INSURANCE
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STEP 01

Tell us about your company.

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INDUSTRY
COMPANY
INDUSTRY
Construction
EMPLOYEES
142
ANNUAL PAYROLL
$8,378,000
WORK MIX
Mixed
STATES
LINES TO QUOTE
  • Medical, dental, vision
  • Life + disability
  • Workers' comp
  • BOP / general liability
  • Commercial auto
FORMS WE'LL SUBMIT · 7
  • ACORD 125
    Commercial insurance application
    Company, locations, loss history
    PRE-FILLEDPreview
  • ACORD 126
    Commercial general liability section
    Operations, revenue, subcontractors
    PRE-FILLEDPreview
  • ACORD 140
    Property section
    Building and contents values
    PRE-FILLEDPreview
  • ACORD 127 / 129
    Business auto section + vehicle schedule
    18 vehicles, 31 drivers
    PRE-FILLEDPreview
  • ACORD 130
    Workers' compensation application
    4 class codes · 3 states
    PRE-FILLEDPreview
  • CENSUS
    Employee census + group application
    142 employees · effective Jan 1
    PRE-FILLEDPreview
  • AUTHORIZATION
    Broker authorization to market
    Lets us request quotes on your behalf
    PRE-FILLEDPreview
AUTHORIZED SIGNER
Your signature
SIGNATURENOT YET SIGNED

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