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Contractors Quote
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First Name
Your answer
Last Name
Your answer
Company / Entity
Your answer
Phone Number
Your answer
eMail
Your answer
Preferred contact method
eMail
Phone
Text
Address
Your answer
City
Your answer
State
Your answer
ZIP Code
Your answer
Business Entity Type
Choose
LLC (Limited Liability Company)
Corportation
Partnership
Sole Proprietorship
Federal ID Number (EIN)
Your answer
Do you own your building?
Yes
No
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Please select the types of coverages needed
General Liability Coverage
Workers Compensation Coverage
Professional Liability Coverage
Cyber Liability Coverage
Business Automotive Coverage
Business Property or Equipment Coverage
How many employees do you have? (1099 and W2)
Your answer
What are your total combined (1099 and W2) annual payroll costs?
Your answer
Do you use subcontractors?
Yes
No
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If so, are your subcontractor costs greater than 25% of your annual gross sales?
Yes
No
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Is this company a new entity?
Yes
No
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How many years of experience do you have in this field?
Your answer
Are you currently insured?
Yes
No
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If so, what is the name of your current carrier?
Your answer
What is your policy renewal date?
MM
/
DD
/
YYYY
Any Loss History?
Your answer
Additional coverage requirements and/or comments?
Your answer
Scope of Work
Plumbing
HVAC
Electrical
Painting
Flooring
Handyman
Interior Carpentry
Exterior Carpentry
Landscaping
Other:
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