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GENERAL LIABILITY

General Liability insurance is a part of the general insurance system of risk  financing to protect the purchaser (the "insured") from the risks of liabilities imposed by lawsuits and similar claims. It protects the insured in the event he or she is sued for claims that come within the coverage of the insurance policy.  Coverage for an insured when negligent acts and/or omissions result in bodily injury and/or property damage on the premises of a Business, when someone is injured as the result of using the product manufactured or distributed by a business, or when someone is injured in the general operation of a business.

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Contact Name:
Address:
City:
State/Providence
Zip/Postal Code
Phone:
Email:
Fax
Company Name:
Policy Expiration Date: (mm/dd/yyyy)
List type of coverages
Quote(s) needed for: Bond Commercial
Auto
Commercial Liability
Commercial Property
Commercial Umbrella
Directors & Officers Liability
Disability
Group Health
Group Life
Professional Liability
Workers Comp
Other

Business Information

 
# of Full-Time Employees
# of Part-Time Employees
How long in Business? (yrs)
How many locations?

Please give a brief description of your business and clientele

Property/Premises Information

Address
Occupancy Status
Year Built
% Occupied
Sprinklers

Stories

# Basements
Sq. Footage
Burglar Alarm
Building Value
Contents
Other Property (specify)

Insurance Information

 
Annual Gross Sales: (before taxes)

Number of Employees

Annualized Payroll

Cost of any Subcontracted Work

Limits Requested

Describe any claims you've had in the past 5 years

Additional Comments