General Liability Coverage

Workers' Compensation

Property Coverage

Auto Coverage

Tools Coverage

Umbrella Coverage

Wrap Coverage

Bonds Coverage

 

YOUR “ONLINE” PRE-RENEWAL FORM

In order to process your General Liability RENEWAL accurately and efficiently we need an UPDATE from YOU.  If updated information is NOT received from you we will base your premium on the same exposures* as last year’s policy.  Therefore, if there have been ANY CHANGES it is IMPERATIVE that you complete the information below and press the “SUBMIT” button, as soon as possible.      *Your Gross Receipts, Employee Payroll, Sub-Contracted Cost and Operations        
Please do not hesitate to contact us, at (800) 443-6566, with any questions, comments or concerns.  We sincerely appreciate your business and benefit tremendously from your REFERRALS!

THANK YOU!     CC Roy Insurance Brokers, Inc.

ESTIMATES FOR THE NEXT 12 MONTHS…

Business Name:
Gross Receipts (Sales): $  
Sub-Contracted Cost: $ or %

Employee Payroll:
“In-the-Field” $    Office/Sales $   
# of F/T   # of P/T

Description of YOUR OPERATIONS

Residential % New (ground up) Const. % New Tract Homes? YES NO  
Commercial % Remodel & Additions % New Condominiums? YES NO  
Industrial % Repair & Service % New Apartments? YES NO  
Institutional % Maintenance % HomeOwners Assoc? YES NO  
  Equals 100%   Equals 100%        

If YOU or YOUR EMPLOYEE(S) operate a Car or Truck for YOUR BUSINESS you should have    
littletruck  Business Auto Insurance because your “personal insurance” may not cover your losses!

Please provide a QUOTE for my BUSINESS AUTO INSURANCE

I am also interested in a Quote for –

WORKERS’ COMPENSATION      UMBRELLA
TOOLS/EQUIP.     HOMEOWNERS

bluestar
Insured’s Name   

Contact Information…
Contact Person:   
E-Mail or Website:
Phone:       Fax:        Cell:

By clicking "Submit" I authorize Contractor’s Bonding Insurance Co. (CBIC) or its Agent (CC Roy Insurance Brokers, Inc.) to investigate my credit with any credit-reporting agency or any other person or entity, and I authorize the release of any such information to Contractor’s Bonding Insurance Co. (CBIC) and its agent (CC Roy Insurance Brokers, Inc.).