General Liability Form - Casual Insurance Group, LLC.

(561) 429-3181 West Palm Beach, FL

We support the brave people of Ukraine in their fight to save their freedom and democracy

We support the brave people of Ukraine in their fight to save their freedom and democracy

General Information

Contact Name *

Company

Address *

City *

County

Zip *

Email *

Phone *

Classification

Tell Us About Your Operations

Type of Business

# Active Owners

# Full-time Field Employees

# Part-time Field Employees

Contractor License #

Work on New Tracts?
Yes No

Work on New Condos, Townhomes, or Apartments?
Yes No

Work Percentage (Must Equal 100%)

New Commercial

Service & Repair

Residential

Miscellaneous Industrial

Remodel

New Custom Homes

Company Information

Annual Payroll (exclude owners) $

Annual Gross Receipts $

Annual Sub Costs $

Current Insurance Carrier (If none, enter "none")

My Policy Renews (Current date if not insured)

How Did You Find Us?:

Provide detailed description of your contracting operations. The more complete the description, the more accurate your quote will be.

Note: Coverage Can Not Be Bound Changed Or Deleted Via Electronic Message

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