Environmental liability insurance | Specializing in environmental insurance solutions for commercial insureds.

Your client shouldn't have to spend a weekend producing three inches of paperwork when all that information is already available on their website. The extent of information available on the website will dictate Beacon Hill's level of response.

Privacy Statement

You can email us right now and we'll respond right away.
All Required fields are marked in Bold.

Applicant's Name: Date:

Address:

Years in Business: Do You Currently Carry: CGL CPL Professional

If Yes, Expiration Date: Retro Date(s) by Coverage

Coverage Required:

Description of Operations:

Projected Revenue for Each Described Operation for the Upcoming 12 Months:

Have you had any claims, or circumstances that might give rise to a claim, in the last five years, that were or could have been covered by a Commercial General Liability, Contractor's Pollution Liability, or a Professional Liability Policy? No Yes

If Yes, Please Explain:

Web Address: www

Comments:

Beacon Hill's Response Should be Addressed to:
Agent:		Phone:
Agency:		Fax:
Agency Address:		Email Address:
		License Number:

Beacon Hill works only with licensed insurance agents and brokers. If you are a consumer with an environmental exposure, go to our home page and click on "If you're not an agent."

Privacy Statement