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General Liability Quote Form


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Company Information
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ZIP / Postal Code
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E-Mail Address
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Primary Phone Number
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Alternate Phone Number
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Company Owner
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Last Name
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Nature of Business
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Number of Owners
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Gross Annual Sales
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Number of Employees
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Annual Employee Payroll
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Payroll per Job Description
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Subcontractors Used
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Type of Subcontractors Used
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Annual Cost of Subcontractors
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Do you obtain Certificates from Subcontractors?
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Square Footage of Location
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Additional Information
Prior Insurance
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Length of Coverage (Months and Years)
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How many additional insureds are required?
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Prior Claims
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How did you hear about us?
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
First Insurance Group
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First Insurance Group
Main Office 2520 South Highway 27 | Somerset, KY 42501 | Phone: (606) 679-3570
Bardstown 107 Lincoln Way | Bardstown, KY 40004 | Phone: (502) 348-5921
Frankfort 1510 Louisville Rd | Frankfort, KY 40601| Phone: (502) 223-5100
Nicholasville 508 North Main St, Suite C | Nicholasville, KY 40356 | Phone: (859) 885-9454
Richmond 312 Jason Dr Suite 3 | Richmond, KY 40475 | Phone: (859) 623-6692
Glasgow 605A Happy Valley Road | Glasgow, KY 42141 | Phone: (270) 651-5723

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