Harris & Associates Insurance Agency 800.809.1730

Harris & Associates Insurance Agency has the expertise in servicing the insurance needs of contractors of all types and sizes. This experience enables us to obtain the best coverage at the lowest price for our clients. We can do the same for your business.

Click here for a printable version to mail or fax us (Otherwise, proceed below to submit an online form to our e-mail).

Items marked with * important to fill out but not required. Please fill in as much of the online form as you can.

*Contractor License Number:

*Business Name:

*Business Address:

*City:

*State:	CA

*Zip:

*Owner/Contact Name:

*Number of Active Owners:

*Business Phone:

Mobile Phone:

Business Fax:

*Business Email:

*Estimated Gross Annual Receipts:	$

*Estimated Annual Field Payroll:	$

*Estimated Annual Sub-Out Cost:	$


Do you provide any new ground up construction?	Yes No

*Claims in the Last Three Years?:	Yes No

*Years Continuous Liability Coverage:	0 1 2 3

Current Insurance Carrier:

Policy Expiration Date:

*Number of Years in Business:

Type of Work You Do: Explain your Operations*

*Request Additional Information Check-mark which areas you would like more information on.	Bonds Equipment Commercial Truck Coverage Workman's Comp (Simply check-mark for additional information).