Texas Community Insurance Group by Hoffman Financial Services, Inc. | Tel (972)758-9300 Fax (972)758-9355 | 1400 Preston Rd, Suite 345 Plano, Texas 75093

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General Liability Quote

Section I - Client Business / Information

Name: Phone: Email:
Mailing Address: City: State: Zip:
Location Address : City: State: Zip:

Description of business:
Contact: Phone :
In business since:
Any exposure in other states: Yes  No *If yes, which states:

Average longevity of employees:
What other types of policies do you have with your current carrier:

Following forms are optional, Please fill in if you would like to provide more information.

Section II - Property Liability

Construction:  Frame  Joisted masonry Light non-combustible Heavy non-combustible
Alarms:  Yes No
Sprinklers:  Yes No
Distance to Hydrant: 1-500 ft 501-600 ft 601-1000 ft > 1000 ft
Year built: Year updated: Roof : Electrical system: Plumbing system:
Square footage: # of stories:
Years at location: Is there a safe on premises: Yes No
Building Deductible: Loss of Income:
Contents: Signs:
Number of Employees Full time: Part-time:
Annual Payroll

Section III - Liability

Umbrella coverage limit:
Worker's Compensation: Yes No
Number of Autos: Hired/Non-owned:

# YEAR MAKE MODEL
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Texas Community Insurance Group by Hoffman Financial Services, Inc. | Tel (972)758-9300 Fax (972)758-9355 | 1400 Preston Rd, Suite 345 Plano, Texas 75093
TDI License Numbers: 1486816/1381618 | Home | About Us | Business | Life/Health | Individual/Family | Contact Us |