California Contractor Insurance | Grand Commercial Insurance Brokerage LLC

Contractor Insurance

Disclaimer: Insurance transactions are not finalized without acknowledgement from a W.C.I.S. representative. All quotes are subject to final underwriter/carrier approval.

*Contractor License Number:

*Business Name:

*Business Address:

*City:

*State:	CA

*Zip:

*Owner/Contact Name:

*Number of Active Owners:

*Business Phone:

Mobile Phone:

Business Fax:

*Business Email:

*Estimated Gross Annual Receipts:	$

*Estimated Annual Field Payroll:	$

*Estimated Annual Sub-Out Cost:	$


Do you provide any new ground up construction?	Yes No

*Claims in the Last Three Years?:	Yes No

*Years Continuous Liability Coverage:	0 1 2 3

Current Insurance Carrier:

Policy Expiration Date:

*Number of Years in Business:

Type of Work You Do: Explain your Operations*

*Request Additional Information Check-mark which areas you would like more information on.	Bonds Equipment Commercial Truck Coverage Workman's Comp (Simply check-mark for additional information). Life Insurance Health Insurance