(323) 654-3616 | Lic. 0H78579

General Liabilities Insurance

*Company Name

Contact Name

Mailing Address

Address Line 2

City

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*Zip Code

*Business Phone

*Email

Organization Type

Years in Business

*Nature of Business

Current Ins. Company

Current Pol. Exp. Date

Current Premium

Number of Losses Last 5 Years

Annual Gross

Payroll

Total Area

Coverage(s)

Business Liability

General Aggregate

Products & Completed Operations Aggregate

Personal & Advertising Injury

Each Occurance

Fire Damage

Medical Expense

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Major Point Insurance Services, Inc. Lic. 0H78579.

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