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: