Insurance Quote SWR GL

INSURANCE QUOTE — SWR GL

This document is an insurance quotation request for SWR GL coverage. Information provided below will be used by the insurer for preliminary underwriting and to generate a formal quote. This quotation is non-binding. Final coverage, premiums, and terms are subject to full underwriting review, verification of information, and issuance of an insurance policy by the insurer.

Applicant / Insured Information

Date of Birth:    Contact Person:    Phone:

Policy Details Requested

Proposed Effective Date:    Proposed Expiration Date:

Desired Coverage Limit:    Deductible:    Estimated Premium (if known):

Coverage Options (select applicable)

Premises & Operations Liability (covers bodily injury and property damage arising from business operations)

Products & Completed Operations Liability (covers after-completion liability)

Personal & Advertising Injury

Contractual Liability (liability assumed under contract)

SWR-specific Exposure Coverage (Site Work & Restoration operations, erosion/runoff mitigation)

Exclusions & Acknowledgements

The following common exclusions may apply to any quote provided. Applicant acknowledges these exclusions are typical and that final policy language governs.

War, hostile or military action, and terrorism-related exclusions

Pollution and contamination exclusion (may be subject to separate endorsement)

Professional errors and omissions (not covered under GL)

Underwriting Information

Prior claims or losses in the last 5 years: Yes No

Beneficiary / Loss Payee Designation

Note: For quote purposes, designate any party to be named as certificate holder or loss payee on issued policy.

Documentation Checklist for Quote

Please indicate which documents are attached or will be provided to complete underwriting.

Completed CGL application / supplemental form

Loss runs (last 5 years)

Representative contracts or subcontracts

Declarations, Authorizations and Notices

By submitting this quotation request, the applicant certifies that the information supplied is true, complete and correct to the best of the applicant's knowledge. The applicant authorizes the insurer and its representatives to obtain and verify information from third parties, including but not limited to loss history, financial information and other underwriting data necessary to evaluate the request. The applicant acknowledges that this form does not bind coverage, create a policy, or establish a binder of insurance.

The insurer's willingness to provide a quote and the terms of any quotation are contingent upon satisfactory completion of underwriting, verification of the information provided, and receipt of any additional documentation requested. Any intentional misrepresentation, omission, or material inaccuracy may result in declination of coverage, policy rescission, or denial of claims.

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