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Started:
06/23/2017
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Rachel Patterson, CIC If at any time you need assistance please contact Rachel Patterson, CIC at 800-342-5572 or rachel@jsausa.com
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HO4, HO6 & Rental Dwellings

Homeowners Program Start Quote

PIA Convention 2017 PIARATES
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Janitorial GL Quote

Important Information! This is a stand alone Janitorial GL quoter designed much like our Artisan Program. If you have a risk that needs more than just the Janitorial class, please click here for the Artisan Program.

Applicant Information
Applicant Name:
Select a State:

Agency Information
Agent Name:
Note: This is the name of the agent requesting the quote, NOT the agency name.
Agency Name:
Agency Phone:  -  - 
Agency Fax:  -  - 

Quote Information
Choose a Limit:
Number of additional insureds needed
without a waiver of subrogation:
Number of additional insureds needed
with a waiver of subrogation:

Cost Information
Gross Receipts: $
Total Payroll:
Must include owner(s)
Select a state above for the minimum payroll info.
$
Subcontracting Cost:
(Subcontracting cost includes all labor and materials paid to subcontractors)
$

Underwriting Questions
What is the desired effective date?
Does the applicant perform any floor waxing?
 
 
Does the applicant perform any work at hospitals or assisted living facilities?
 
 
Does the applicant perform any work in establishments that are open 24 hours a day?
 
 

Loss Information
Number of losses within the last 3 years:
If number of losses is greater than zero, please specify the total amount of loss: $

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This program is only available to properly licensed retail insurance offices
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