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DeGennaro Insurance, Inc. (est. 1984)
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GENERAL LIABILITY
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YOUR ACCOUNT WILL BE HANDLED BY OUR CALIFORNIA LICENSED INSURANCE PROFESSIONALS
↓COMPLETE INFORMATION BELOW FOR A QUOTE↓
First Name
Middle Name
Last Name
Company Name
Address Line 1
City
State
Zip Code
Fax
(
)
-
E-mail Address
Business Phone #
Cell Phone #
Limits of Insurance Needed
Type of Contractors License
Gross Receipts
Payroll
Number of Employees
Years In business with insurance
Years of Experience in Trade
% Commercial
% Residential
Sub Costs
Number of Claims / Type of Claim
California Department of Insurance License # OE24624
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