any coverage declines, cancelled, or non-renewed during the last five (5) years?

Yes

Reason declined, cancelled, or non-renewed

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Law Offices of Bradford & Barthel, LLP

Primary Applicant

Co-Applicant

Primary Policy Information

Autos and Recreational Vehicles Information

Property Information

Watercraft Information

Operators / Drivers

General Information

Get Insurance

Resources

For Clients

Start Your Quotes

Make a selection below.

Workers Compensation

Business Insurance

Contractors Insurance

Don’t have an account?

Law Offices of Bradford & Barthel, LLP

Primary Applicant

Co-Applicant

Primary Policy Information

Autos and Recreational Vehicles Information

Property Information

Watercraft Information

Operators / Drivers

General Information

Get Insurance

Resources

For Clients

Start Your Quotes

Make a selection below.

Workers Compensation

Business Insurance

Contractors Insurance

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Don’t have an account?