Tell Us About

Your Store

Contact Our Insurance Agents

No matter what insurance products you need, you can trust our company to provide you with the best coverage for your business. Discuss your requirements with us. Our insurance agents will gladly walk you through your options depending on your needs and budget. Book an appointment today! Call us for more details about our insurance company and how we can help you.

General Information

Complete Legal Name
Street Address
Phone (required)
Email (required)
Years in business

Package Insurance

Name of current insurance company
Expiration date
Building Coverage
Contents Coverage
Square footage of space you occupy
Square footage of your building
Year built
If built before 1990 last updated
# of stories
Sprinkler system in building
Yes No
Central station alarm
Yes No
Refrigeration maintenance agreement
Yes No
Value of unattached sign
Does your store do any cooking?
Yes No
If yes, is there an ansul system
Yes No
Total estimated annual sales
Total sales of privately labeled/relabeled sales
Total value of point of sale system
Total value of product stored in refrigeration
Liquor Sales
Is alcohol served on premises?
Yes No

Is there a restaurant located in the entire building you occupy?
Yes No
Are there residential apartments located in your building?
Yes No
Are you involved in any other type of business?
Yes No

Building Construction


Yes No

Workers Comp

Name of current insurance company
Expiration date

Cannot Quote WC Without the FEIN


Experince Mod

Exec. officers included
 Yes  No

Class / Code Payroll
Store / 8017
Store / 8006

Clerical / 8810



Number of property and liability claims in last 5 years

Number of workers comp claims in last 5 years


Completed by


If you have any questions please contact Dane Meisler
Phone - 203-676-0971

Request a Quick Insurance Quote Today!

Keep your business financially secure regardless of the circumstances with the help of Kapatoes Insurance Services; The Health Food Insurance Group in Warwick, RI and Lake Mary, FL. Choose our insurance products, and let us provide you with outstanding solutions you won’t find elsewhere. Fill out our form to get an insurance quote today!

Business Group Having Informal Meeting