J&C Corbett Insurance Services, Inc.

General Liability

Please answer all the questions below and press submit to receive a free quote. Issuance of an insurance policy is subject to underwriter/carrier approval.

* Required fields.

Business Name:*

Company Type:*

Sole Owner

Partnership

Corp.

Owners:*

License Number:*

Classification(s):*

Years of Experience:*

Years Licensed:*

Mailing Address:*

Physical Address:*

City:*

Phone:*

Cell Phone:

Zip Code:*

County:

Fax:

Email:*

Description of work you perform (e.g., electrical, plumbing, painting, finish carpentry, drywall):*

What Portion of Your Work is Residential?

Commericlal? (Must Equal 100%)

What Portion of Your Work is New Construction?

Remodeling? (Must Equal 100%)

Requested Liability Amount:*

Estimated Gross Sales:*

Do You Use Subcontractors?*

Estimated Annual Sub. Costs:

Yes

Estimated Annual Employee Payroll
(Not Including Owners):*

Labor hired from labor agency:*

Details of any losses within the last 5 years:*

Do you perform any new construction of apartments, condominiums, townhouse associations, or tract homes?

Yes

A General Liability Policy typically does not cover the loss of tools, but coverage can be added at a discounted rate. Do you want coverage for loss of tools?

Yes

How soon is insurance needed?

Are you currently insured, and if so, for how many years witihout a lapse in coverage?

How did you hear about us?

Are you already a client?

Corbett Code or Bond Number

Comments, questions, or write us a brief message:

See our privacy policy.

Questions? Call us!
1-800-400-1125

Our location:

Main Office:
609 Court Street
Woodland, CA 95695

Hours of operation:
8 am - 4:30 pm Monday - Friday

Phone: 1-800-400-1125
Local: 530-419-2000
Fax: 530-419-2019
Email:
info@corbett-insurance.com

California License Number: 0D34028