California Auto Insurance

30423 Canwood Street, Unit#112,
Agoura Hills, CA 91301
Call Direct: 1-818-735-4959

 

Auto Insurance

Kelley Insurance Agency offers Automobile Insurance Discounts for Good Drivers, Non-Smokers, Good Students, Senior Drivers, Multiple Car Discount, Auto/Home and Educational Discounts such as 55 alive and Youth Education and Safety courses. We offer Automobile insurance coverage for the State Law Minimum Liability Insurance requirements as well as Full Automobile Coverage Insurance. We can provide insurance for your Cars, Trucks, Motorcycles, Campers, Boats and Sport Cars.


Click here to read more about auto insurance coverage terms.

 

Auto Insurance Quote Form - State of California

Please Complete All Questions On The Form

Step 1: General Information
* Required field
Contact Info:
*First Name: 
*Last Name: 
*Phone: 
Fax: 
Note: For a return quote please leave a fax number if available.
*Email Address: 
Please enter an e-mail address
General Info:
*Marital Status: 
Business Name (Commercial Auto): 
 
Garaging Address: 
*Street:    Street 2: 
*City:    *County: 
*Zip Code: 
 
Mailing Address (if diferent):
Mail address is same as above:
Street:    Street 2: 
City:    County: 
Zip Code: 
Current annual premium: 
Number of drivers: 
Number of vehicles: 
 
Step 2: Driver Information
 
Driver 1 Information:
Name (first and last): 
Sex: 
Age: 
Birth Date: 
Driver License Number: 
Social Security Number: 
Number of minor moving violations in the last 3 years: 
Number of major moving violations in the last 5 years: 
Number of chargeable accidents in the last 3 years: 
Were there any injuries associated with the moving violation(s) or accident(s): 
Occupation: 
Note: Discount awarded to some occupations.
Who is your current insurance company: 
Renewal date: 
(mm/dd/year)
How many years of prior insurance: 
Discounts you may be entitled to are: Multi-Car, Auto/Home, Good Student, Good Driver, Business Professional Group Discount, 55+ Senior Defensive Driver and Youth Education & Safety Discount. 
 
 
Step 3: Vehicle Information
 
Vehicle 1 Information: 
Year: 
Make: 
Model: 
Vehicle Identification Number (VIN#): 
Distance one way to work or school: 
Miles driven per year: 
Auto Seatbelt: 
Airbag: 
4 Wheel Antilock Braking System (ABS): 
LoJack Alarm System: 
List any custom equipment or parts and it's dollar value: 
(example: twin turbo-chargers $1,500, carbon-fiber hood $800)
Type of coverage required: 
Bodily Injury Limits (Required by law): 
Property Damage: 
Uninsured Motorist Coverage: 
Medical Payments: 
Comprehensive Coverage Deductable: 
Collision Coverage Deductable: 
Rental Car Coverage: 
Towing Coverage: 
 
 
Optional Step 4: Additional Drivers
 
Driver 2 Information:
Name (first and last): 
Sex: 
Age: 
Birth Date: 
Driver License Number: 
Social Security Number: 
Number of minor moving violations in the last 3 years: 
Number of major moving violations in the last 5 years: 
Number of chargeable accidents in the last 3 years: 
Were there any injuries associated with the moving violation(s) or accident(s): 
Occupation: 
Note: Discount awarded to some occupations.
Who is your current insurance company: 
Renewal date: 
(mm/dd/year)
How many years of prior insurance: 
Discounts you may be entitled to are: Multi-Car, Auto/Home, Good Student, Good Driver, Business Professional Group Discount, 55+ Senior Defensive Driver and Youth Education & Safety Discount. 
 
