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General Liability Quote Form:
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Name:
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Business Name:
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Address:
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Best Contact Number:
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Fax Number:
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LLC, Individual Corp. Etc.
Number of Owners:
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Years Experience in this field:
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Years Job Bidding Experience:
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Years in Business:
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Years Management Experience:
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Type of Business:
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% of Residential/Commercial Work (Out of 100%)
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Estimated Earnings this Year:
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Earnings Last Year:
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Current Insurance:
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Current Carrier:
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Total Premium:
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Loses in the past 5 years:
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Explain:
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Number of Employees:
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Total Annual Payroll:
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Are Subcontractors Used:
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Total Percentage of Subs: (Out of 100% total work):
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Total Cost of Subs:
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Workers Comp Carried:
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General Liability Limits:
| $2,000,000/$4,000,000
$1,000,000/$2,000,000
$500,000/$1,000,000
$300,000/$600,000 |
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