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Contractor's Liability Insurance!

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On-Line Contractor
General Liability Quote Form
One Simple Form - takes only 2-3 Minutes!

Your Name:
Mailing Address:
State: (Must be Texas)
E-Mail again for accuracy:
Fax (optional):
Business Underwriting Information
Type of operation:
Describe operations in detail:
License class:
License Number:
Limit of Liability
Coverage Requested?
$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?)
Amount Paid Annually to Sub-Contractors Who Carry Their Own Insurance: $
Amount Paid Annually to Sub-Contractors Who Do NOT Carry Their Own Insurance: $
Do you do foundation work? Yes No
Do you work on condos? Yes No
Do you do NEW Residential
Tract home work?
Yes No
Do you have a safety program? Yes No

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