ConstruTEC Liability
ConstruTEC Liability
Company Name
Name
Name
*
First
Last
Entity Type
Entity Type
Individual
LLC
EIN or SSN
How many years experience?
How long have you been in business?
Phone
Phone
*
-
###
-
###
####
Address
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Type of work (carpenter, painter, plumber, etc)
*
Approximate Gross Sales (before expenses)
*
$
Dollars
.
Cents
Do you have employees? (w-2 form)
Yes
No
Monthly wages
$
Dollars
.
Cents
Do you hire sub contractors?
*
Yes
No
Percentage of work in New Homes:
Percentage of Remodeling Work:
Percentage Residential work:
Percentage Commercial work:
How much do you estimate you pay to subcontractors a year?
$
Dollars
.
Cents
Email
What do you currently pay for your insurance?
$
Dollars
.
Cents
Insurance Type Needed
*
Insurance Type Needed
General Liability
Auto
Umbrella
Workers Comp
Tools
Who is your Current Insurance Company?
Any Additional Information Provided?
Sales Rep
Current Insurance Dec Page (For Faster Quote & If Available)
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