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Recent Work Comp Activity

DRYWALL INSTALLATION
$8,342

BUILDING MAINTENANCE
$9,340

Great News! We are working on a new and improved price indicator! In the meantime, please complete and submit the easy application below. Thanks!
UMBRELLA/EXCESS - ONLINE SUBMISSION
Quote Type:
Policy Number:
Agent's Name:
Agency Name:
Agent's Phone:
Agent's Fax:
Agent's Email:
APPLICANT INFORMATION
Applicant's Name:
Street Address:  
City:
State:
ZIP:
County:
RATING INFORMATION
Type Of Insured:  
Type Of Insured Other:
Description of Operations:  
 
Number of Employees:
  Describe the last three largest jobs:
Job Type of Work Height Receipts
1.
2.
3.

Any New Residential Work (prior to certificate of occupancy)?  

Please select the number of years in business:
 
Subcontracting Costs:
(If None Enter 0)


Umbrella offers insurance protection for the following artisan contractor classes:

(If the class you are looking for does not appear on the list, please call your underwriter.)



Umbrella’s additional target classes include:

(If the class you are looking for does not appear on the list, please call your underwriter.)

Sales Receipts:
Umbrella/XS Limit:
Other limits or Comments:  
 
EXCESS AND UNDERLYING POLICY INFORMATION
GL SECTION:
GL Underlying Limits:  
GL Underlying Premium:
GL Underlying Carrier:
GL Underlying Policy #:
GL Expiration Date:
Per Project General Aggregate Endt:  
Liquor Liability U/L Limits
(If Approved):
 
Liquor Liability Premium:
EL Underlying Limits:
EL Underlying Carrier:
EL Expiration Date:

AUTO SECTION:

(only complete if Excess coverage to go over GL And Auto)
AL Underlying Limits:
AL Underlying Premium:  
AL Underlying Carrier:  
AL Expiration Date:
Auto Fleet:
# of Private Passenger Vehicles:    
# of Light Trucks:
 
# of Medium Trucks:  
# of Heavy Trucks:  
 

© Copyright 2007 Builders & Tradesmen's Insurance Services, Inc. • 6610 Sierra College Boulevard • Rocklin, California 95677
Phone: 916.772.9200 - Fax: 916.772.9292 • CDI #0D10271 • All non-admitted business is placed through LAE Insurance Services, Inc. CDI # 0E44215