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Customer
Testimonials!

Levy Insurance Agency
17 Bishop Hollow Road,
Suite B
Newtown Square, PA.
19073

Phone: 877-325-2242 Fax: 610-646-0750

Contractor Insurance

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On-Line Contractor General Liability Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Name:
BUSINESS Name:
How Did Your Hear About Us?
Mailing Address:
City:
State:
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax:
 
Business Underwriting Information
Type of operation:
Describe Operations in Detail Please:
Social Sec. or Employer ID#:
 
Limit of Liability
Coverage Requested?		 $300,000
$500,000
$1 Million
 
Currently Insured? Yes No
Name of Carrier & how long insured?
Describe Any Prior Losses and Amounts Paid in Detail Please:
 
Years in business:
Years experience in field:
Percentage of work residential:
Percentage of work commercial:
 
Number of Active Owners:
 
Number of Full-Time Employees
Working in the Field:
 
Number of Part-Time Employees
Working in the Field:
 
Annual payroll for employees performing contracting work: $
 
Annual Gross Sales: $
 
Do you subcontract work? Yes No
(If yes, what percentage of your work
is subbed, and what kind of work?)
Amount Paid to Subcontractors Annually
Do you work on condos? Yes No
If a Roofer, do you do hot tar work? Yes No N/A
If a Landscaper, do you do tree work? Yes No N/A
Do you have a safety program? Yes No

 
Comments/Remarks:
 
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Contact the Levy Insurance Agency at: tlevy@levyagency.com
17 Bishop Hollow Road, Suite B,     Newtown Square, PA.    19073
Toll Free Phone: 877-325-2242     Fax: 610-646-0750
Privacy Notice/Copyright Info.   |    © 2006 Insurance-Web-Sales
Questions or site-related technical problems, contact: tlevy@levyagency.com