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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 Michigan)
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:
 
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 (full & part time):
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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Regular Mail
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We have two convenient Michigan office locations, contact whichever is EASY for you to do business with:
Contractor Insurance Pros.com, A Service of Preferred First Insurance | Email: rsavage@preferredfirst.com
SAGINAW OFFICE: 7773 Bay Road | Saginaw, MI 48604 | Local Phone: 989-799-9082 | Fax: 989-799-9072
CLIO OFFICE: 5105 W. Vienna Road, Suite C | Clio, MI 48420 | Local Phone: 810-686-9200 | Fax: 810-686-9200

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