Contractors General Liability Indication Request

Thank you for your interest in the small to medium contractors program through GSS Insurance Services, LLC. In order to obtain a quote please complete the following. Indications are typically delivered within 1-2 hours.

Producer Name*

Producer Email*

Producer Phone*

Insured Name / Owner*

Company Name / DBA*

Entity Type*

Insured License #*

Insured Address*

City*

State*

Zip*

Insured Phone*

Insured Email*

Owner Trade Experience / Years In Business*

Effective Date*

Effective Date

Estimated Sales Next 12 Months*

Estimated Sub Costs Nest 12 Months*

# of active Owners/Partners*

Field Employee Payroll*

Risk Experience*

Classification Description*

Percentage of Work*

Classification Description

Percentage of Work

Classification Description

Percentage of Work

New Construction %*

Remodel %*

Service & Repair %*

The total must sum up to 100%

Work Performed Inside Building*

Work Performed Outside Building*

The total must sum up to 100%

Commercial %*

Residential %*

Industrial %*

Institutional %*

The total must sum up to 100%

Description of Operations*

Describe the largest project that you have performed during the past five years (For NEW VENTURES, describe the largest projects performed as an employee, name of employer and years employed)*

Describe current projects or those scheduled to commence over the next twelve months*

Notes / Special Endorsements Needed

File Upload