GENERAL LIABILITY

Benton Insurance Agency we know how important General Liability Insurance is for your project.  With our experience and access to various carriers we can write your coverage quickly at a price that will fit your budget.

Please fill out the form below to request a quote. 

Items with * are required fields
   
Contractor License Number:*
License Class*
Business Name:*
Business Address:*
City:*
State:*
CA
Zip:*
Owner/Contact Name:*
Business Phone:*
  Mobile Phone:
  Business Fax:
Business Email:*
Estimated Gross Annual Receipts:*
$
Number of Owners in the Field:*
Number of Employees:
Estimated Annual Employee Payroll:*
$
Estimated Annual Sub-Out Cost:*
$
Trades Subbed Out*

Detailed Description of Operations
(Type of Work You Do):*
   
New Condo New Townhome New Tract Work
   
Percentages
(type %  for each that apply)

New Construction

Remodels

Total

100%
Commercial
Residential
Total 100%
Inside
Outside
Total 100%
   
*Liability Limit:*

$300,000/$500,000
$500,000/$1,000,000
$1,000,000/$1,000,000
$1,000,000/$2,000,000

   
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:*
 
 
   
How Did You Find Us? *
Flyer in the mail   
Online search
Referral
Other (If checked, please specify:)
 
 
 

 
   

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