General Liability policies- low cost and meeting the need
Start the process to get a quote
Georgia Painters Insurance.com
Items with the * are required
Business Entity is a(n)*
Association Corporation Individual Venture Non-Profit Org Partnership LLC S-Corp
Doing Business As: (Leave Blank if no Business Name)
(Only fill in if there is a Business Name)
First Name of Applicant:
*
Last Name of Applicant:
Location Address:
(No PO Boxes)
City:
State, Zip:
AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY * *
County:
Applicant's Phone Number:
* ex. 716-837-8804
Applicant’s E-Mail Address:
Applicant’s Birth Day
Describe Business:
Enter percentage of work performed. Total must equal 100%
Painting Residential
Painting - Commercial
Other
BUSINESS SUMMARY
Years In Business:
Years Experience:
Percent of Work Performed:
Residential :
Commercial : * Must total 100%
Inside :
Outside : * Must total 100%
New Constuction :
Remodel/Repair : *Must total 100%
Number of owners :
Employees:(No owners or clerical)
Full Time * Part Time *
Part Time Employees work less than 120 days per year
Total Payroll: (Do not enter commas)
*(No owners or clerical)
Annual Gross Receipts:
* (do not enter commas or dollar signs)
Are subcontractors used?:
Yes No *
If yes, what is the annual cost of subcontractors:
(do not enter commas or dollar signs)
Are Subcontractors required to maintain coverage?
Yes No
If Yes, What limits do the subs carry?
Are you involved (present or future) in new residential construction &/or development? (This would include dwellings, townhouses or condo units located in a single development):
List the last 3 jobs including the cost of those jobs.
Location
Type of Job
Job Receipts
1. *
2. *
3. *
Does Risk have a Safety Program in operation?:
Does applicant currently have General Liability coverage? :
Was there past General Liability coverage? :
The following 6 items are required if they had prior coverage or currently have coverage.
Enter name of most recent carrier :
Policy #
Is or was policy being cancelled or
non-renewed?
If yes, please explain:
Most recent Policy Premium :
Loss History: (Date of loss, Brief Desc. and Amount Paid)
If none enter NONE :
LIABILITY INFORMATION
Liability Limits 1: ($)
300/600 500/1,000 1,000/2,000 2,000/4,000
Liability Limits 2: (optional): ($)
SUBMISSION OF THIS APPLICATION IN NO WAY CONSTITUTES A RECIEPT OF QUOTATION OR APPROVAL FOR BINDING. BINDING WILL BE CONFIRMED BY A WRITTEN RELEASE OF A BINDER NUMBER AFTER ALL REQUIREMENTS ARE RECEIVED IN OUR OFFICE. RATE IS BASED ON INFORMATION PROVIDED ON THIS APPLICATION AND IS SUBJECT TO CHANGE.