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On-Line Contractor
General Liability Quote Form
One Simple Form - takes only 2-3 Minutes!
GENERAL LIABILITY
EASY PAYMENT PLANS!
LOW RATES!
FAST QUOTES!
PROMPT CERTICATES!
WE WILL RATE AS MANY AS 42 QUALITY CARRIERS TO GET YOU THE BEST QUOTE! HERE ARE SOME OF THE RECENT ACCOUNTS WE HAVE PLACED:
Heat/AC Contractor $1 Million Liability,
ONLY $1167 A YEAR
Plumbing Contractor $2 Million Liability,
ONLY $1679 A YEAR
Masonry Contractor $2 Million Liability,
ONLY $1526 A YEAR
Roofing Contractor $1 Million Liability,
ONLY $3694 A YEAR
Your Name:
BUSINESS Name:
Mailing Address:
City:
State:
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California
Colorado
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Louisiana
Nevada
Texas
Zip/Postal:
E-Mail (REQUIRED):
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for accuracy:
Phone:
Fax (optional):
Business Underwriting Information
Type of operation:
Describe operations in detail:
License class:
License Number:
Limit of Liability
Coverage Requested?
$300,000
$500,000
$1 Million
Currently Insured?
Yes
No
Name of Carrier & how long insured?
Prior Claims?
Yes
No
Describe claims in detail:
Years in business:
Years experience in field:
Percentage of work residential:
Percentage of work commercial:
Number of Active Owners:
Number of Employees:
0
1
2
3+
Annual Employee Payroll: $
Annual Gross Sales: $
Do you subcontract work?
Yes
No
(If yes, what percentage of your work
is subbed, and what kind of work?)
Do you do foundation work?
Yes
No
Do you work on condos?
Yes
No
Employees paid over $18/hour?
Yes
No
Do you have a safety program?
Yes
No
Comments/Remarks:
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