Contractors Quick Quote Request

You can submit your Quick-Quote request for a no-obligation quote. If you prefer, you can fax or email us copies of your current policies. As always, we welcome you to visit our office to meet with our insurance professionals and discuss your insurance needs.

E-mail: info@keefeins.com
Fax: 508-528-3887

Contractors Liability Insurance
Contractors Business Auto Insurance
Contractors Workers Compensation Insurance

Contractors Liability Insurance Quick Quote Application

Full-time operations only

*Your Name:
*Business Name:
*Mailing Address:
*City:
*State:
*Zip:
*Phone:
E-mail Address:
Website:
Legal Entity:
Describe your contracting operation in detail:

* Required information

Name the Owners, Corporate Officers, Partners or LLC members and the work they perform:
Annual payroll not including owners, partners and corporate officers:
Number of Full-time employees:
Number of Part-time employees:
Years in Business:
Years of experience in field:
We will quote $1,000,000 for General Liability unless higher limits are requested
Currently Insured?:	Yes No
Name of carrier:
Policy renewal date:
Current Premium:
How long insured:
Prior claims?:	Yes No
Describe claims in detail for last 3 years
Percentage of work residential:
Percentage of work commercial:
Type of commercial work performed:
Do you subcontract work? (if yes, what percentage of work is subbed and what kind of work	Yes No
Do you want to insure your tools and equipment?:	Yes No
Value of your tools and equipment:
Location you store the tools and equipment:
If you own the building what is the replacement value	$
Do you want to insure mobile equipment your own: if yes:
Equipment description	Value
	$
	$
	$
	$
Do you have an Umbrella Liability policy?:	Yes No