Kentucky Contractor Insurance Quote from Gross Insurance Agency, Inc.

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Gross Insurance Agency, Inc.
26 North Ft. Thomas Avenue
PO Box 75249
Ft. Thomas, KY 41075-0249
Phone: 1-859-781-0434
Fax: 1-859-781-1780
E-Mail us at: Gross_Ins@yahoo.com

On-Line Contractor General Liability Quote Form One Simple Form - takes only 2-3 Minutes!
Your Name:
BUSINESS Name:
Mailing Address:
City:
State: (Must be KY or OH)
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax (optional):

Business Underwriting Information
Type of operation:
Describe operations in detail:
License class:
License Number:
Social Sec. or Employer ID#:

Limit of Liability Coverage Requested?	$300,000 $500,000 $1 Million

Currently Insured?	Yes No
Name of Carrier & how long insured?
Prior Claims?	Yes No
Describe claims in detail:

Years in business:
Years experience in field:
Percentage of work residential:
Percentage of work commercial:

Number of Active Owners:
Number of Employees:	0 1 2 3+
Annual Employee Payroll: $
Annual Gross Sales: $

Do you subcontract work?	Yes No
(If yes, what percentage of your work is subbed, and what kind of work?)
Do you do foundation work?	Yes No
Do you work on condos?	Yes No
Employees paid over $18/hour?	Yes No
Do you have a safety program?	Yes No

Comments/Remarks:

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