**Information received from this Connecticut Business Liability Insurance quote
request form sent to the William Malloy Insurance Agency will be for our use only
and will not be sold, given to or distributed to any other parties. A quote will be
based on the business liability insurance policy information provided and does not
guarantee acceptance of the risk by us. The precise coverage afforded is subject to
meeting underwriting guidelines, and the terms, conditions and exclusions of the
policy as issued. By submitting this request you acknowledge that this is neither an
offer to insure nor a guarantee of insurance. Completion of this form does not entitle
your business to a Connecticut Liability Insurance policy. We are licensed in
Connecticut and will not provide quotes for other states.
We are your local Fairfield County insurance agency, offering affordable business
liability insurance policies and services in the following Connecticut cities and
counties: Stamford, Norwalk, Greenwich, Darien, Riverside, Belltown,
Springdale, Round Hill, Old Greenwich, East Norwalk, New Canaan, Glenville,
Byram, Cos Cob, Mianus, North Stamford, Glenbrook, Wilton, Weston, Long
Ridge, Noroton, West Norwalk, Westport, High Ridge, Southport, North Wilton,
Winnipauk, Cannondale, Turn of River, South Wilton, Lyons Plains, Georgetown,
Ridgefield, Branchville, Redding, Topstone, Ridgebury, Redding Ridge,
Branchville, Dodgingtown, West Redding, Titicus, Hattertown, Bethel, Danbury,
New Fairfield, Newtown, Hawleyville, Botsford, Monroe, Bridgeport, Stepney,
Shelton, Huntington, Upper Stepney, Long Hill, Trumbull, Stratford, Easton,
Fairfield, Greenfield Hill, Stratfield, Nichols, Oronoque, Rivercliff, Devon, Lordship,
and East Bridgeport, New Haven, Hartford, Torrington, Waterbury, Meriden, New
Britain, New London, Norwich, Manchester, East Hartford, Suffield, Granby,
West Haven, West Hartford, Branford, East Haven, Hamden, Woodbridge,
Orange, North Haven, Groton, Rocky Hill, Newington, Wethersfield, Glastonbury,
Bloomfield, Blue Hills, South Windsor, Naugatuck, New Hartford, Chesire, East
Lyme, Old Mystic, Wallingford, Southington, Middletown, Bristol, Laurel Beach,
Litchfield, Pleasure Beach, Mystic, North Westchester, Double Beach,
Willimantic, Storrs, Canaan, East Windsor, Vernon, South Canaan, Putnam,
Guilford, Windham, South Britain, Willington, Windsor, East Hampton, Brooklyn,
Westchester, and everywhere else in New Haven County, Litchfield County,
Middlesex County, New London County, Hartford County, Tolland County and
Windham County, CT.
In addition to Liability
Insurance for your
Connecticut business,
we also offer affordable
Property Insurance
premiums or choose
another CT business
insurance coverage
from the list below.
Do you have questions about
business liability insurance?
Business Name:    
Premises Address:
City:     State:     Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 
Federal Employer's ID #:
Description of Operations or SIC code:


# of full-time employees:    # of part-time employees:
# of locations:    Estimated Annual Payroll: $
Gross Sales:$

Select all that apply to your Connecticut business:
Operate or lease aircraft/watercraft     Work Underground
Work above 15 feet                           Require out of state travel
Use Subcontractors                            Delivery Service
Pre-employment physicals                   Offer safety incentive programs
Store, treat, dispose, or transport hazardour waste
Work on vessels, docks, or bridges over water
Other



Current Insurance Company: 
Policy #: Expiration Date: (mm/dd/yyyy)
What types of coverages do you currently have:
Benefit Liability               Business Liability
Commercial Umbrella     Directors & Officers Liability
Discrimination                 Errors & Omissions
Product Liability              Professional Liability
Other

Other Insurance Company Used Within Past 3 Years: 
Policy #:
Losses past 3 years:
Description of losses or loss runs:



General Aggregate Limit (other than products completed)   
Products/Completed Operations Aggregate Limit                
Umbrella Amount:



Building 1
Building Value: $   Contents Value: $
Total Building Area:        Year Built:
Construction Type:      Sprinklers:
Central Alarm:
List Neighboring Businesses:
To the right:   Distance:
To the left:     Distance:
To the rear:    Distance:

Building 2
Building Value: $   Contents Value: $
Total Building Area:        Year Built:
Construction Type:      Sprinklers:
Central Alarm:
List Neighboring Businesses:
To the right:   Distance:
To the left:     Distance:
To the rear:    Distance:

Additional Information or Comments



Click on the "Submit Quote Information" button below to send your
Connecticut Business Liability Insurance quote request.


Choose Connecticut Business Liability Insurance Limits:
Connecticut Business Information:
Recent Insurance Information:
If you've already filled out information on your buildings or facilities
in another insurance quote form then skip the section below.
Connecticut
Business Liability
Insurance Quote
We provide comprehensive Business Liability Insurance services throughout Connecticut!
Fairfield County Connecticut Insurance Agency
Malloy Insurance Agency
Connecticut Business, Home, Health
& Car Insurance Specialists
Copyright 2004-2008 William Malloy Insurance Agency, Inc. - All rights reserved
William Malloy
Insurance Agency
87 Glenbrook Road
Stamford, Connecticut 06902
(203) 351-9898
Fax: (203) 351-9880
"Your Fairfield County
Business Liability
Insurance Agent"
Connecticut Business
Insurance Quotes
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