Independent Insurance Agent

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Please fill out all the fields that apply to your situation. If you are not sure if a field applies to you, please just leave it blank, but be sure to include your email address. Or, if you prefer, just give us your name, phone number and the best time to call you. We will be glad to contact you and together we will determine your needs.

Call Us at (858)642-0200 / (800) 799-1478. For immediate quotes

Please Fill up the Form

General Information:
Business Name:
Contact Name:
Email Address:
Street Address:
State: Zip:
Phone Number:
Best Time to Call:
My Current Policy Expires:

Amount of General Liability Required:
$100,000 $300,000 $500,000 $1,000,000 $2,000,000
Annual Payroll:
Gross Sales:

Please list or describe types of business personal property that you need coverage for:
(office contents, inventory, equipment on premises, etc.)

Inland Marine:
(property off premises, in transit, on job site, misc., tools, scheduled equipment by item and value)

Business Auto: (Schedule of autos, trucks, vans trailers, etc.)

  Year Make and Model Purpose Value Driver's name Driver's lic. #

Physical damage deductible: $500 $1,000 $2,500 None

Other Coverages Desired or Comments:

If you are in a contruction business, please continue answering below

All others, please press the "SUBMIT" button.

Contractors only, please complete the following:

Operations Data:
Contractor's License #:
Drivers License:
Type of Contractor:
Years in Business:
Years Experience:

Describe your operations and safety precautions used:

The average number of employees is:
Full Time Part Time

Please tick box if you subcontract: I subcontract percent of my work to others.

Please check all items below that you subcontract:

Blasting Carpentry Dry Wall
Fencing Landscaping Mechanical (HVAC)
Painting Roofing Steel Erection
Cabinet Concrete Electrical Roof
Insulation Masonry Tearoff
Plumbing Septic/Sewer Excavating

Please check if:
Signed contracts are used with all subcontractors.
You are named as additional insured on the sub's insurance policy.
You collect certificates of insurance from each of your subs.

Please indicate how much of your total business is in each category:

Residential: %
Industrial: %
Commercial: %

New Contruction:







Single-Family: %
Homes: %
Apartments: %
Commercial: %

Maximum number of stories upon which you will work:

Describe current jobs:

If you will be involved in the construction of tract homes, town houses, condominiums, apartments, or other multi-family dwellings in the next 12 months, please provide a detailed description:

Underwriting information: (check all that apply)

Operation involves pollutants (asbestos, lead or chemicals)
Operation involves multiple unit structures. (including condos, townhouses, apartements)
You have ever acted as a subcontractor on tract home subdivisions.
Owner supervises daily jobs or operation directly.
You perform work above two (2) stories or use scaffolding.
You hold other people's property for service or repair.
Perform any work below grade. (maximum depth = feet)
You always check with local utilities authority before digging.
You dig or grade next to existing foundations or other structures.
You do any spray painting.
You have done roofing or roofing related operation within the last three (3) years.
You work on trees requiring ladders, cherry pickers, etc.
You use heavy machinery such as cranes, cherry pickers, etc.
You work in earthquake designated areas.
You have worked on any of the following: (please check all that apply)
Railroads Irrigation projects
Roads Septic tanks
Flood control Solar
Right of Ways Drainage problems
Swimming pools Retaining walls
Gas lines Bridges
Sewer mains  

Describe any claims, losses or lawsuits that you have been involved in for the past five years and indicate the amount of damages paid, if any. (if none, write "none"):