General Liability Quote Request | JF Wealth Strategies

1 · Business 2 · Coverage 3 · Exposures 4 · Prior & Losses 5 · Questionnaire 6 · Submit

Prefer to fill it out by hand? Download the PDF version → and email it to jason@jfwealthstrategies.com.

Business Information

Named Insured (Legal Business Name)*

FEIN #*

DBA / Trade Name

Desired Effective Date

Mailing Address (Street)

City

State

ZIP

Contact Name*

Phone*

Email*

Type of Organization

Description of Business Operations / Products & Services*

Coverage Requested

State desired limits — or leave blank for standard $1M / $2M.

Each Occurrence ($)

General Aggregate ($)

Products / Completed Ops ($)

Personal & Adv. Injury ($)

Damage to Rented Premises ($)

Medical Expense — ea. person ($)

Deductible (if any)

Desired Policy Term

Exposures & Rating Basis

Annual Gross Sales / Receipts ($)

Annual Payroll ($)

Annual Subcontracted Cost ($)

Total Square Footage Occupied

# Employees (Full / Part-Time)

# Owners / Partners

Operations & Risk Detail

Largest Single Job / Contract ($)

If Roofing — Max Height Worked

Total # of Locations

Describe products / services, subcontractor controls, or any 'Yes' detail

Prior Coverage & Loss History

3-year loss runs are required to bind coverage. Prior loss detail helps us get you the best pricing.

Prior Carrier

Expiring Annual Premium ($)

Prior Losses — Last 3 Years

General Liability Questionnaire

Answer each Yes or No. Explain any 'Yes' responses in the notes box at the bottom.

Notes — explain all 'Yes' responses

Review & Submit

Confirm below and submit. We'll begin shopping your coverage and follow up within one business day.

Questions first? Book a call →

Request received — thank you.

We'll start shopping your general liability coverage and reach out within one business day. To bind, we'll need 3-year loss runs. Questions? Call (951) 405-2020.