Specialty Liability

Business General Liability Insurance Quote
*Business Name:
*Contact Name:
*State:     *Zip:
*Business Phone:
*Contact Email Address:
Desired Limits: (Each Occurrence / General Aggregate)
(other limits may be available upon request)
What percentage, if any, of gross receipts/revenues is derived from service and/or installation of products? %
What percentage, if any, of gross receipts/revenues is derived from the rental of any equipment? %
Please indicate whether any of the following optional coverages are desired: (the limits provided will be the same as the limits chosen in number 1 above)
Employee Benefits Liability     
Liquor Liability     
If yes, please provide annual liquor receipts $:
Hired and non-owned auto liability     
Stop gap liability (if applicable)     
Limited International General Liability Extension Endorsement     
Please indicate whether any of the following exclusions are desired.
a) General Liability Enhancement Endorsement (adds additional insureds and other broadening coverages)     
b) General Liability Extended Enhancement Endorsement (adds extended property damage and other broadening coverages)     
Wholesale Applicants ONLY
Are all goods manufactured domestically or by a company with a location in the US?     
If no, is Imported Products Liability Coverage desired?     
If Imported Products Liability Coverage is desired, what are the gross annual sales for foreign manufactured products? $
Do you do any repackaging, re-labeling, repair or re-manufacturing of products?     
Additional Comments
Please give any additional comments or questions:

No coverage of any kind is bound or implied by
submitting information via this online form

  • Information from you and other sources, such as your driving, claims and insurance histories, may be used to calculate an accurate price for your insurance.
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