Georgia Electrician Agent

Quote

Start the quoting process with the form below or consider printing the following application and faxing it to our office.  We can provide Coverage Quickly with the either format of the information.

Quote Form
  2. (required)
  3. (valid email required)
  7. (required)
  15. (required)
  16. (required)
Desired Coverage Levels
  1. Liability Options

  4. Is Tool, Equipment, or Installation Coverage needed? $225.00 for this coverage.
  6. Do you own or rent commercial space or occupy your own building?
Percentage of work preformed
  1. (each grouping's % should equal 100%)
  2. (required)
  3. (required)
  4. (required)
  5. (required)
  6. (required)
  7. (required)
Subs
  1. Are Subcontactors Used?
  3. Are Subs required to maintain coverage?
  6. (required)
Other Questions
  1. Are you involved (present-future) in new residential construction and or development?
  3. Do you have a Written Safety Program in Operation?
  5. Do you own or operate any other business?
  7. Is this a new client to this agency?
  9. Have you been canceled, non-renewed, or declined coverage in the past three years?
  11. Any bankruptcies, tax or credit leins against the applicant in the past 5 years?
  13. In the past, present, or discontinued operations involve(d) storing, treating, discharging, applying, disposing, or transporting of hazardous materials?
  15. Do you sponsor and athletic teams?
  17. During the last 10 years, has any applicant been convicted of any degree of the crime of arson?
Contractor Questions
  1. Are you a subsidiary of another entity or do you have any subsidiaries?
  3. Is there any part of this operation where a formal safety program is not in place?
  5. Do you do any snowplowing of streets or roads or municipal plowing or salting/sanding?
  7. Do subcontractors carry less liability limites than you maintain?
  9. Are certificates of insurance required from sub-contractors?
  11. Are there any instances where you do not require hold harmless agreements from all sub-contractors?
  13. Do you lease employees to or from other employers?
  15. Do you lease, loan or rent equipment to or from others with or without operators?
  17. Any use of cranes?
  19. Any boats, docks or floats owned, hired, leased as part of this busienss?
  21. Any operations include blasting or explosives storage?
  23. Any alarm work?
  25. Any LPG work?
  27. Do draw plans, designs, or specifications?
  29. Do you own a gravel pit?
  31. Do you do any roofing or re-roofing?
  34. Captcha
 

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