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Georgia Insurance Underwriters, LLC
Insurance Service Associates
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Georgia Insurance Underwriters, LLC
Local 770-493-4203  or   Toll Free 877-234-5995

 Commercial General Liability
Worker's Compensation
Contractors Insurance Quote form
Electrical, Heating & A/C, Plumbing, Concrete, Carpentry, and IT Contractors


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data is safe from prying eyes. The data you enter here is used for insurance quoting purposes only.




   

Legal Entity:

Named Insured*

DBA: Name:

Contact Name*

Email Address*

Location Address:

Location Address 2:


City:



State:



Zip Code:


Contact Phone *



FEIN
- EIN



Year Business Established:


Currently Insured Y/ N:



Current Expiration Date:


Current Insurance Carrier:


Description of work you perform

Total Number of Insured
Subcontractors
1099 Tax

Annual Employee Payroll


$10,000 Minimum Payroll

No of Uninsured Subcontractors 1099 Tax:

Uninsured
Subcontracted Labor Cost:

No of Insured Subcontractors (with certificates):


Insured Subcontracted Labor Cost:


Limits of Liability:


Additional Coverage Lines Needed

Commercial Property Commercial Auto
Worker's Compensation Commercial UmbrellaInland Marine Bond


Date Quote Needed:


Comments:


Have Questions? Please call us 770-493-4203

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