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Contractors General Liability Insurance Information Sheet California Contractors General Liability

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Current Liability Company

Current Premium

Next Renewal Date

Description of Operations

D.B.A. Name

Number of Owners

Contractors License #

Contractors License Class

Limit of Liability Requested Select$300,000$500,000$1,000,000

Number of Claims in Last 3 Yrs

Years of Experience

Years in Business

Do Work on Tracts? SelectNoYes

Do Work on HOAs? SelectNoYes

Do Work on Condos? SelectNoYes

Work out of Home or Office SelectHomeOffice

Percentage of Residential Work 0%10%20%30%40%50%60%70%80%90%100%

Percentage of Commercial Work 0%10%20%30%40%50%60%70%80%90%100%

Percentage of New Construction 0%10%20%30%40%50%60%70%80%90%100%

Percentage of Remodeling 0%10%20%30%40%50%60%70%80%90%100%

Percentage of Repair 0%10%20%30%40%50%60%70%80%90%100%

Current Number of Employees

Percentage of Work Subbed Out 0%10%20%30%40%50%60%70%80%90%100%

Total Payroll to Employees

Annual Gross Receipts

E-Mail

Name

Address

City

State

Zip

County

Phone

Fax

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