LPI Contractor's Insurance Inquiry
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Name:
*
Tel. No.
*
Email:
*
Would You Like to Receive a Free, No Obligation Quote?
*
Yes
No
Company or Business Name:
*
Business Address (if any) or Applicant's Address:
*
Are you the owner of the business?
*
Yes
No
When did you become the owner of the business?
*
How many years of experience do you have in the industry?
*
If you are not the owner of the business, what is your job title?
Is your Business Conducted from:
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A Home Office
Fixed Location
Mobile Operation Only
How many employees does your business have including yourself?
*
What is your expected Annual Gross Revenues?
Do you perform Spray Painting?
*
Yes
No
What percentage of your business is Residential?
What percentage of your business is Commercial?
What percentage of your business is Industrial?
Do you subcontract out any of your work? If yes, what percentage?
What percentage of your annual gross income is generated by your subcontractors?
Which of the following types of insurance do you currently carry? Check all that appy:
Commercial General Liability
Commercial Auto/Fleet
Tools & Equipment
Contents (Office/Shop)
Business Interruption
Please describe any other Insurance you carry, if any:
Do you store any materials or inventory?
Yes
No
Do you require business interruption Insurance?
Yes
No
Do you require tools coverage?
Yes
No
If yes, what is the value of the tools you own?
Do you require coverage for rented or leased tools?
Yes
No
If yes, what is the value of your rented and/or leased tools?
How much liability insurance do you currently carry?
How much liability insurance are you required to carry?
What is your current total annual premium?
Who is your insurer?
Have you had any claims in the last 5 years? If yes, please describe them:
Please upload a copy of your current insurance policy here (optional):
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