Janitorial
RJ United Business Insurance Agency
13711 Van Nuys Boulevard Suite 7, Pacoima, CA 91331 | Phone (818) 834-8562 | Fax (866) 834-4442
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javier@rjunited.com
Janitorial
General Info
Company Name:
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Contact Name:
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Address:
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City:
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State:
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Zip:
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Phone:
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Cell Phone:
Fax:
E-mail:
Ownership:
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Choose...
Sole Proprietor
Partnership
Corporation
LLC
LLP
Ltd.
Coverages
Provide Quotes For:
General Liability
Workers Compensation
Bonds
Liability:
*
Choose...
$500,000
$1,000,000
$2,000,000
Current Insurance Carrier:
Policy Expiration:
Click for Workers Compensation
Federal Tax ID:
First Employee Hired Date:
Click for Bonds
Amount of Bond:
$5,000
$10,000
$25,000
$50,000
$100,000
General Description (Janitorial Only)
Description of Operations:
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% of Residential:
% of Commercial:
% of Window Cleaning:
% of Floor Waxing:
% of Carpet Cleaning:
Any Claims in the past 3 years?
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Yes
No
If any Claims, please Explain:
Gross Sales:
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# of Employees (full):
# of Employees (part):
Employee Payroll (excluding owners):
Years in Business:
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Years of Experience:
Subcontract Costs (if any):