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Janitorial &
Building Maintenance Insurance
Same Day Quote & Issue |
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Call
Toll Free 1-800-874-9191
Fax
480-452-0593
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For no-obligation
Janitorial insurance quote, please complete
the following form
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| Insured Name |
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| Address
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| Address 2 |
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| City |
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| State |
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| Zip |
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| Entity Type |
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| Name &
Title of Principals |
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| Years Experience |
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Primary
Contact |
| Contact Name |
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| E-mail |
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Business Phone |
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(Area + Number) |
| Fax |
-
(Area + Number) |
| Cell phone |
-
(Area + Number) |
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Business Information |
| Desired
Policy Effective Date? |
| Start |
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Liability Limit |
Per Occurrence |
| Number
of full time employees |
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| Number
of part time employees |
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Annual Payroll |
$
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Estimated Gross Annual Revenue |
$
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Type of Work performed |
Commercial
% + Residential
% = 100% |
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Policy Options
— in addition to general
liability do you require? : |
| a.
Additional Insureds added to policy? |
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| b. Hired &
Non-owned auto
liability? |
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| c. Third-party property damage
coverage? |
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| d.
Miscellaneous tools & equipment coverage? |
$ <- if yes, enter total
replacement value |
| e.
Fidelity Bond coverage? |
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Underwriting Questions |
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1.
Underwriting Questions |
| a. Do
you use subcontractors? |
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| b. Do
you rent or lease your equipment to others? |
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c. Do
your operations involve exterior building work
over 3 stories? |
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| d. Do
you work at commercial airport or government office buildings? |
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| e. Do
you or your subcontractors remove any asbestos or asbestos products? |
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f. Do
your operations involve include blasting or
explosive materials? |
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| g. Any
losses in past 3 years? |
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| h. Are
you a International Janitorial Cleaning Services Association member? |
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How did you hear about us? |
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Comments or Special
Instructions |
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| AFIG
Producer - Please enter Name & Number |
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Insurance Definitions |