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Contractors Liability Quote Request


Thank you for your interest in securing an individualized liability quote for your business. In order to provide this quote we will need the following additional information to customize a liability quote for you. Please fill out all fields as completely as possible.

Business Name
Required
E-Mail Address
Required
First Name
Required
Last Name
Required
Street
Required
City
Required
State
Required
ZIP / Postal Code
Required
Primary Phone Number
Required
How many years have you been in business?
Required
How many years do you have in this trade?
Required
Desired Limit of Liability
Required
Desired Deductible
Required
Additional Insureds Needed?
Optional

Waivers of Subrogation Needed?
Optional

Expected Gross Receipts
Required
# Active Partners, Owners, Directors, Officers
Required
# Clerical Employees and Payroll
Required
# Sales Employees and Payroll
Required
# Other Employees and Payroll
Required
Are you involved in the building of any new single-family houses including residential condominiums, multi-unit homes, tract housing, subdivisions, townhouses, or apartment buildings?
Required
Do you ever use workers from any daily labor pools or other alternative staffing firms, other than a PEO?
Optional

Do you have any knowledge of an occurence that could result in a claim?
Optional

Have you ever been named in a construction defect claim or suit?
Optional

Have you ever declared bankruptcy or had a judgment entered against you? (does not apply if caused solely by medical expenses)
Optional

Do any directors, partners, or officers have a prior felony conviction? (other than a solely drug-related charge at least 10 years old)
Optional

Do you have all required licenses and permits for all work to be performed under this insurance?
Optional

Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
   

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Adcock-Adcock Insurance Agency
315 W. Fletcher Ave Tampa, FL 33612 | Driving Directions
Office: (813) 933-6691 | Toll Free: (866) 933-6691 |  Fax: (813) 932-6287
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