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General Liability Insurance Quote Application
Fill out the below form or give us a call at
833-239-7868
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Nature of the Business
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Apartments
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Contractor
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Office
Restaurant
Retail
Service
Wholesale
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Your Title / Position
Number of Employees
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Years in Business
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Business FEIN #
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Phone Number
Fax Number
Business Type
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Individual
Partnership
LLC
S-Corp
Other
Annual Payroll
Current Payroll
Business Underwriting Information
Type of Operation
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Carpentry
Masonry
Remodelling
Air Conditioning
Appliance Installation - Commercial
Appliance Installation - Household (residential)
Carpentry - Commercial
Carpentry - Handyman
Carpentry - Interior
Carpentry - Residential
Carpet-Upholstery Cleaning
Ceiling/Wall Installation - Metal
Communication Equipment Installation
Concrete Construction
Conduit Construction - Cable/Wire
Debris Removal - Construction Site
Door/Millwork Installation - Metal
Drilling - Water
Driveway/Sidewalk Paving
Drywall
Electrical - Within Buildings
Excavation
Fence Erection
Floor Covering - No Tile
Grading
Heat/AC no LPG
House Furnishing Installation
Janitorial - Commercial
Landscaping Gardening
Masonry
Metal Erection - Decorative
Paint Exterior (3 stories & Under)
Paint Interior
Paperhanging
Plaster/Stucco
Plumbing Commercial
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Prefabricated Building Erection
Refrigeration Equipment Installation/Service
Satellite Dish Installation
Septic Tank Cleaning
Septic Tank Installation
Sewer Mains Construction
Siding and Gutter Installation
Sign Painting
Tile/Stone Installation
Water Mains Construction
Business Type
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LLC
Corporation
Individual
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Describe Typical Projects
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Limits of Liability Coverage Requested
$300 000
$500 000
$1 000 000
$2 000 000
$5 000 000
Currently Insured
Yes
No
Name of carrier
Prior Claims
Yes
No
Claim Type
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Fire / smoke
Water (non-weather related)
Weather-related water
Other weather (wind, hail, hurricane)
Dog bite liability
Other liability (slip / fall and other)
Theft / burglary / vandalism / malicious mischief
All other
Date of Claim
Date Business Started
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Years in Business
Years in Filed
% of Residential Work
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% of Commercial Work
*
Number of Active Owners
Number of Employees
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Annual Employee Payroll
Annual Gross Sales
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Do You Subcontract Work?
Yes
No
Comments
Please upload you current or past year policy declarations page (Allowed format: jpg, png or pdf)
About Us
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Personal Lines
Auto
Life
Home
Renters and Landlords
Flood Insurance
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Watercraft
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Business Owner Policy
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Workers Compensation
Church Insurance
Landlord’s Insurance
Commercial Property
EZ Quote
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