California insurance from Wise Insurance Agency
FAST & FREE Online Califonia Business and Personal Insurance Quotes!
Personal Auto, Homeowners Insurance from Wise Insurance Agency
Personal Auto, Homeowners Insurance from Wise Insurance Agency
 • Auto Insurance

 • Homeowners \Renters

 • Personal Umbrella

 • Recreational Vehicle

Commercial and Business Insurance from Wise Insurance Agency
 • Contractor Liability

 • Business Owners

 • Innkeepers Insurance

 • Workers Compensation

 • Builder's Risks

 • Commercial Auto

 • Special Event


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California Insurance Lic #0770590
 

On-Line Contractor
General Liability Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Name:
BUSINESS Name:
Mailing Address:
City:
State: MUST be California!
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Business Underwriting Information
Type of operation:
Describe operations in detail:
License class:
License Number:
Social Sec. or Employer ID#:
 
Limit of Liability
Coverage Requested?		 $300,000
$500,000
$1 Million
 
Currently Insured? Yes No
Name of Carrier & how long insured?
Prior Claims? Yes No
Describe claims in detail:
 
Years in business:
Years experience in field:
Percentage of work residential:
Percentage of work commercial:
 
Number of Active Owners:
Number of Employees: 0   1   2   3+
Annual Employee Payroll: $
Annual Gross Sales: $
 
Do you subcontract work? Yes No
(If yes, what percentage of your work
is subbed, and what kind of work?)
Do you do foundation work? Yes No
Do you work on condos? Yes No
Employees paid over $18/hour? Yes No
Do you have a safety program? Yes No

 
Comments/Remarks:
 
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Wise Insurance Agency . 3100 Kerner Blvd. Suite H . San Rafael, CA 94901 . Lic#0770590
Toll Free Phone: 800-939-8730 . Phone: 415-258-9912 . Fax: 415-457-6428
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