GENERAL LIABILITY

Submitted by insureitsmart on Mon, 03/25/2019 - 12:45

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COMPANY OWNER

Company Name

First Name

Last Name

Phone

Email *

Street Address

City

State

Zip

COMPANY INFORMATION

Nature of Business

Number of Owners

Gross Annual Sales $

Number of Employees

Annual Employee Payroll $

Subcontractors Used

Yes

Annual Cost of Subcontractors $

Square Footage of Location sq.ft

ADDITIONAL INFORMATION

Prior Insurance

Length of Coverage (Months and Years)

How many additional insureds are required?

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