Contractors Insurance Quote

Thank you for your interest in Legere Insurance Agency.
Please enter the following information so we can respond to your request quickly and efficiently. Fields followed by an asterisk(*) are required information.
Note: We are licensed to sell insurance only in Massachusetts.

Contact Information:

Name: *
Street: *
City: *
State: *
Zip Code: *
Email Address *
Phone: *		Home    Business    Cell

Best way to contact you: *

Phone:   Time: Choose Time Mornings Afternoons Early Evenings  or Email:

Trade or Occupation: *

Select One Air Conditioning & Heating Cabinet Makers & Installers Carpentry - Exterior Commercial Carpentry - Exterior Residential Carpentry - Interior Carpet, Rug or Upholstery Cleaners Concrete Construction Doors, Windows & Partition Installation Drywall, Wallboard Installation Electrician Excavation Contractor Fence Erection Contractor Floor Covering Installation Glaziers Home Appliances & Electronics - Installation, Servicing Home Furnishing Installation Interior Decorators Janitorial Services Landscape - Gardening Locksmith Marble, Terrazzo Tile or Stone Work - Interior Masonry Painting - Exterior three stories or less Painting - Interior / Paperhanging Paving - Driveway, Parking Areas, Sidewalk Plaster or Stucco Work Plumbing - Commercial Plumbing - Residential Prefab Building Construction Septic Tank Install - Service - Repair Sheet Metal Work Siding Installation Sign Painting or Lettering Tree Trimming, Pruning or Dusting Upholstery - Furniture Window Cleaning

Type of Business: *

		Individual    Partnership    Corporation
Other:

Number of Employees: *

Full time:
Part time:

Estimated Annual Payroll: *

Estimated Annual Gross Receipts: *

In Business for 3 or more years? *

Yes    No

Do you carry Worker’s Compensation Coverage? *

Yes    No

If yes, Company:

Do you use Subcontractors? *

Yes    No

Do you have a Professional Trade License? *

Yes    No

If yes, license number?

Any claims submitted during the past three years? *

Yes    No

If yes, description of claim including date and amount paid:

Proposed effective date of coverage:*

Liability Insurance Limits: *

		$100,000 Each Occurrence / $200,000 Aggregate
		$300,000 Each Occurrence / $600,000 Aggregate
		$500,000 Each Occurrence / $1,000,000 Aggregate
		$1,000,000 Each Occurrence / $2,000,000 Aggregate

Fire Legal Liability Limit:

-- Select -- $50,000 $75,000 $100,000 $150,000 $250,000 $500,000 Higher amount, let's discuss Unsure, let's discuss

Medical Payments to Others Limit:

-- Select -- $5,000 $4,000 $3,000 $2,000 $1,000

How did you hear about Legere Insurance?

		-- Select -- Article in industry publication Advertisement (print) Yellow Pages Banner Ads Direct Mail Internet Search Newspaper Public Relations Web Site Link Word of Mouth
Other:

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