Contractor Liability Insurance

On-Line Contractor General Liability Quote Form
Your Name:
BUSINESS Name:
Mailing Address:
City:
*State:
Zip/Postal:
E-Mail (REQUIRED):
Confirm E-Mail:
Phone:
Fax (optional):

Business Underwriting Information
Type of operation:
Describe operations in detail:
License class:
License Number:
Social Sec. or Employer ID#:

Limit of Liability Coverage Requested?	$300,000 $500,000 $1 Million

Currently Insured?	Yes No
Name of Carrier & how long insured?
Prior Claims?	Yes No
Describe claims in detail:

Years in business:
Years experience in field:
Percentage of work residential:
Percentage of work commercial:

Number of Active Owners:
Number of Employees:	0 1 2 3+
Annual Employee Payroll: $
Annual Gross Sales: $

Do you subcontract work?	Yes No
(If yes, what percentage of your work is subbed, and what kind of work?)
Do you do foundation work?	Yes No
Do you work on condos?	Yes No
Employees paid over $18/hour?	Yes No
Do you have a safety program?	Yes No

Comments/Remarks:

Send my quotation via:	E-Mail Fax Regular Mail Please Call Me!

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release them from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a Quote NOW!

*Hawkins Insurance Group is licensed to sell in more than 20 states. If you are contacting us from a state in which we are not licensed, we will contact you to inform you that we cannot provide you with a quote.

Click Button Below When Done

Please Click Only Once

Our Other Business Insurance Product

Business property Insurance

Contractor Liability

Workers Compensation

Garage/Dealer Insurance

Tow Truck Insurance

Restaurant/Hotel/Motel

Professional Liability

Directors & Officers

Back To Our Main Page