 
 
Driver 3 Information:
Name (first and last): 
Sex: 
Age: 
Birth Date: 
Driver License Number: 
Social Security Number: 
Number of minor moving violations in the last 3 years: 
Number of major moving violations in the last 5 years: 
Number of chargeable accidents in the last 3 years: 
Were there any injuries associated with the moving violation(s) or accident(s): 
Occupation: 
Note: Discount awarded to some occupations.
Who is your current insurance company: 
Renewal date: 
(mm/dd/year)
How many years of prior insurance: 
Discounts you may be entitled to are: Multi-Car, Auto/Home, Good Student, Good Driver, Business Professional Group Discount, 55+ Senior Defensive Driver and Youth Education & Safety Discount. 
 
 
 
Driver 4 Information:
Name (first and last): 
Sex: 
Age: 
Birth Date: 
Driver License Number: 
Social Security Number: 
Number of minor moving violations in the last 3 years: 
Number of major moving violations in the last 5 years: 
Number of chargeable accidents in the last 3 years: 
Were there any injuries associated with the moving violation(s) or accident(s): 
Occupation: 
Note: Discount awarded to some occupations.
Who is your current insurance company: 
Renewal date: 
(mm/dd/year)
How many years of prior insurance: 
Discounts you may be entitled to are: Multi-Car, Auto/Home, Good Student, Good Driver, Business Professional Group Discount, 55+ Senior Defensive Driver and Youth Education & Safety Discount. 
Optional Step 5: Additional Vehicles
 
Vehicle 2 Information: 
Year: 
Make: 
Model: 
Vehicle Identification Number (VIN#): 
Distance one way to work or school: 
Miles driven per year: 
Auto Seatbelt: 
Airbag: 
4 Wheel Antilock Braking System (ABS): 
LoJack Alarm System: 
List any custom equipment or parts and it's dollar value: 
(example: twin turbo-chargers $1,500, carbon-fiber hood $800)
Type of coverage required: 
Bodily Injury Limits (Required by law): 
Property Damage: 
Uninsured Motorist Coverage: 
Medical Payments: 
Comprehensive Coverage Deductable: 
Collision Coverage Deductable: 
Rental Car Coverage: 
Towing Coverage: 
 
 
 
Vehicle 3 Information: 
Year: 
Make: 
Model: 
Vehicle Identification Number (VIN#): 
Distance one way to work or school: 
Miles driven per year: 
Auto Seatbelt: 
Airbag: 
4 Wheel Antilock Braking System (ABS): 
LoJack Alarm System: 
List any custom equipment or parts and it's dollar value: 
(example: twin turbo-chargers $1,500, carbon-fiber hood $800)
Type of coverage required: 
Bodily Injury Limits (Required by law): 
Property Damage: 
Uninsured Motorist Coverage: 
Medical Payments: 
Comprehensive Coverage Deductable: 
Collision Coverage Deductable: 
Rental Car Coverage: 
Towing Coverage: 
 
 
 
Vehicle 4 Information: 
Year: 
Make: 
Model: 
Vehicle Identification Number (VIN#): 
Distance one way to work or school: 
Miles driven per year: 
Auto Seatbelt: 
Airbag: 
4 Wheel Antilock Braking System (ABS): 
LoJack Alarm System: 
List any custom equipment or parts and it's dollar value: 
(example: twin turbo-chargers $1,500, carbon-fiber hood $800)
Type of coverage required: 
Bodily Injury Limits (Required by law): 
Property Damage: 
Uninsured Motorist Coverage: 
Medical Payments: 
Comprehensive Coverage Deductable: 
Collision Coverage Deductable: 
Rental Car Coverage: 
Towing Coverage: 
 

How much you can save on your insurance bill?

Request an insurance quote now by filling out the online form.

Service and Sales 1-818-735-4959
M - F:  9 a.m. to 6 p.m.

JKelleyInsurance.com
We sell insurance policies for:

Auto Insurance
Business Insurance
Health Insurance
Home Insurance
Life Insurance

Kelley Insurance Agency, California Insurance Broker
30423 Canwood Street, Unit#112,
Agoura Hills, CA 91301

Office: 818-735-4959
Fax: 818-735-9931
E-Mail Jim Kelley