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Janitorial Program
Request for Insurance Quote
Company Name
Start Date Needed
*
required
Phone
Business Address
Contact First Name
Contact Last Name
Contact Email
FEIN Number
Year Started Business
Number of Claims (Last 3 Years)
Choose an option
Number of Full- Time Employees
Number of Part-Time Employees
Percentage of Work on Ladders
Total Payroll (Yearly) - Include Owner
Approximate Yearly Sales
Percentage of Work over 2 stories
Number of Years Prior Insuance
*
1 Year
2 Years
3 Years
4 and More Years
NO Prior Insurance
Insurance Needed?
*
Required
General Liability
Property
Workers Compensation
Auto Policy
Umbrella Policy
Business Description
*
Required
Janitorial Services by Contractors--No Window Cleaning Above Ground Level
Janitorial Services--Residential Cleaning Services by Contractor--Inside
Window Cleaning--Above Ground Level (Above 2 Stories)
Window Cleaning--Not Above Ground Level
Cleaning--Outside Surfaces of Buildings & Other Exterior Surfaces--Janitorial Service
Comments / Description of Operations:
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