General Liability

~ Under 5 Minute Quote Worksheet

 
Company Name:
Address:
Phone:
          Fax:
E-mail:
Contact:
Contact Phone:
   

 Have you had any claims made in the last 4 years?

 Yes No
Type of business:
Annual Sales/receipts:
Business personal property value (i.e. computers, etc.):
$
Build outs Replacement Cost:
Year office building was built (estimate OK):
Square footage of space to be insured (estimate OK):
Sprinklered?
Yes No
Other locations?
Yes No
If yes, other addresses:
Current Company:
Effective Date:
   
Your quick-quote/estimate will include:
Business Liability, Business Personal Property (contents), Tenant Improvements (Build-Outs), Non-Owned and Hired Auto Liability, Employee Dishonesty plus other coverages and limits to be outlined on our quick-quote/estimate.
   

Date: 

Name and Title:
   
Serving The Real Estate Community Since 1988
Errors & Omissions, General Liability, Workers Compensation, Health & Dental Insurance
CA License #OC10853