Contractors Policy Quote Form
Fields marked with * are required!
Your Information:
Contact Name:* 
Business Name:* 
Address: 
City/State/Zip Code:*
Phone: 
Fax: 
Email:*   
Your present insurance:
Do you have insurance now?  Yes No
Who is your current insurance company?  
My current policy expires:  
Business Information:
Business type:  Sole ProprietorCorporationPartnership
Type of License:   
Do you have current loss runs?  Yes No
Do you have any claims in the past 3 years?   YesNo
If you had claims: (please explain here)
Length of time in business:
Working under your name:    Years working for others:   
Number of full time employees:   Number of part time employees:  
Annual Gross Receipts:   Annual Payroll: minus owner & clerical
Annual Amount subcontracted to others:  
Have you built single family homes or condominiums?   YesNo
Do you plan to build single family homes or condominiums in the future?   YesNo
What Percent of your business is:
Residential: Commercial: New Construction Remodeling
Describe your business operations:

(What do you do?)
What type of operations that are subcontracted:
Coverages Needed:
What Coverages do you need?
Building Coverage- - -Amount of Building Coverage
Business Personal Property- - -Amount of Personal Property Coverage
Business Liability- - -Amount of Liability Coverage
List any additional coverage you would like to have included here.
Comments Questions and Other information:
Comments or Questions:

This page is provided as a service to you. It is not possible to bind any new coverage from this request. If you have NOT received your confirmation from us within 24 hours the same or next business day, please contact us. NO COVERAGE IS CONSIDERED BOUND UNTIL YOU RECEIVE OUR CONFIRMATION. Thank you for your understanding.

  Thank you for completing our form.
We welcome the opportunity to serve you.
Ramsey Insurance Agency
CA Ins. License #0490642

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