General Liability Insurance Rates

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					                                         STATEWIDE INSURANCE CORP.
                                          P.O. Box 30527, Phoenix, Arizona 85046

                                       Service Contractors Program
                                        Colony Insurance Company
                                   General Liability - Coverages and Rates

Insured:                                                     Policy #:
Effective:                                                   Agency:

Has this insured had prior insurance coverage?
Is this business a New Venture?
Has this insured been claim free with Statewide for more than one year?
                                                                      PREMIUM MODIFIER =                      1.00

                                     GENERAL LIABILITY CALCULATIONS

                                                             Please Select Class Description Below
Class Description and Code #:
Occurrence Limit:                                            Please Select Desired Occurrence Limit                      0
Do you want Double Aggregate Limits?
General Aggregate Limit
Deductible ($500/$1,000)                                     Please Select Deductible
Does the Applicant want E&O Coverage?
Additional Insured's Requested ($100 each):

                                Deductible      Double                       Final Modified                    Final
  Class Code     Base Rate                                       Modifier                     Payroll
                                  Factor       Aggregate                          Rate                       Premium

      0                           TOTAL GL PREMIUM                 $0

                                TERRORISM PREMIUM                  $0          Rejected

                               Accept Terrorism Coverage?                    Submit Signed Terrorism Form

                                          FINAL COMPUTATIONS

                              General Liability:                   $0
                              Add'l Insureds:                      $0
                              E&O Coverage:                        $0
                                Sub-Total                          $0
                              Policy Fee                           $0
                              Terrorism:         Rejected          $0
                              Taxes / Fees:                       $0.00

                                  Total                     See Note Below

                              Premium Not Offered; Please Select Deductible

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Description: General Liability Insurance Rates document sample