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Quote Request - Contractor
Company Name
Phone
Business Address
First Name:
Last Name:
Email:
Year Started Business
FEIN Number
Website Address:
Number of Full- Time Employees
Number of Part-Time Employees
Total Payroll (Yearly) - Include Owner
Approximate Yearly Sales
Number of Claims (Last 3 Years)
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Aprox Building Coverage Amt if Needed
Approx Contents Amt if Needed
Square Footage of Building/Space
Year Buiding was Built
Year Roof Updated/Replace
Fire/Alarm System?
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% of Work = Commericial New
% of Work = Commericial Service
% of work subcontracted
% of Work = Residential New
% of Work = Residential Service
% of Certs Gathered form subcontracted
Renewal / Effective Date?
Insurance Needed?
General Liability
Property
Workers Compensation
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Umbrella Policy
Inland Marine/Contractors Eqip
Comments / Description of Operations:
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