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Contractors Insurance Quote

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Contractors Insurance Quote

Please complete the following general questionnaire. Our professional staff will contact you regarding your quote, or call us at (800) 779-PARS.

Your Personal Data
Insured's Name
Phone Number
Fax Number
Email Address
Insured is
Business Name
Street Address
City
Zip Code CA
Number of Owners
Number of Partners
Number of Full-Time Employees
Number of Part-Time Employees
Employees Payroll
What Percentage of work is subcontracted %
Estimated Receipts Current Year
Estimated Receipts Next Year

Loss History
Prior carrier and loss history for the past three years
From Mo. Yr. To Mo. Yr.
Company Name
Policy number
Cancelled or Non-renewed
Reason

Nature of Business/Description of Operation:
 

Desired Coverages
 
Comprehensive General Liability  
Coverage Per Occurrence 00,000
Coverage Aggregate 00,000
Property Coverage
Cargo Coverage (if required)
Hired (if required)
Non-owned (if required)
Send my quotation via: E-Mail Fax
Regular Mail
Call me by Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency release this information via the method you have chosen, and to release us any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me the Quote NOW!
 

       
 

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