Contractor General Liability – Capital Partners Insurance Agency, Inc

Capital Partners Insurance Agency, Inc

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(800) 889-7162

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Call Us Toll Free

(800) 889-7162

Home
About Us
Products
Applications
Contact

Contractor General Liability

Thank you for allowing Capital Partners Insurance Agency, Inc. the opportunity
to save you money on your insurance. Please fill out the information below and click the "submit" button.
Business Name:
Year Established:
Contractor License #:
Name:

First NameLast Name
E-mail:
Phone Number:

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Business FEIN/Tax ID:
Description of Business:
Number of Full-Time Employees
Number of Part-Time Employees:
Number of Total Employees:
Business Entity:

IndividualLLCCorporationPartnershipAssociationJoint VentureOther
Bussines Annual Gross:
Number of Locations:
Franchise:

YesNo
Are employee health plans provided?:

YesNo
Driving Radius:

No Driving< 50 miles51-100 miles101-250 miles251-300 miles> 300 miles
Number of Vehicles Used:
Number of Drivers Used:
Type of Vehicles:

SUV'sTrucksVansSedansTractorsOther
Officer Names/Title/% of Ownership
Explain all Exterior and/or Interior work performed:
Work performed as General Contractor %
Work performed as Sub-Contractor %
Percentage of Residential Business:
Percentage of Commercial Business:
Percentage of Industrial:
Other:
% of work that is New Construction:
% of work that is Remodel/Repair:
Do you draw any plans or blueprints used in your construction services:

YesNo
Any work performed above 2 stories?

YesNo
Any use of Cranes?

YesNo
Building Owned:

YesNo
Building Dwelling Cost:
Business Inventory on Policy:
Any use of Scaffolds?

YesNo
Any Concrete tilt-up work?

YesNo
Any Roof Exposure?

YesNo
Material Handling Exposure?

YesNo
Manual Lifting?

Below 50 lbsAbove 50 lbs
Work Performed Underground or Aboveground more than 15 Feet?

YesNo
Does the Building have an alarm system:

YesNo
Does the Building have Sprinkler System:

YesNo
Does the Building have a Surveillance:

YesNo
Does your policy include property of others:

YesNo
Should be Empty:

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Capital Partners Insurance Agency, Inc / CA Ins License #:6012780

369 S Doheny Dr. Suite 207 Beverly Hills, CA 90211

Phone: (800) 889-7162 Fax: (888) 248-7333

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