Commercial Contractors General Liability Insurance Quotes

Form data will be submitted via a secure connection.Please take a moment to fill out the form below and one of our local insurance agents will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.
  • View Printable Version
  • Requested Policy Period

  • Insured Information

  • Add a new row
    Press the "+" symbol to list another owner.
  • Agency Information

  • New Venture Section

  • If more than 3 years under current name, please proceed to loss history section.
  • Add a new row
    Press the "+" symbol to list another business.
  • Loss History

    * If losses apply please attach currently valued loss runs including a complete description of all losses.
  • Prior Carrier Information

  • CarrierPolicy NumberEff-Exp DateTotal Premium 
    Add a new row
    Press the "+" symbol to list another carrier.
  • Program Specific Information

  • Commercial (%)Residential (%)
  • Commercial (%)Residential (%)
  • * Subcontractors must carry limits equal to or greater than applicant to be considered insured.
    The total cost of all work let or sublet in connection with each specific project including:

    1. The cost of all labor, materials and equipment furnished, used or delivered for use in the execution of the work, however, do not include the cost of finished equipment installed but not furnished by the subcontractor if the subcontractor does no other work on or in connection with such equipment; and

    2. All fees, bonuses or commissions made, paid or due.

    The rates apply per $1,000 of Total Cost.
  • Direct Payroll (Exclude Owners)Total Subcontractor CostGross Receipts
  • Direct Payroll (Exclude Owners)Total Subcontractor CostGross Receipts
  • Direct Payroll (Exclude Owners)Total Subcontractor CostGross Receipts
  • Questionnaire

    Further information may be required based on answers below.
    It is a crime to knowingly and intentionally attempt to defraud an insurance company by providing false or misleading information or concealing material information during the application process or when filing a claim. Such conduct could result in the policy being voided and subject you to criminal and civil penalties.

    By continuing with this bind/application process, you and your business partners confirm that the facts in the application are true and that all premiums due will be remitted.

    I have read and agree with these statements, and acknowledge the above Fraud Warning. I hereby declare that the application for insurance is true and I have not misstated any material fact and that I agree that all premiums due will be remitted.
  • This field is for validation purposes and should be left unchanged.
October 27th, 2015 by XS Specialty, LLC