BY USING THIS FORM YOU ARE GRANTING PERMISSION TO THE EDGAR ORTIZ AGENCY CA LIC# 4095732 TO PROVIDE A HOME INSURANCE QUOTE. ALL INDICATIONS ARE BASED ON PUBLIC INFORMATION SHOULD THERE BE ANY DISCREPANCY IT MAY CAUSE A CHANGE IN THE PREMIUM.
BY USING THIS FORM YOU ARE GRANTING PERMISSION TO THE EDGAR ORTIZ AGENCY CA LIC# 4095732 TO PROVIDE AUTO INSURANCE QUOTE. ALL INDICATIONS ARE BASED ON PUBLIC INFORMATION SHOULD THERE BE ANY DISCREPANCY IT MAY CAUSE A CHANGE IN THE PREMIUM.
Number of Full-time Employees: *. Number of Part-time Employees: *.
Total Annual Receipts: *. Total Square Footage Occupied by Insured: *.
Number of Locations: *. Total Receipts: *.Catering Receipts: *.Liquor Receipts: *.What is the number of Employees: *.
Number of Buildings: *. Does applicant own the building? Yes NoFire Sprikler System: Yes No*Dry Chemical Wet Foam Water Spray Other* Are deep fat fryers used? Yes No*
Is the applicant or their employees a general contractor or hold a current general contractor license?Yes No* What is the total gross annual receipts for applicants business? *Does the applicant subcontract any work? Yes No* Employee Tools Coverage: *
SMS Opt-In
If you would like to review our Privacy Statements Click the link Here.