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AVIATION INSURANCE

"The Business Insurance Specialists"

General Liability

General Liability package policy protects your company in the event that a client is injured on your premises or if you or one of your employees injures someone or damages property at a client's location. The General Liability coverage on a business liability insurance policy also meets your landlord's requirement that you carry business premises liability insurance.

Date

E-mail Address

Bussiness Owner's Name:

Business Name:

Type of Entity:

City, State, Zip

Address

Phone (work)

Phone (Cell)

Fax

Business Description

Years in Business

Years Experience

% Commercial

% Residential

Prior Insurance ~ 3 Years:
Name of Company

Prior Claim History

Expiration Date

Has the applicant been working without insurance?

Yes

No of Employees:

Full Time

Part Time

Estimated Annual Payroll of Employees

Annual Gross Receipts

If yes, how much paid out annually?

If yes, how much?

Subcontractors?

Yes

Tool or Equipment Coverage

Yes

Any Work on New Homes?

Yes

If, yes:

Liability Coverage (in 1,000's):