Get a Pollution Quote - New Empire Insurance Services

Get an environmental quote.

Getting an environmental quote has never been easier. Answer a few simple questions below and receive an indication. If you like it, we move on. If not, we hope you come back with your next risk.

Recover Online Indication

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Step 1 of 6

16%

First Name*

Last Name*

Email*

Agency Name*

Applicant Name*

Location Address*

City*

State*

Zip Code*

Building Square Footage*

Number of Stories

Year Constructed

Is there an oil tank at this location?*

What is the gallon capacity of the tank?

Is the tank underground?

Is the underground tank more than 25 years old?

Please note, underground tanks more than 25 years old are NOT eligible for coverage.

Based on the information you have provided
your indication for environmental insurance is only
$1,460 annually

Based on the information you have provided
your indication for environmental insurance is only
$1,710 annually

Based on the information you have provided
your indication for environmental insurance is only
$1,460 annually

Based on the information you have provided
your indication for environmental insurance is only
$1,905 annually

Based on the information you have provided
your indication for environmental insurance is only
$2,155 annually

Based on the information you have provided
your indication for environmental insurance is only
$1,905 annually

Based on the information you have provided
your indication for environmental insurance is only
$2,420 annually

Based on the information you have provided
your indication for environmental insurance is only
$2,670 annually

Based on the information you have provided
your indication for environmental insurance is only
$2,420 annually

Based on the information you have provided we need to refer this to one of our underwriters.

To proceed with the quote, complete an online application.

Agency Name*

Submitted By*

Agency Address*

City*

State*

Zip Code*

Please describe the nature of the risk (check all that apply)*

Apartment

Co-op/Condo

Commercial Occupancy

Swimming Pools

Golf Course

Warehouse

Manufacturing

Farmland

Marina

Effective Date:*

MM slash DD slash YYYY

Who is the commercial tenant?

Is there a Property Manager?*

Yes

Property Manager:

Property Manager Mailing Address:

Has the insured ever had, or has there been at this location, a pollution claim, incident, or occurence of any kind, whether or not insured?*

Yes

If yes, please explain:

Are you aware of any circumstances which may reasonably be expected to give rise to a claim or generate a request for coverage under this policy?*

Yes

If yes, please explain:

Within the past five years have any claims been made or legal actions (including any regulatory proceedings) been brought against the applicant or any other party to the proposed insurance?*

Yes

If yes, please explain:

Has there been any past, present or planned remediation, monitoring or sampling to investigate potential contamination at any covered location(s) listed above?*

Yes

If yes, please explain:

Are there any known plans for future development, improvement, demolition or plans for changes in site operations at any of the covered location(s) listed above?*

Yes

If yes, please explain:

OIL TANK INFORMATION

Age of oil tank*

Length of piping*

Construction of piping*

Is the AST located on the ground?*

Yes

If no, where

Fuel type (2, 4, 6)*

Bulk petroleum storage ID#

Are there any plans to remove the tank(s) during the next two years?*

Yes

If yes, please explain:

Is there a leak detection system?*

Yes

Is there a corrosion protection?*

Yes

Are any other tanks in use at this location?*

Yes

If yes, please select the type of tank:*

AST

UST

What is the gallon capacity of the tank?*

Fuel type (2, 4, 6)*

Age of oil tank?*

Length of piping?

Construction of piping?

Bulk petroleum storage ID #

LEAD & ASBESTOS

Are you seeking coverage for Lead & Asbestos?*

Yes

Is there any lead-based paint or asbestos containing material (ACM) present in the building at covered location(s) that you are aware of?*

Yes

Has the building ever been inspected for lead-based paint or ACM?*

Yes

Have any health concerns been raised, or any claims been made, with respect to the presence of lead-based paint, asbestos or asbestos containing materials at any of the buildings located at the proposed covered location(s)?*

Yes

If lead-based paint and/or ACM are present or suspected in the building at covered location(s), are qualified contractors used when addressing any management issues?*

Yes

Has a lead-based paint or ACM disclosure been provided to any building tenants at any covered location(s) indicating that lead-based paint may be present in the building (typical for all buildings constructed prior to 1978)?*

Yes

FRAUD WARNINGS

NOTICE TO NEW YORK APPLICANTS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime, and shall be also subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

THE APPLICATION REPRESENTS THAT THE ABOVE STATEMENTS AND FACTS ARE TRUE AND THAT NO MATERIAL FACTS HAVE BEEN SUPPRESSED OR MISSTATED.

COMPLETION OF THIS FORM DOES NOT BIND COVERAGE. APPLICANT’S ACCEPTANCE OF THE COMPANY’S QUOTATION IS REQUIRED PRIOR TO BINDING COVERAGE AND POLICY ISSUANCE.

ALL WRITTEN STATEMENTS AND MATERIALS FURNISHED TO THE COMPANY IN CONJUNCTION WITH THIS APPLICATION ARE HEREBY INCORPORATED BY REFERENCE INTO THIS APPLICATION AND MADE A PART HEREOF.

Agent Name*

Date*

MM slash DD slash YYYY

This is not a quote but rather a general indication based on information you have provided. Please complete and submit an application for a full quote.

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Get an environmental quote.

Recover Online Indication

OIL TANK INFORMATION

LEAD & ASBESTOS

FRAUD WARNINGS

Join the hundreds of agents who ❤️ our programs

Craig S.

Allan Twitty

Andrea Cornell

Sindy Durkovic

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