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Request a Quote for Commercial General Liability Insurancecpskdeveloper2019-05-15T13:07:08-05:00

Request a Quote for Commercial General Liability Insurance

Name *

First

Last

Business Name *

Email *

Cell Phone *

Business Phone

Website

Business Address *

Address Line 1

Address Line 2

City

State

Zip Code

Policy Effective Date Requested *

Entity Type *

Individual
Coporation
LLC
Partnership
Other

EIN or or SSN: *

Year Business Started *

Years of Experience in this Type of Business *

Total estimated annual sales/receipts/revenue (in $ amounts): *

Total estimated payroll for direct employees (in $): *

Description of Business *

Tell Us About Your Employees

# of Full Time Employees *

# of Part Time Employees *

Total # of Locations *

Are Subcontractors/Independent Contractors Used? *

Yes
No

If yes, do you require that they provide you with a Certificate of Insurance as evidence of their own insurance?

Yes
No

Total Annual Cost for Subcontractors/Independent Contractors (in $ amount) (copy)

Do you own the building in which you operate your business from? *

Yes
No

Square footage occupied by your business: *

Building Construction

Wood Frame
Jointed Masonry
Non-Combustible
Masonry Non-Combustible
Fire Resistive

General Liability Coverage

Per Occurrence/Aggregate *

$1,000,000/ $2,000,000
$2,000,000/ $4,000,000

Premises Medical Payments Limit *

$5,000
$10,000

Hired and Non Owned Auto Liability Included? *

Yes
No

UMBRELLA LIABILITY (Optional Coverage for additional premium)

This coverage would respond if the Liability limits on your scheduled underlying General Liability [Businessowners], Employers Liability [Workers Compensation] and/or Business Auto Liability policies were to be exhausted I depleted due to a covered catastrophic loss.

Desired Limit: *

$1,000,000
$2,000,000
Other (specify in next question)

Other desired limit: *

Are any automobiles titled in the name of, owned by or leased by your business? *

Yes
No

If yes- please feel free to contact us regarding Business Auto coverage options.

Any prior coverage declined, cancelled or non-renewed in past 3 years? *

Yes
No

Prior Insurance (Include each company with the policy number, # of claims, and the amount paid on each claim)

Please provide 5 years valued Loss Runs at your earliest convenience. If this is a new, or relatively new business venture, please provide Loss Runs for the amount of years that you have had coverage.

By typing my name in the field below, I attest that the above information is true and correct.

Today's Date

Comment

Contact Us

(816) 380-3800

2765 Cantrell Rd.
Harrisonville, MO 64701

We are located inside the Mill-Walk Mall.

JOHN SOUTHARD
john@cpskinsurance.com

RANDY MAY
randy@cpskinsurance.com

AMANDA TABER
amanda@cpskinsurance.com

CHANDRA TURNER
chandra@cpskinsurance.com

SUMMER SMITH
summer@cpskinsurance.com

REQUEST A QUOTE

INSURANCE SERVICES

2765 Cantrell Rd.
Harrisonville, MO 64701

Phone: (816) 380-3800

Copyright 2019 CPSK Insurance Services Inc. | All Rights Reserved