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
   

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