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Commercial Quote
Name:
Email:
Age:
Occupation:
Address:
City:
State:
Zip:
Work phone:
Home phone:
Present Insurer:
Fax:
Email address:
Type of work preformed:
Canvas repair
Canvas Installation
Carpentry
Cleaning
Detailing Electronics
Fiberglass
Gas freeing
Painting
Rigging
Welding
Engines described in detail:
Type of craft:
Where is work performed?
Does your work include driving?
Yes
No
Describe underwater activities:
Are the propellers pulled and replaced?
Yes
No
Maximum value any one vessel: %
Maximum value at any one time: $
Do you tow any watercraft?
Yes
No
Do you haul/launch?
Yes
No
Do you have docks or slips at your place of business?
Yes
No
If yes, please explain:
Do any of your customers visit your place of business?
Yes
No
If yes, please explain:
Are you a sub-contractor?
Yes
No
How many years have you performed this this work?
Do you sub-contract?:
Yes
No
If yes, please explain:
How many years have you performed this work?
Gross receipts including parts and labor: $
How many people do you employ?
Do you preform any other work or service or provide or sell any other parts, equipment or material in your business?
Yes
No
If yes, please explain:
What are the receipts or sales for this other operation? $
Describe all losses, whether insured or not, for the last five (5) years:
Current Insurance Company?
Has your Insurance ever been cancelled?
Yes
No
if yes, please explain:
Limit of Liability? $
P&I Insurance?
Yes
No
Date policy to be effective?
Additional comments:
Thank you for contacting us.
We will get back to you as soon as possible
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Contact
Phone Number
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760-200-9800
Emai
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Address:
77035 Desi Drive,
Indian Wells, CA 92210
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