california auto insurance

Insurance Experience You Can Count On. Secure - Reliable - Affordable!
california auto insurance
 
 

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):
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:
 
Send my quotation via: E-Mail Fax
Regular Mail
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Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release them from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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You may contact our agency at the address and phone numbers below:
 
Alive Insurance Services, Inc.
6328 Fairmount Avenue, Suite 230   El Cerrito, CA 94530
Phone: Toll Free: 1-866-343-2437 / Phone: 1-510-524-3200
Facsimile: 1-510-524-0059 / Calif. Ins. License# 0E70937
E-Mail us at: ALIVE INSURANCE@aol.com