Multiple Quotes Survey

Please complete the survey to the best of your ability. We aim to cover all aspects comprehensively.

First Name *

Last Name *

Email *

Phone

Do They Have CGC License?

Yes

Needed By *

State *

City

Address

Postal code

Scope of Work & Notes *

Type of Work *

% of Commercial Areas *

% of Residential Areas *

Max Height Exposure *

Percentage of work above 3 stories

Percentage of work from 2 stories to 3 stories

What equipment is used to reach heights above 15 ft? - Multiple Quotes Survey *

Percentage of work below 15ft - Multiple Quotes Survey

Percentage of work from 15ft to 2 stories - Multiple Quotes Survey

Subs Used *

Estimated Amount Paid to Sub Contractors Annually *

Type of Services Subbed Out *

What quote do you need?

Total Number of Employees in your Business *

Class Code for Clerical Workers

WC Class Code for Labor Employees

How Many Labor Employees do you have?

Annual Gross Payroll for all Labor Employees Above

How Many Non Labor Employees Do You Have For Clerical/Sales/Managers Category? Number #2

Annual Gross Payroll for the Clerical/Sales/Managers Category. Number#2

How many Secondary Labor Employees do you have other than the primary labor category? Number# 3

Annual Gross Payroll for Labor Employees Above #3

Claims In The Past Three Years? *

How Many Claims Within the Last 3 Years?

Do You Need Any Additional Quotes? *

Anticipated Annual Gross Sales *

How many employees do you have? *

Percentage of Work Subbed Out *

Estimate how much you plan on paying to subs over the next 12 months *

Do You Need Any Additional Quotes? *

Desired Umbrella Limits

Do You Need Any Additional Quotes? - 3

Desired Limits

Comprehensive Deductible

Garaging Address

Birthdate #1

Civil Status #1

Civil Status #2

Do You Need To Add Another Driver? *

Yes

Driver License Number #3

Driver Name #3

Birthdate #3

Civil Status #3

Do You Need Any Additional Quotes? - 4

Any Additional Comments?

Underwriting Documents - Multiple Quotes Survey

Here you can upload any helpful documents to expedite the issuance of an underwritten and approved quote. For example, pictures of the owners Drivers License, current or previous policies, loss run reports, etc.