Georgia General Liability

Contractor/Artisan Quick Application Click Here  (eligibility-Less than 50,000 subcontracted)

General Contractor or Artisan Contractors with More than $50,000.00 of yearly sub-contracted work.  General Contractor Quick Application Click Here

For the Business Owner with Retail, Wholesale, or a Service, Professional, Medical Location, please start by filling out the following application. 

NOTE: By filing out the first portion only, we will contact and guide you through the application and help with any questions.  Your info will not be used in mass e-mail or sold to others.

Quick Contact Data

1. Your Name(required)
2. Business Name
3. Business Type Individual Corporation Association LLC Partnership Joint Venture Non-Profit Other S-Corp
4. Phone Number
5. Email(valid email required)
6. Business Web Site
7. Business Street Address
8. City and County
9. Zip Code
10. Quick Buiness Description
11. Stop Here and Submit and we will contact you for the remainder of the information. OR CONTINUE and our phone conversation will not require as much time.

Current Coverage

1. Is There Existing Coverage?
2. Yes No
3. Name of Carrier and Coverage Amount
4. Have there been any Prior Claims?
5. Yes No

Desired Coverage Level

1. Liability Coverage
2. 300/600 500/1,000
   1 million / 2 million 2 million / 4 million
   500,000 1,000,000 2,000,000
3. Building Coverage? No Building Coverage Rent Commercial Space Owner Commercial Space Run Business out of Home Other
4. Content Coverage

Rating Info

1. Years Experience
2. Years at Location
3. Is Business located in an Enclosed Mall?
4. Yes No
5. Is the Business closed more than 60 consecutive days each year?
6. Yes No
7. Is the Business a Member of a Franchise Group?
8. Yes No
9. If occupying a building, % of building that is Vacant
10. If occupying a building, Are there Apartments In the Building?
11. Yes No
12. If occupying a building, the construction is?
13. Joisted Masonry Frame Non-Combustible Masonry Fire Resistive
14. If occupying a building, the building Square Footage is?
15. If occupying a building, the business is occupying how many square feet?
16. If occupying a building, how many floors is the building?
17. If occupying a building, name the other occupants
18. If occupying a building, is there a basement?
19. Yes No
20. If occupying a building, is there a sprinkler fire protection system?
21. Yes No
22. If occupying a building, is there a burglar alarm? Local Alarm-No Central Station Central Station None Other
23. If occupying a building, when was the structure built?
24. How many Owners are there of the Business?
25. What is the Owner's Approximate Payroll?
26. What is the approximate payroll for Full Time Employees?
27. What is the approximate payroll for Part Time Employees?
28. Approximately what is the Gross Reciepts for the Business?
29. Is the Business open 24 hours a day?
30. Yes No
31. Added Opportunity to Makes Notes or Clarify Data Above

Validation and Submittal

1. Please input text from picture into box

 

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