Tuttle & Traina Insurance Agency, Inc.

Insurance & Surety Account Services

Richard C. Traina

William B. Tuttle

Thomas D. Moylan

Raoul Cormier

44 Main Street, Post Office Box 489, Sterling, MA 01564
Phone: (978) 422-7700    Fax: (978) 422-8106
 
On-Line Business Request for Insurance Information and Quotation

Please fill out the following form. After you are finished, just click on the submit button.
A representative will call you as soon as possible. Required items are marked with an asterisk(*).
Need help? We are available to help you Monday through Friday, 8:30 AM - 4:45 PM EST. 

(800) 376-7747 or   (978) 422-7700

General Information
Contact Name*:
Company Name*:
Address 1:
Address 2:
City:
State*:
Zip*:
E-Mail Address*:
Telephone:   Fax:
Best Time to Call:

Type of Business:

           Other:

Number of Employees:

 Full-time  Part-time  Annual payroll

How Long in Business:

years      Years of Experience

Approx. Annual Sales:

   Approx. Subcontract Costs:

Please Provide a brief Description of Your Business and Clientele:

Any Losses in Last 5 Years:

If Yes, Please Explain Losses and Amount Paid:              
 

Insurance Coverage(s) Requested

                                    Commercial Coverages:                                      
                                      

                Commercial General Liability       Umbrella, Excess Liability                                Employer Practices Liability         Directors & Officers Liability
 
                Protection & Indemnity                Hull & Machinery 

                Environmental Liability - Pollution Liability

                Business Automobile                   Garage Liability
 
                 Property - Buildings                    Business Personal Property
                Inland Marine                             Contractor's Equipment
 
                Worker's Compensation             USL&H Endorsement
                                                                        Jones Act Endorsement
                Bonds - Surety                           Fidelity or Crime Coverages

                                   Group Life
                                   Group Health Insurance Plans
                                   Business Benefits - Davis Bacon Qualified Plans
                                   Key Man Life Insurance
Additional Information

Please review our "Exposure Survey"
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