Professional Liability Quote Step 1 of 4 25% Professional Liability Insurance Name of Business* What type of work do you do-- interior or exterior?* Interior Exterior Both Is any window cleaning over one story performed?* Yes No Is any service such as asbestos or lead abatement, mold remediation, pest control, fire or flood restoration, hospital or surgical room cleaning, or crime scene clean-up performed?* Yes No Do you perform any tree trimming services?* Yes No Crew Full-time W2 employees*Estimated Annual Employee payroll*Do you hire subcontractors?* Yes No Percent of labor that goes to subcontractors* What percentage of your subcontractors are uninsured?* Projected cost of uninsured subcontractors:* Projected cost of insured subcontractors:* Coverage History Tell us a little bit about your current insurance coverage.Do you currently have a professional liability policy in effect?* Yes No Any claims in the past 3 years?* Yes No Please explain:* Professional Liability Insurance List the qualifications of key personnel.*NameQualifications What's your projected revenue for the next fiscal year?* What percentage of your gross revenue is earned from your largest client?*For your single largest customer, anticipated over the next 12 months, please provide the total value of all goods or products sold, services rendered, operations performed, any rentals and fees. Do not include sales or excise taxes. In what industry do the majority of your clients work?* Do you require the customer to sign-off on deliverables?*This would indicate the customer signed, initialed and/or dated any documents that define the scope of work for the project. Yes No Do you require a legal review of all contracts?*Please confirm if you use an attorney for any changes to your standard contracts. Yes No Do your contracts have indemnification clauses in your favor?* Yes No Choose your aggregate limitThe total coverage amount for claims expenses, damages, and supplemental payments during the policy. $500,000 $1,000,000 $2,000,000 Choose your deductible*The amount you have to pay out of pocket before your insurance company starts helping. $2,500 $5,000 $7,500 $10,000 Do you use written contracts or statements of work for all business and services you provide?*A written contract or statement of work is a formal document that defines the scope of work, timelines, payment terms and any other key terms and conditions. Always (100%) Most of the time (75% - 100%) Sometimes (50% - 75%) Seldom (25 - 50%) Never (0%)
