Welcome to Mullen Insurance Agency Inc.

Submit this form for a quote. If supplements are required, return to this page and follow the link to submit the supplement.

	Apartments Supplement
	Contractors Supplement (Remodeling, Home Improvements, Builder)
	Daycare Supplement

General Liability

Quick Quote Sheet

Agency Information

I am: Agency/Producer Name Agent/Producer Phone

required! Email Address: (retail customer or agent)

Applicant Information

Name:		DBA:
Address:
City:		Phone:
County:		Fax:
State:	Must be based in Texas.
Zip:

Description of your business:

Operations Information
# Owners		# Employees		Employee Annual Payroll NOT including the owner(s)
Square Footage		Gross Annual Sales		Owner or Tennant?
Years In Business		Years Experience		Business Hours:
Gas Station?		If so, number of pumps

Subcontractors/Additional Insureds
Are subcontactors used?		If yes, what percentage?
Do all subs carry their own insurance?		Cost of subs annually
How many additional insureds needed?		How many waivers of subrogation needed?

Coverages
Liability	Liab CSL

Additional Information

If a Janitorial Service, what is cleaned?			Is business involved with New Construction?
If a Restaurant, is alcohol served?			Percentage of gross sales
If Apartments, complete the Apartment Supplemental Questionnaire and submit
If a Convenience Store with Gas Station, what percentage is store operation?			What percentage is gas sales operations?
	Is there a restaurant with cooking done?		What percentage is restaurant operations?
If Remodeling/Home Improvements/Builder, complete the Contractors Supplemental Questionnaire and submit
If Childrens Day Care, complete the Day Care Center Supplemental Questionnaire and submit
If Painting, what percentage is exterior?			What percentage is interior?
	Any buildings over 3 stories?
If Concrete Work, is foundation repair done?			Highway work done?
If Plumber, what percentage is commercial			What percentage is residential?
If a Church, is there a playground?			Any day care operations?

3-Year Prior Carrier and Loss History if no losses, say NONE or NA
	Carrier	Loss amount & description
Expiring
1st Prior
2nd Prior

Additional Information
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