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? YesNo
    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? YesNo
    Other locations? YesNo
    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:

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      3697 Mt. Diablo Blvd Suite 100,
      Lafayette, CA 94549
      CA Lic# OB29370
      (925) 412-3861