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Commercial Contractors / Workers Compensation Quote
Commercial Contractors / Workers Compensation Quote
Client's Name
Business Name
Type
Corporations
LLC
Sole Proprietor
Mailing Address
Location Address
Number of Locations
Additional Information
Year Built
Stories
Squarefoot
Construction Type
Year of Updates
Electric
Roof
Heater
All Other
Description of Operation
FEIN or Social Security #
Owners DOB
MM slash DD slash YYYY
Years in Business
Year's Experience
Losses (last four years)
Current Insurance
# of Owners (DE 20,000 - PA 5,200 Minimum)
# of Employees
# of Clerical
Employee Payroll
Gross Sales
States Doing Business In
% of Work in Each State
List of Equipment
Total Value
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