Business - Contractor - Chris Elliott Insurance Agency

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Business - Contractor

Step 1 of 2

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Business Name

Address

Approximate number of years insured

General liability covered desired

Property coverage desired?

Auto coverage desired?

Describe operations

Approximate annual revenue

# Employees

Approximate annual payroll

Approximate annual subcontractor costs

Description and approximate dates of any claims in the last five years

Current Coverage Details

I have a current policy and can upload a declarations page so you can match coverage.

I have a current policy, but cannot upload a declarations page.

I do not currently have a policy.

Policy Upload

Max. file size: 5 MB.

Renewal Date

General Liability coverage limit; Property coverage limit; Other coverages and limits; Deductible

Approximate current annual premium

Desired coverage preferences

Desired general liability limit; Desired property coverage limit

Is there anything you would like to add?