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Bike Shops Form

Insured Information

Registered Shop / Business Operating Name *

First Name *

Last Name *

Job Title

Phone *

Email Address *

Business Address *

Apartment, suite, etc

City *

Province *

Postal Code *

Who is your current policy with? *

When is your current policy up for renewal? *

Upload current policy documents for a review and comparison

Drag and Drop (or) Choose Files

Optional

Do you own any other businesses?YesNo

Store Information

Form of Business *

Year Founded *

Business Operations

Projected sales for next fiscal year *

Sales % of Revenue *

Service/Repair % of Revenue *

Rentals % of Revenue

Group Rides % of Revenue

Other % of Revenue

Do you Sell/ Service E-bikes? *YesNo

Are the E-bike batteries and chargers sold UL Certified? *

What precautions are you taking to avoid e-bike fires? *

Please Explain *

Do you sell winter gear? *YesNo

Do you sell water sport gear? *YesNo

Company Website

Insurance Information

Do you purchase all bikes from North American Wholesalers? *YesNo

Number of Employees *

Do you offer Rental Bikes? *YesNo

Number of Rental Bike Customers Annually *

Do you require signed waivers? *YesNo

Upload Waivers

Drag and Drop (or) Choose Files

Do you offer guided rides or coaching? *YesNo

Are your guides and/or coaches certified? *YesNo

Upload Certifications *

Drag and Drop (or) Choose Files

Do you have any US or Foreign Sales? *Yes, US RevenueYes, Foreign RevenueNone

Has the business been involved in any claims in the last 5 years? *YesNo

List Date(s) of Claim Occurrence(s) *

List Date(s) Claim(s) Closed/Paid Out *

Enter details for property or liability loss(es) *

During the past three years has any insurer cancelled or refused to renew? *YesNo

Building Information

Building Type *

Street Address *

Apartment, suite, etc

City *

Province *

Postal Code *

Deductible Requested *

Do you rent or own your building? *RentOwn

Building Age

Square Footage

Building Construction

Does the building have a monitored alarm system?YesNo

Does the building have a sprinkler system?YesNo

Year of most recent electrical updates

Age of Roof

Type of Roof

Age of Heating System

Type of Heating System

Age of Plumbing

Type of Plumbing

Building Limit Requested *

Inventory Limit Requested *

Equipment Limit Requested *Tools and equipment owned by the business. I.e. shop wrenches, work stands, desks

Bailee Requested *Customer property within your building. Insure value of bikes in the shop at any given time

Amount of Commercial General Liability *

Business Interruption RequestedYesNo

Consent

Are you interested in obtaining a quote for your personal home policy or any other business ventures you have?Yes

bicyclebroker.ca is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you. If you consent to us contacting you for this purpose, please tick below to say how you would like us to contact you:

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Consent *

I consent to allow bicyclebroker.ca to store and process the personal information submitted above to provide you the content requested.

I confirm that the information I have provided is true and accurate to the best of my knowledge and understand that it will be used to prepare an insurance quote.

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Call Us

(+1) 877.621.6940 ext 5

Email

contact@bicyclebroker.ca

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Our recommendations can help lower the price of insurance for cycling businesses and everyday bike enthusiasts here across Canada.

British Columbia

997 Seymour St #250
Vancouver, BC V6B 3M1

BC Corporate License – LIC-2024-0049497-R01

Alberta

5005 Dalhousie Dr NW Unit 175 #1441
Calgary, AB T3A 5R8

AB License – K-2200253-11394034-2024

Ontario

605 James St N Suite 200
Hamilton, ON L8L 1J9

ON Corporate License – 6076

contact@bicyclebroker.ca
(+1) 877.621.6940

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Insurance Solutions
Blog
About
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- Careers
Claims
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