Harris & Associates Insurance Agency 800.809.1730

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Ron Harris of Harris & Associates Insurance Agency has the expertise in servicing the insurance needs of contractors of all types and sizes, this has been developed over the past 40+ years. 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). Life Insurance Health Insurance

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