(816) 308-4778

Insurance
About
Support
Contact

Insurance
About
Support
Contact

Home > Business Insurance Quote

Business Insurance Quote

Name: Heartland Insurance Agency
Address: 7611 State Line Rd, Kansas City, MO, 64114, US
Telephone: (816) 308-4778

Business Insurance Application

* indicates required fields

Underwriting Summary

Insured Name*

Entity Type

Years in Business

Business Description

Annual Revenue

Number of Employees

Number of Locations

Total Insured Value (TIV)

Current Carrier

Requested Effective Date*

MM slash DD slash YYYY

Requested Coverages

Loss Summary

Risk Snapshot

Sprinklered

Burglar Alarm

Fire Alarm

Subcontractors Used

Producer Notes / Narrative

Applicant Information

Legal Business Name

DBA

FEIN

Years in Business

Entity Type

Website

Primary Contact

First Last

Phone Number*

Email

Mailing address

Street Address Address Line 2 City State ZIP Code

Physical Address

Street Address Address Line 2 City State ZIP Code

Operations Overview

Business Type / Industry

Annual Revenue

Payroll

Number of Employees

Subcontractors %

Years of Industry Experience

States of Operation

Alabama

Alaska

American Samoa

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Guam

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

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Any Hazardous Operations

Work at Heights

Business Description / Operations Narrative

Primary Location Information

Location Address

Street Address Address Line 2 City State ZIP Code

Occupancy

Sq Ft

Year Built

Roof Age

Construction Type

Roof Type

Building Limit

BPP Limit

Business Income

Equipment / Tools

Protection and Security

Sprinklered

Burglar Alarm

Fire Alarm

Any Additional Locations?

Additional Location Notes

Coverage Requested

Select Type of Coverage Requested

General Liability

Property

Business Income

Umbrella

Inland Marine

Cyber

Professional Liability

Equipment / Tools

GL Limit

Umbrella Limit

Products/Completed Ops

Underwriting Questions

Additional Insured Required

Contracts Require Waiver

Any Prior Claims

Any Cancellations / Non-Renewals

Any Bankruptcy History

Any OSHA Violations

Additional Underwriting Notes

Loss History (5 Years)

Loss History

Date

Description

Amount

Status

At Fault?

Please add additional losses by clicking the "+" icon to your right.
If you can attach a copy of your current declarations page, you can skip this step.

Email

This field is for validation purposes and should be left unchanged.

Δ

Insurance

Personal Insurance
Business Insurance
Life Insurance
Health Insurance
Group Benefits

Personal Insurance
Business Insurance
Life Insurance
Health Insurance
Group Benefits

About

About Us
Meet Our Team
Customer Reviews
Insurance Companies
Insurance Blog

About Us
Meet Our Team
Customer Reviews
Insurance Companies
Insurance Blog

Policy Service

Support
Online Billing & Payments
File A Claim
Policy Change Request
Annual Insurance Review

Support
Online Billing & Payments
File A Claim
Policy Change Request
Annual Insurance Review

Ben Javaheri, MBA

President

Contact

Heartland Insurance Agency
7611 State Line Rd
Suite 160
Kansas City, Missouri 64114

Phone: (816) 308-4778
Fax: (816) 393-0366

Office Hours:

Mon-Fri: 9:00am-5:00pm
Sat-Sun: Closed

Map-marker-alt Facebook Yelp Linkedin

Heartland Insurance Agency provides business insurance, manufacturing insurance, malpractice insurance, professional liability insurance, and commercial trucking insurance to all of Missouri, including Kansas City, Overland Park, Leawood, Prairie Village, and Mission. We're licensed in Missouri, Kansas, Colorado, and Oklahoma.

Websites for Insurance (opens in new tab)

Heartland Premier: Because Your Story Deserves Better
Heartland Premier
Because Your Story Deserves Better Than a Standard Policy
Find Out More Here