California Contractor's Insurance

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Small Business

Why do you need it?

It covers you in case you become legally obligated to pay for damage to some else's property or pay for injury to a third party. It also pays your legal fees if you are wrongfully sued.

Small Business

Please fill out form as completely as possible. Fields with bold titles may not be left blank. All information is held in the strictest confidence.

Your Name:
Business Name:
Street Address:
Street Address (continued):
City:
State:	*We only provide services in California.*
Zip Code:
E-mail:
Work Phone:
Home Phone:
Mobile Phone:
FAX:
Description Of Your Small Business:
Value of Building:
Value of Contents:
Total Square Feet:
Year Built:
Construction Type:
Do You Own Or Rent The Building:
If you selected own, do you rent to others?:	Yes No
If so, how many square feet?:
Is there a basement?:
Do you have a burglar alarm?:	Yes No
If yes, is it a Central Station Alarm?:	Yes No
Name of Alarm Company:
Do you have a fire alarm?:	Yes No
Who maintains it?:
Have you made any improvements to the building?:	Yes No
If yes, please tell us what and when?:
Distance from the nearest building:	Right: Left: Rear:
Annual Gross Receipts:
Annual Payroll:
Number of Years in Business:
Desired Deductable:
Carrier:
Current Insurance Carrier:
Current Policy Number:
Policy Expiration Date:
Please prioritize your request:	I need it now, please quote ASAP! Please quote prior to my renewal No hurry, just checking