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General Liability Quote — Fusco Insurance

Answer once, in plain English. Your answers go straight into the standard industry application (the ACORD forms every carrier uses), and we shop your quote with our carriers and come back with real numbers. No obligation, and no coverage is bound by this form — a quote is a quote until you tell us to place it. Takes about 6–8 minutes. Anything you don't
know, say so — we'll pick it up on a short call.

About the business

Contact name (you)

Contact email

Contact phone

Business legal name (exactly as it should appear on a policy)

DBA / trade name, if any

Entity type

State where the business is located

Mailing address (street, city, ZIP)

Years in business

Years of experience in this trade/industry

Website, if any

Describe what the business does (the work you actually perform, in your own words)

Number of owners/officers/partners

Is the business a subsidiary of another entity, or does it have subsidiaries?

A
B

Please explain (subsidiary/subsidiaries)

Locations

Location #1 address (street, city, state, ZIP)

Do you own or rent this location?

What happens at this location? (office, shop, warehouse, job sites only, retail...)

Exposure basis

Total annual gross sales/receipts (all locations)

Total annual payroll

Payroll for work done by the business's own employees

Payroll for work subcontracted out

Annual cost of subcontracted work

Do you require certificates of insurance from your subcontractors?

A
B

Number of full-time employees

Number of part-time employees

Do you sell, manufacture, or distribute any products?

A
B

Annual product sales, if any

What products do you sell, manufacture, or distribute?

Do you do any work at heights, underground, or with hazardous materials?

A
B

If yes, please describe

Current coverage & requested limits

Requested effective date

Do you have general liability insurance now?

A
B

If yes: current carrier

If yes: current policy expiration date

If yes: current limits (per occurrence / aggregate), if known

Limits you want quoted

Coverage basis preference

Do any contracts require you to add additional insureds, waivers of subrogation, or specific limits?

A
B

If yes, please describe the requirements

Loss history

Any liability claims or losses in the last 5 years?

A
B

For each claim or loss: year, what happened, amount paid or reserved

Has any carrier cancelled or non-renewed your liability coverage in the last 5 years?

A
B

If yes, please explain

Is the business currently in bankruptcy, or has it been in the last 5 years?

A
B

Certificates

Will you need certificates of insurance for clients/landlords/GCs?

A
B

If yes, how many, roughly?