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E-Mail:
vickie@contractors
1stinsurance.com

Toll Free Phone:
800-238-4654

Insurance License
Numbers:
CALIFORNIA OE61983
TEXAS 1416119
ARIZONA 873215
COLORADO 277626
LOUISIANA 417236
NEVADA 634600

Contractors We Write:

• Framers
• Roofers
• HVAC
• Drywall
• Plasterers

• Masonry
• Concrete
• Sanitation
• Janitorial
• Plumbers

• Electricians
• Low Voltage
• Landscapers
• Grading
• Excavation

• Paving Contractors
• New Home Builders
• Artisan Contractors
• Tile Contractors
• Pool Contractors

• Welders
• Steel Contractors
• Sheet Metal
• Ornamental Metal
• Pipeline Contractors

• Floor Installers
• Cabinetmakers
• General Contractors
• Remodelers
• Home Builders

• Commercial Contractors
• Developers
• Tract Home Builders
• Condo Builders
• Many More!

On-Line Contractor General Liability Quote Form One Simple Form - takes only 2-3 Minutes!
Your Name:
BUSINESS Name:
Mailing Address:
City:
State:
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):

Business Underwriting Information
Type of operation:
Describe operations in detail:
License class:
License Number:

Limit of Liability Coverage Requested?	$300,000 $500,000 $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?)
Do you do foundation work?	Yes No
Do you work on condos?	Yes No
Employees paid over $18/hour?	Yes No
Do you have a safety program?	Yes No

Comments/Remarks:

Send my quotation via:	E-Mail Fax Regular Mail Please Call Me!

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