Commercial General Liability

Step 1
Step 2
Step 3

Step 1 General Information

Corporate / Business Name

Address

Name of Applicant:

NOTECommercial General Liability Insurance policies specifically excludes coverage for Professional Liability (a.k.a. Errors & Omissions Insurance).

If you require this coverage we would be happy to provide you with a quotation. Please advise our office and we will arrange to have the appropriate application form forwarded to you ASAP.

Step 2 Contact Information

Name(s) of Principals

Phone (office)

Cell

Date Incorporated

Length of time in similar or related business

Description of Business Products, Services & Activities

Gross Business Receipts Last 12 Months

Anticipated Gross Business Receipts Next 12 Months

Step 3 Prior Insurance History

Name of Insurer

Phone (office)

Amount of Coverage

Are you required to provide this insurance?

e.g. to satisfy a contract. If yes, please email or fax us a copy of the contract wording which outlines the insurance requirements.

Any Claims or Losses?

If yes, please email or fax us the details.

What Limit(s) of Commercial Liability Insurance are you requesting pricing for?