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Welcome To Clear Path Insurance Services.
We Are Here To Help You.
Home
About Us
Auto Insurance
Home Insurance
Business Insurance
Builders’ Risk Insurance
Business Interruption Insurance
Business Owners Package
Commercial Auto Insurance
Commercial Earthquake Insurance
Commercial Trucking Insurance
Commercial Umbrella Insurance
Contractor’s General Liability Insurance
Cyber Security
Cyber Liability Insurance
Directors and Officers Liability Insurance
Employment Practices Liability Insurance (EPLI)
Garage Insurance
General Liability Insurance
Manufacturers Insurance
Medical Malpractice Insurance
Non-Profit Insurance
Product Liability Insurance
Professional Liability (Errors & Omissions) Insurance
Property Insurance
Special Event Insurance
Surety Bonds
Technology Insurance
Used Car Dealers Insurance
Wholesalers & Distributors Insurance
Life Insurance
Term Life Insurance
Whole LIfe Insurance
Universal life Insurance
Cyber Insurance
Bonds
Flood Insurance
Make a Payment
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Welcome To Clear Path Insurance Services.
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Step
1
of 7
BUSINESS INFORMATION
Business Name
*
Established Date
Business Address:
*
Address Line 1
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Contact Person
*
First
Middle
Last
Tell in Operation
Phone Number
*
Email Address
*
Next
BUSINESS DETAILS
Type of Business Entity
*
Select Type of Business Entity
Sole Proprietorship
Partnership
Corporation
LLC
Other
What Kind Of Business?
Industry/Sector
Select Industry/Sector
Agriculture & Farming
Construction & Real Estate
Retail & Wholesale
Transportation & Logistics
Hospitality & Food Services
Professional Services
Healthcare & Social Assistance
Manufacturing & Industrial
Education & Non-Profits
Media & Entertainment
Technology & Telecommunications
Financial Services
Personal Services
Automotive Services
Miscellaneous
Other
Tell Us
Business Description
Years in Operation
Number of Employees
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Next
INSURANCE COVERAGE NEEDS
Types of Coverage Needed (check all that apply)
*
General Liability
Commercial Property
Business Interruption
Workers’ Compensation
Professional Liability (E&O)
Cyber Liability
Commercial Auto
Other
Describe
Current Insurance Coverage (if applicable)
Insurer Name
Policy Expiration Date
Current Premium Amount:
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Next
BUSINESS PREMISES INFORMATION
Building Ownership:
Owned
Leased
Square Footage
Building Age
Security Systems (check all that apply)
Fire Alarms
Sprinkler Systems
Burglar Alarms
Surveillance Cameras
None
Previous
Next
Revenue & Payroll Information
Estimated Annual Revenue
Annual Payroll (for Workers’ Compensation needs)
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Next
Loss History
Any Claims in the Past 5 Years?
Yes
No
Date
MM
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DD
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YYYY
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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1931
1930
1929
1928
1927
1926
1925
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1921
1920
Type of Claim
Select Type of Claim
General Liability Insurance Claims
Commercial Property Insurance Claims
Professional Liability Insurance Claims
Workers’ Compensation Insurance Claims
Business Interruption Insurance Claims
Cyber Liability Insurance Claims
Product Liability Insurance Claims
Commercial Auto Insurance Claims
Directors and Officers (D&O) Insurance Claims
Inland Marine Insurance Claims
Employment Practices Liability Insurance (EPLI) Claims
Business Owner’s Policy (BOP) Claims
Commercial Property Insurance Claims
Professional Liability Insurance Claims
Workers’ Compensation Insurance Claims
Business Interruption Insurance Claims
Cyber Liability Insurance Claims
Product Liability Insurance Claims
Commercial Auto Insurance Claims
Directors and Officers (D&O) Insurance Claims
Inland Marine Insurance Claims
Employment Practices Liability Insurance (EPLI) Claims
Business Owner’s Policy (BOP) Claims
Amount Paid/Reserved:
Select Amount Paid/Reserved:
Paid
Reserved
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Next
Additional Information
Any Hazardous Materials Handled or Stored?
Yes
No
Please specify
Are Company Vehicles Used for Business Purposes?
Yes
No
How Did You Hear About Us?
*
How Did You Hear About Us?
FACEBOOK
INSTAGRAM
TWITTER
LINKEDIN
YOUTUBE
TIKTOK
GOOGLE ADS
REFERENCE
OTHER
Tell Us
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