General Liability Quote

Business General Liability Insurance Quote

Name of Business:
Contact Name:
Address:
City:
State & Zip:
Business Phone:
Email Address:
Fax Number:

Questions

Desired Limits: (Each Occurrence / General Aggregate)
(other limits may be available upon request)

$300,000/$600,000
$500,000/$1,000,000
$1,000,000/$2,000,000
What percentage, if any, of gross receipts/revenues is derived from service and/or installation of products?
%
What percentage, if any, of gross receipts/revenues is derived from the rental of any equipment?
%

Please indicate whether any of the following optional coverages are desired: (the limits provided will be the same as the limits chosen in number 1 above)

Employee Benefits Liability
Yes No
Liquor Liability
Yes No
If yes, please provide annual Liquor Receipts $
Hired and Non-owned Auto Liability
Yes No
Stop Gap Liability (if applicable)
Yes No
Limited International General Liability Extension Endorsement
Yes No

Please indicate whether any of the following exclusions are desired.

a) General Liability Enhancement Endorsement (adds additional insureds and other broadening coverages).
Yes No
b) General Liability Extended Enhancement Endorsement (adds extended property damage and other broadening coverages).
Yes No

Wholesale Applicants ONLY

Are all goods manufactured domestically or by a company with a location in the US?
Yes No
If no, is Imported Products Liability Coverage desired?
Yes No
If Imported Products Liability Coverage is desired, what are the gross annual sales for foreign manufactured products?
$
Do you do any repackaging, re-labeling, repair or re-manufacturing of products?
Yes No

Additional Comments

Please give any additional comments or questions


No coverage of any kind is bound or implied by submitting information via this online form

  • Information from you and other sources, such as your driving, claims and insurance histories, may be used to calculate an accurate price for your insurance.
  • We will not distribute information to other parties other than for insurance underwriting purposes.
  • By checking the box below you agree to release us from any liability should this information be accidentally viewed by others.

YES! I Agree


Get a Quote

Homeowners
Auto
Renters
Motorcycle
Boat
Flood
Umbrella
Life
Health
Business Owners
General Liability
Business Auto
Worker's Compensation
Landlord

Related Videos




Copyright © 2010, 713Insured.com. All rights reserved.
 Site by Markpalmamedia.com -Custom Web Design Corporate Email