Current Quote Status
Started:
03/19/2019
Incomplete Provide Basic Information
Incomplete Add Classifications
Incomplete Answer Eligibility Questions
Incomplete Generate Applications
Incomplete Request to Bind
Quote Look-Up
Rachel Patterson, CIC

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If at any time you need assistance please contact Rachel Patterson, CIC at or rachel@jsausa.com

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Applicant Information
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Agency Information
Agent Name:
Note: This is the name of the agent requesting the quote, NOT the agency name.
Agency Name:
Agency Phone:  -  - 
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Underwriting Questions
What is the desired effective date?
How many losses has the applicant had within the last 3 years?
Does applicant perform any roofing work?  Yes
 No
Does the applicant perform any environmental services including but not limited to asbestos/lead/mold abatement, fire/smoke/water restoration?  Yes
 No
Does the applicant perform any waterproofing?  Yes
 No
Does the applicant perform and snow plowing?  Yes
 No
Does the applicant perform any Exterior Insulation Finishing Systems (EIFS) work?  Yes
 No
Does the applicant perform work on any aircraft or watercraft?  Yes
 No
Does the applicant perform work on barges, vessels, docks or bridges over water?  Yes
 No