General Liability

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Commercial General Liability Insurance Quote

Complete Business Name:

Date Business Started:

FEIN (EMPLOYER TAX ID #):

Address:

CITY, STATE, ZIP:

Contact Person Name:

Email:

Phone:

Website:

Detailed Description of Operations:

Annual Sales (anticipated next 12 months):

Owner Name(s):

Owner Annual Payroll:

# OF FULL TIME EMPLOYEES

& Annual Payroll

# OF PART TIME EMPLOYEES

& Annual Payroll

Dollar Amount Value of Business Property to Insure?

Description of Business Property to Insure:

TOTAL SQUARE FOOTAGE TO BE OCCUPIED:

If the building is older than 15 years, have THE ROOF, PLUMBING, ELECTRICAL, and HVAC been updated or replaced?

IS THERE A SPRINKLER SYSTEM INSTALLED?

What percentage of building?

Is there a monitored Burglar/Fire Alarm installed?

Monitoring Company:

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