Contact Information

We are located at:
5201 Blue Lagoon Dr.
Penthouse Suite,
Miami, FL 33126

Toll-free:
877-674-2366
Tel:
305-444-3692
Fax:
305-460-3692
Email:   MrInsurance@DozaIns.com

Commercial Property and/or Liability

Company Name*
Contact Person*
Telephone*
Fax
E-Mail*
Cell Phone
Business Description

LIABILITY
Amount of Coverage
Location Square Footage
Annual Payroll
Annual Sales
Liquor Sales (if applicable)

PROPERTY
Building Amount
Content Amount
# of Units
# of Floors
Square Footage
Merchandise Type
Monitored Alarm
Fire Sprinklers
Hurricane Coverage Required

OTHER INSURANCE
Signs
If Yes, How Much?
Business Income
How Much?
Workers Comp
Glass Coverage
Food Spoilage
Bonds
Employee Dishonesty
Health
Life
Business Auto

       * Denotes required field