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Janitorial Program
Request for Insurance Quote
Company Name
Start Date Needed
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
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